Simkhada Bibha, Teijlingen Edwin R van, Porter Maureen, Simkhada Padam
Public Health Department and Dugald Baird Centre, University of Aberdeen, UK.
J Adv Nurs. 2008 Feb;61(3):244-60. doi: 10.1111/j.1365-2648.2007.04532.x.
This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.
Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.
A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched.
A systematic review was carried out and both quantitative and qualitative studies were included.
Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.
More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.
本文是一项系统评价报告，旨在识别和分析影响发展中国家产前保健利用的主要因素。
产前保健是降低孕产妇死亡率的关键策略，但发展中国家数百万妇女无法获得该服务。
检索了一系列电子数据库，以查找1990年至2006年间在发展中国家开展并发表的研究。使用相关关键词检索英文出版物，并手工检索参考文献列表。
进行了一项系统评价，并纳入了定量和定性研究。
该综述纳入了28篇论文。研究最常确定以下影响产前保健利用的因素：孕产妇教育程度、丈夫教育程度、婚姻状况、可及性、成本、家庭收入、妇女就业、媒体曝光以及有产科并发症史。关于怀孕的文化信仰和观念也对产前保健的使用有影响。产次对充分就诊率有统计学上的显著负面影响。虽然较高产次的妇女往往较少使用产前保健，但产次与妇女年龄和宗教之间存在相互作用。只有一项研究考察了产前服务质量对利用的影响。没有研究发现此类服务的利用与对其满意度之间存在关联。
需要开展更多定性研究，以探讨妇女满意度、自主权和性别角色在决策过程中的影响。仅通过建立保健中心无法实现产前保健的充分利用；需要考虑妇女的整体（社会、政治和经济）地位。
