Journal of Community Health

, Volume 37, Issue 4, pp 865–873 | Cite as

Determinants of Time of Start of Prenatal Care and Number of Prenatal Care Visits During Pregnancy Among Nepalese Women

Original Paper

Abstract

This study is aimed at investigating the factors determining the timing of first prenatal care (PNC) visit and the number of PNC visits among a national representative sample of Nepali women. Data was drawn from the 2006 Nepal Demographic and Health Survey on women age 15–49 years old who had delivery within three years prior to the survey (N = 4,136). Multinomial logistic regression was used to study the association between socio-demographic variables and two outcome variables—the timing of first PNC and number of PNC visits. Most of the women (45%) started prenatal care after 3 months of pregnancy while 28% had no care. About 43% of women had 1–3 PNC visits, 29% had more than 3 visits. Age, education, parity and wealth were associated with both the timing of PNC and the number of PNC visits such that older women and those socioeconomically disadvantaged had late and fewer PNC visits compared to the younger ones and those with socioeconomic advantage, respectively. Women with higher parity and those in rural residencies were more likely to delay PNC, have fewer PNC or have no care at all. Majority of Nepali women do not attend prenatal care during the first trimester of pregnancy contrary to the WHO recommendation for women in developing countries. Programmes aimed at improving maternal health in general and participation in PNC in particular should target all Nepali women, especially those: in rural residencies, with no education, with high parity; older women and those from poor households.

Keywords

Quantity of prenatal care Maternal demographic factors Demographic Health Survey Nepal Timing of PNC 

