Why pregnant women skip antenatal services

Officials from different health centres across the country have reported that some pregnant women skip maternal health services during pregnancy, resulting in complications to both parents and babies upon delivery. Health experts recommend that pregnant women seek antenatal care at least four times before delivery in order to eliminate or identify any complications for both mothers and newborns. According to Doctor Samuel Kagali, a gynecologist at Kacyiru Police Hospital in Kigali, essential interventions in Antenatal Care (ANC) include identification and management of obstetric complications such as preeclampsia, tetanus toxoid immunisation, and intermittent preventive treatment for malaria during pregnancy. Antenatal services will also help to identify and manage infections such as HIV, syphilis, and other sexually transmitted infections (STIs), the doctor says. He also noted that ANC remains an opportunity to promote the use of skilled attendance at birth and healthy behaviours such as breastfeeding, early postnatal care, and planning for optimal pregnancy spacing. But many women in Rwanda continue to miss the above opportunities even if more than two-thirds of pregnant women receive at least one antenatal visit, health officials in the country say. Doctors like Alphonse Butoyi at Kibagabaga Hospital in Kigali said that laziness on the part of patients may be one reason why some antenatal services are skipped, but beliefs in natural and traditional delivery processes and ignorance about dangers associated with them could also be major factors behind the vice. Jeanette Ndayisaba, a mother of four from Kimonyi Sector in Musanze District, has been going for antenatal services depending on advice she received for her different pregnancies. “I used to go for antenatal services whenever I was pregnant but couldn’t go there four times. I went there twice for my first born and the second one but I went there three times for my third born because I was told I could have complications. My forth born has never been anything of complications and I delivered after visiting the hospital only once,” she said. Another mother of five in Nyabihu District’s Nyirakigugu Cell of Jenda Sector who was only identified as Odette said that it is rare in her area for women to go for antenatal services more than twice. “We know the importance of attending antenatal services but for me I think two times are enough. Most of us have beliefs that even a woman can deliver well without antenatal care as it was in the past when we were born,” she said. Community health workers say that traditional beliefs that safe delivery is possible at home remain the major reason why many expectant women in rural areas skip antenatal services. “They believe it is of no use going there, others ignore it willingly while others fear to be seen pregnant,” said Etienne Muyoboke, a community health worker in Rusagara Cell of Muhoza Sector in Musanze District. Dr Anita Asiimwe, the minister of state for health in charge of public health and primary health care, says that 94 per cent of pregnant women in Rwanda have attended antenatal care at least once, which she says is a great improvement even if it’s far from enough. “We cannot ignore the 6 per cent. We have to continue educating the people about the importance of antenatal care especially through community health workers who are closest to the people,” Asiimwe said.