Barriers to Early Antenatal Care: Insights from Muembeladu Hospital, Zanzibar

Abstract

Background: Early attendance at the antenatal clinic (ANC) is crucial for ensuring the health and well-being of both the mother and the unborn child. It allows for the early detection and management of potential health complications, such as gestational diabetes, hypertension or infection, which could negatively impact pregnancy outcome. Early attendance helps women receive the full range of recommended services, ensuring a healthier pregnancy and safe delivery. Objectives: This study aimed to identify factors affecting late attendance to antenatal clinic consultation among pregnant women at Muembeladu Hospital. Methodology: The study used a descriptive cross-sectional design, targeting pregnant women who received ANC at Muembeladu Hospital from May to June 2025. A sample size of 150 pregnant women was selected using simple random sampling. Data were collected using a structured questionnaire, initially prepared in English and translated into Kiswahili for administration in face-to-face interviews, complemented by group discussions with the target population and personal observations. Analysis was done using relevant statistical methods. Results: Although 80.7% of women knew the best time to initiate ANC was within the first trimester, 52.7% attended late (Between 4-6 months). Younger women aged between 18 and 25, primigravida, housewives, and those with only primary education were more likely to attend early. Late attendance to ANC was significantly associated with age, gravidity, occupation, education level, and marital status. Institutional barriers, such as distance, cost, and the attitude of health providers, were not significant; however, long waiting times were reported by 51.3% as a barrier. All participants cited social and cultural misconceptions about ANC services as a key reason for delayed attendance. Additionally, 69.3% reported that increased household expenditures negatively influenced ANC visits, indicating indirect socio-economic pressures as a major factor. Conclusion: Late ANC attendance is primarily influenced by demographic and occupational factors, socioeconomic burdens, and persistent misconceptions about ANC, rather than direct institutional barriers. Addressing these gaps through targeted education, improved service delivery, and community support is crucial for promoting the timely initiation of ANC.