References

  1. 1.
    Kogan, M. D., Alexander, G. R., Jack, B. W., & Allen, M. C. (1998). The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States. Pediatrics, 102, 25–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Hueston, W. J., Gilbert, G. E., Davis, L., & Sturgill, V. (2003). Delayed prenatal care and the risk of low birth weight delivery. Journal of Community Health, 28, 199–208.PubMedCrossRefGoogle Scholar
  3. 3.
    Nwaru, B. I., Wu, Z., Hemminki, E. (2010). Determinants of the use of prenatal care in rural China: The role of care content. Maternal Child Health Journal. doi:10.1007/s10995-010-0734-0.
  4. 4.
    World Health Organization, WHO. (2006). Report on maternal mortality. [http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/].
  5. 5.
    World Health Organization, WHO. (2009). Women’s health fact sheet N 334 [http://www.who.int/mediacentre/factsheets/fs334/en/index.html].
  6. 6.
    Cokkinides, V., & Society, American. Cancer. (2001). Health insurance coverage-enrollment and adequacy of prenatal care utilization. Journal of Health Care for the Poor and Underserved, 12(4), 461–473.PubMedGoogle Scholar
  7. 7.
    Oropesa, R. S., Landale, N. S., Inkley, M., et al. (2000). Prenatal care among Puerto Ricans on the United States mainland. Social Science and Medicine, 51(2), 1723–1739.PubMedCrossRefGoogle Scholar
  8. 8.
    Mrisho, M., Obrist, B., Schellenberg, J. A., Haws, R. A., Mushi, A. K., Mshinda, H., et al. (2009). The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy and Childbirth, 9, 10.PubMedCrossRefGoogle Scholar
  9. 9.
    World Health Organization, WHO. (1994). Antenatal care: Report of a Technical Working Group. Geneva, 31 October–4 November.Google Scholar
  10. 10.
    Ochako, R., Fotso, J. C., Ikamari, L., & Khasakhala, A. (2011). Utilization of maternal health services among young women in Kenya: Insights from the Kenya demographic and health survey, 2003. BMC Pregnancy and Childbirth, 11, 1.PubMedCrossRefGoogle Scholar
  11. 11.
    Kurth, F., Be′lard, S., Mombo-Ngoma, G., Schuster, K., Adegnika, A. A., et al. (2010). Adolescence as risk factor for adverse pregnancy outcome in Central Africa—a cross-sectional study. PLoS ONE 5(12), e14367. doi:10.1371/journal.pone.0014367.
  12. 12.
    Frisbie, W. P., Echevarria, S., & Hummer, R. A. (2001). Prenatal care utilization among Non-Hispanic Whites, African Americans, and Mexican Americans. Maternal and Child Health Journal, 5(1), 21–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Park, J. H., Vincent, D., & Hastings-Tolsma, M. (2007). Disparity in prenatal care among women of colour in the USA. Midwifery, 23(1), 28–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Wu, Z., Viisainen, K., Wang, Y., & Hemminki, E. (2003). Perinatal mortality in rural China: Retrospective cohort study. BMJ, 327, 1319–1322.PubMedCrossRefGoogle Scholar
  15. 15.
    Dhakal, S., Chapman, G., Simkhada, P., et al. (2007). Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth, 7, 19.PubMedCrossRefGoogle Scholar
  16. 16.
    Jahn, A., Dar Iang, M., Shah, U., & Diesfeld, H. J. (2000). Maternity care in rural Nepal: A health service analysis. Tropical Medicine and International Health, 5(9), 657–665.PubMedCrossRefGoogle Scholar
  17. 17.
    Nepal Demographic and Health Survey (NDHS) Report. (2007). New ERA Kathmandu Nepal and Macro International Inc. USA: Ministry of Health and Population Government of Nepal.Google Scholar
  18. 18.
    Krueger, P. M., & Scholl, T. O. (2000). Adequacy of prenatal care and pregnancy outcome. Journal of American Osteopathic Association, 100, 485–492.Google Scholar
  19. 19.
    Raatikainen, K., Heiskanen, N., & Heinonen, S. (2007). Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health, 7, 268.PubMedCrossRefGoogle Scholar
  20. 20.
    Petrou, S., Kupek, E., Vause, S., & Maresh, M. (2001). Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales. Social Science and Medicine, 52, 1123–1134.PubMedCrossRefGoogle Scholar
  21. 21.
    Beeckman, K., Louckx, F., & Putman, K. (2010). Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health, 10, 527.PubMedCrossRefGoogle Scholar
  22. 22.
    Trinh, L. T., Dibley, M. J., & Byles, J. (2007). Determinants of antenatal care utilization in three rural areas of Vietnam. Public Health Nursing, 24, 300–310.PubMedCrossRefGoogle Scholar
  23. 23.
    Magadi, M. A., Nyovani, M., & Rodrigues, R. N. (2000). Frequency and timing of antenatal care in Kenya: Explaining the variations between women of different communities. Social Science and Medicine, 51, 551–561.PubMedCrossRefGoogle Scholar
  24. 24.
    Fotso, J. C., Ezeh, A., & Oronje, R. (2008). Provision and use of maternal health services among urban poor women in Kenya: What do we know and what can we do? Journal of Urban Health, 85(3), 428–442.PubMedCrossRefGoogle Scholar
  25. 25.
    Simkhada, B., van Teijlingen, E. R., Porter, M., & Simkhada, P. (2008). Factors affecting the utilization of antenatal care in developing countries: Systematic review of the literature. Journal of Advanced Nursing, 61(3), 244–260.PubMedCrossRefGoogle Scholar
  26. 26.
    Furuta, M., & Salway, S. (2006). Women’s position within the household as a determinant of maternal health care use in Nepal. International Family Planning Perspectives, 32(1), 17–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2010). Factors associated with underutilization of antenatal care services in Indonesia: Results of Indonesia demographic and health survey 2002/2003 and 2007. BMC Public Health, 10, 485.PubMedCrossRefGoogle Scholar
  28. 28.
    Bhatia, J. C., & Cleland, J. (1995). Determinants of maternal care in a region of South India. Health Transition Review, 5, 127–142.Google Scholar
  29. 29.
    Magadi, M. A., Agwanda, A. O., & Obare, F. A. (2007). A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: Evidence from demographic and health surveys (DHS). Social Science and Medicine, 64, 1311–1325.PubMedCrossRefGoogle Scholar
  30. 30.
    Pallikadavath, S., Foss, M., & Stones, R. W. (2004). Antenatal care: Provision and inequality in rural north India. Social Science and Medicine, 59(6), 1147–1158.PubMedCrossRefGoogle Scholar
  31. 31.
    Celik, Y., & Hotchkiss, D. R. (2000). The socio-economic determinants of maternal health care utilization in Turkey. Social Science and Medicine, 50(12), 1797–1806.PubMedCrossRefGoogle Scholar
  32. 32.
    Lodewyckx, K., Peeters, G., Spitz, B., Blot, S., Temmerman, M., Zhang, W., et al. (2008). Nationale richtlijn prenatale zorg: een basis voor een klinisch pad voor de opvolging van zwangerschappen. In KCE reports (Vol. 6A). Federaal Kenniscentrum voor de Gezondheidszorg, 26-11-2008.Google Scholar
  33. 33.
    Trinh, L. T. T., Dibley, M. J., & Byles, J. (2006). Antenatal care adequacy in three provinces of Vietnam: Long an, Ben tre and Quang ngai. Public Health Reports, 121(4), 468–475.PubMedGoogle Scholar
  34. 34.
    Pagnini, D. L., & Reichman, N. E. (2000). Psychosocial factors and the timing of prenatal care among women in New Jersey’s healthstart program. Family Planning Perspectives, 32(2), 56–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.School of Health SciencesUniversity of TampereTampereFinland

Personalised recommendations