Abstract / Summary
Maternal and neonatal mortality remain major public health challenges in developing countries. Although antenatal care (ANC) is essential for preventing these deaths through early detection of pregnancy-related complications, the utilization of the recommended services remains suboptimal in Rwanda. To improve ANC utilization and quality of care, Rwanda piloted the WHO’s ANC package through the New Antenatal Model in Africa and India in Nyanza and Nyagatare districts. This study explored the perceptions and experiences of pregnant women and their male spouses regarding ANC services, to inform the implementation and scale-up of the intervention. A qualitative phenomenological study was conducted using 12 focus group discussions (FGDs), including 6 FGDs among pregnant women and 6 FGDs among their male spouses. In total, 46 pregnant women and 43 male spouses were purposively selected from 6 health centers (HCs) in the Nyanza and Nyagatare districts. The data were transcribed verbatim in Kinyarwanda, then translated into English. The transcripts were analyzed using an inductive thematic content analysis technique with ATLAS.ti version 8. Three major themes emerged: barriers to ANC access, facilitators of ANC utilization, and suggestions for improving ANC services and increasing the number of contacts. Key barriers included long waiting times, long distances and transportation costs, household responsibilities (reported only by pregnant women), domestic conflict and violence, lack of health insurance coverage, and negative beliefs about pregnancy-related witchcraft. Facilitators included support and guidance from community health workers, free provision of mosquito nets, and fear of fines for non-compliance with the recommended number of ANC contacts. Suggested improvements focused on providing respectful care, increasing the number of health workers, offering ultrasound services at HCs, equipping health posts with ANC services, increasing community education to allay fears such as those about witchcraft, and offering monetary incentives and work leave for male spouses to encourage their involvement in ANC. This study highlights that ANC access is influenced by a complex interplay of health-system, socioeconomic, and sociocultural factors, and emphasizes the need for respectful care and increased public awareness and education. Improving access to ANC services therefore requires addressing key structural, interpersonal, and social barriers, while strengthening community engagement and the quality of care provided by health workers.