Use of antenatal care in an urban area of Dhaka City

Abstract

Objective: Describe the types, patterns and use of antenatal care (ANC) in an urban area of Dhaka city. Methodology: A community-based study of antenatal care-seeking behaviour was conducted during February-June 1996. A sample of 200 women who were pregnant for at least six months was identified from an ongoing health and demographic surveillance system set up in Zone 3 of the Dhaka city. A pre-tested structured questionnaire was used for collecting information on the sociodemographic characteristics, reproductive history, and the ANC use patterns. In-depth interviews were also conducted among a subsample (n=l 6) of these women to understand the process of seeking ANC. Results: Most study women (88%) received some form of ANC. However, about a quarter received only tetanus immunization (TT), and less than 10% received all the necessary elements of ANC as recommended by the Government of Bangladesh. In addition, half of the women made only one or two visits, and only one-third made the first visit during their first trimester. A diverse variety of health-care providers was used by the study women. While most women obtained ANC from modern providers, about a quarter used traditional providers, either alone or as an adjunct to the care given by modern providers. Factors affecting the use of ANC suggest that the women who were more educated had fewer children, and whose husbands had more schooling and who had higher monthly income were more likely to use ANC (p<0.05). Women's ANC-seeking behaviour seems to follow a four-stage process: recognition of the importance of ANC, stance to seek ANC, selection of a provider, and finally, seeking ANC. Conclusion: Although the findings of the study reveal that the TT coverage among the pregnant women was high in urban Dhaka, other ANC services were very weak. The results of the study also suggest that there is still ample room for improvement in the delivery and organization of antenatal care, particularly in the process of client-provider interaction.