Peer-reviewed article
A qualitative study to explore women's perceptions of pregnancy and antenatal care in Chizenga village, Chikwawa, Malawi.
Layton H, Nyirenda D, Kana T ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study explored why pregnant women in a rural Malawi village delay attending antenatal care, even though only about one quarter attend their first visit in the first trimester. Researchers interviewed 14 pregnant women and found that while women valued antenatal care and understood its importance, they faced major barriers including distance, transport costs, and limited health literacy. Women also described experiencing both respectful and disrespectful care from health workers, and some mentioned beliefs about witchcraft affecting their attendance. The study recommends community-based health education, mobile outreach services, and improved transport support to increase access to antenatal care.
Key points
- Only about one quarter of pregnant women in Malawi attend their first antenatal care visit in the first trimester, with most initiating care after the first trimester
- Women valued antenatal care and recognised its role in reducing maternal and neonatal mortality, despite barriers to attendance
- Distance to health facilities and transport costs were major socioeconomic barriers, with some women walking over 22 kilometres to access services
- Quality of care varied, with women experiencing both respectful and disrespectful treatment from health workers
- Women proposed community-based solutions including health worker outreach and improved access to services
Limitations
This is a small qualitative study with only 14 participants from one rural village, so findings cannot be generalised to all of Malawi or other settings. The study explores women's perceptions and experiences but does not measure the actual health outcomes of antenatal care attendance or non-attendance.
Abstract
National survey data indicate that only around one quarter of women in Malawi attend their first antenatal care (ANC) visit during the first trimester. This study explores women's perceptions of ANC in Chizenga village, Chikwawa, a rural setting with high maternal mortality and low ANC uptake. Using an interpretivist qualitative design, 14 pregnant women aged 18-44 years were recruited through purposive sampling. Semi-structured interviews were conducted in Chichewa, translated into English, and analysed using thematic analysis to identify patterns across the dataset and develop themes grounded in participants' accounts. Findings indicate that while women valued ANC and recognised its role in reducing maternal and neonatal mortality, most initiated care after the first trimester. Key themes included understanding of pregnancy health and ANC, nutritional constraints despite awareness, gendered dynamics in ANC attendance, the perceived influence of witchcraft, experiences of respectful and disrespectful care, and structural barriers related to distance and transport. Socioeconomic constraints, particularly distance, transport costs, and limited health literacy, contributed to delayed ANC attendance. Nevertheless, women demonstrated resilience and a strong commitment to maternal health, with some walking over 22 kilometres to access services. Participants voiced a need for increased ANC education and proposed community-based solutions such as health worker outreach and improved access to services. The study calls for context-sensitive policy interventions, including community-based health education, outreach antenatal services, and improved transport support, to ensure equitable access to respectful antenatal care.