Peer-reviewed article

Antenatal care access in Tanzania: progress, challenges, and recommendations for a healthier maternal and child well-being

Vicky G. Raymond, Monica M. Ndalla, Jovin Rushagala Tibenderana · 1 Nov 2023

Abstract

Introduction Antenatal care (ANC) is the care provided to a pregnant woman to ensure her best health during pregnancy. It should begin when the mother is aware that she is pregnant. It is very essential since it helps asses risk, promote health, and provide medical and psychosocial intervention and follow-up1. In Tanzania, the health ministry has been on the front row in enhancing the need for ANC clinics and its importance by recommending at least four visits to a healthcare for uncomplicated pregnancies1,2.The current status of ANC in Tanzania is not that much good, although the future is promising. Significance of ANC ANC services give a room for early detection of danger signs, pregnancy complications, counseling together with prevention of mother to child HIV transmission (PMTCT)3. It also exposes women to health education on the danger signs. Inadequate ANC is associated with high maternal and child mortality due to a failure to detect early danger signs, which can harm both the mother and the fetus4. Most antenatal research focuses on ANC adequacy rather than concepts of quality1. Providers acknowledge the need of knowing the overall social context of the patient; however, despite most mothers having positive ANC care experience they can also bring up complains associated with providers negative assumptions and disregard of their options in care provision. Globally, strengthening patient-provider interaction and communication during ANC visits is the major breakthrough in better provision of care and health promotion among pregnant women. Progress and initiatives In 1974, Tanzania officially established maternal and child health services. Other initiatives include safe motherhood initiatives (1989) and integrate management of child illness (1996)1. Since then, the government has been the main lead in promoting maternal and child health through the construction of healthcare facilities, improve access to ANC services, expanded financing for maternity and child health programs as well as educating the society, particularly the women who are the main target in this field5. The milestone obtained from technological development has helped NGOs and other international organizations in ensuring a continuous progression of maternal and child health. Despite the challenges encountered, frontiers concerned with maternal and child health have been part and parcel in ensuring the best health for both the mother and the child. NGOs like Maternity Africa based in the Arusha region seeks to improve maternal condition5. UNICEF and many other international-organization play a crucial role in improving ANC6. The accessibility of ANC is significantly improved by community health workers. Their outreach activities help women navigate the healthcare system and teach them the value of ANC. Antenatal services are being used more frequently, and mother and child health outcomes have improved, according to success stories from the communities where these interventions have been put into place7. The safety of the mother comes first in prenatal care, since monitoring the mother equals protecting the baby. The discovery of BP cuffs for checking blood pressure has been a very good advancement in managing pre-eclampsia, which is one of the major complications of pregnancy. Ultrasound and other upcoming imaging techniques have rescued an uncountable number of mothers and children out there without forgetting the preventive measures and devices, which detect early dangers that can harm the mother and the baby2. Challenges in ANC access in Tanzania Many Tanzanian women still struggle to reach healthcare facilities due to long distances and inadequate transportation. This geographic barrier prevents timely ANC utilization, leading to complications during pregnancy and childbirth. Poverty and the associated costs of transportation and healthcare services hinder access to ANC. Women from low-income backgrounds often cannot afford antenatal check-ups, making it essential to address these economic disparities. Cultural beliefs and traditional practices sometimes discourage women from seeking ANC. Addressing these cultural factors through community education and engagement is crucial to promote ANC access. Tanzania faces a shortage of skilled healthcare workers and lacks adequate healthcare infrastructure in rural areas. This shortage limits the availability and quality of ANC services. Remote and rural regions face greater challenges in accessing ANC compared to urban areas. Ensuring equitable distribution of healthcare facilities and resources is essential to overcome these geographic disparities. Recommendations The progress made in recent years is commendable, but challenges persist. To address these challenges, we recommend a multifaceted approach. Fostering strong ties between government and NGO’s together with international organizations is crucial as they are superlative in reaching far off areas. The primary important step to be taken in improving ANC access is the construction of infrastructures and repairing the existing ones, construction of healthcare facilities and road construction especially towards the rural areas is very important in ensuring that pregnant women from remote places are reached effectively. Provision of transportation assistance for due pregnant mothers and empowering the existing program like M-MAMA is surely one of the open strategies in improving ANC quality together with reduction of neonatal mortality. Notably, the healthcare providers should not be left out of the scope, training them to be competent, and aware of the best up-to-date knowledge on the management of stages of labor and the early detection of danger signs is even more crucial for the quality improvement of ANC. Robust monitoring and evaluation systems, as well as research initiatives, are vital to track progress and tailor interventions. Economic support programs for expectant mothers can alleviate financial burdens, while telehealth initiatives and partnerships with local and international organizations can extend the reach of the ANC. Conclusion While significant efforts have been made to enhance maternal and child health services, numerous obstacles persist, particularly in remote and underserved areas. The importance of accessible and quality ANC cannot be overstated, as it significantly impacts the well-being of both mothers and their children. The challenges that face overall prenatal care services in Tanzania are far from being eliminated in the near future if control measures will not be taken. It is imperative to jointly emphasize more on collaborative efforts between the government, healthcare organizations, NGOs, and international partners to improve ANC access and protect future generation. Thus, this calls for all stakeholders in maternal and child health to prioritize accessible and quality care. By working together and acting now, we can ensure that maternal and child health becomes a global priority. Ethical approval Ethics approval was not required for this correspondence. Consent Informed consent was not required for this correspondence. Sources of funding We did not receive any financial support for this manuscript. Author contribution J.R.T.: conceptualization and writing; M.M.N.: writing and proof reading; V.G.R.: writing and proof reading. All others authors contributed equally in this correspondence. Conflicts of interest disclosures We declare no conflicts of interest. Research registration unique identifying number (UIN) Not applicable. Guarantor Jovin R. Tibenderana, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania. E-mail: [email protected]