Tengera Olive, Meharry Pamela, Nkurunziza Aimable, Babenko-Mould Yolanda, Rugema Joselyne, Rulisa Stephen, Nyirazinyoye Laetitia
School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
School of Nursing, University of Illinois Chicago, Chicago, United States of America.
PLoS One. 2025 May 21;20(5):e0323762. doi: 10.1371/journal.pone.0323762. eCollection 2025.
Antenatal care (ANC) improves maternal and neonatal health. However, less than half of pregnant women in sub-Saharan African (SSA) countries, including Rwanda, attend adequate ANC designed to provide routine care and detect and treat early pregnancy complications. This article explores the women's views on factors that hinder adherence to ANC visits in Rwanda.
This exploratory qualitative research used in-depth interviews to collect data from 22 pregnant women. Data were recorded, transcribed verbatim, and analyzed using a thematic approach.
A Thematic analysis revealed four themes: a) stigma dynamics, b) sociocultural beliefs and practices, c) lack of partner's support, and d) Challenges to and at the healthcare setting. Unintended pregnancies, multiparity, and early weaning were identified as reasons why participants delayed attending the ANC. Sociocultural practices and beliefs that place women at the center of domestic chores, cultural misbeliefs, the influence of intergenerational behaviours, and social context were also reported as barriers to attending or adhering to ANC visits. The lack of partner support has been reported as a barrier due to existing family conflicts, domestic violence, competing personal priorities of partners over ANC, and fear of partners of HIV tests. They reported several structural barriers, including attendance and adherence to ANC visits, mandatory requirements before receiving ANC, long distance to the health facility, scattered health services within a health facility, long wait times, and negative attitudes and actions of healthcare providers.
The identified factors hindering pregnant women's participation in ANC visits are modifiable in progressive countries such as Rwanda. Continued National support could reduce these barriers, increase ANC attendance, and meet the 2030 Sustainable Development Goal 3.
产前保健可改善孕产妇和新生儿健康。然而，在包括卢旺达在内的撒哈拉以南非洲（SSA）国家，不到一半的孕妇接受了旨在提供常规护理以及检测和治疗早期妊娠并发症的充分产前保健。本文探讨了卢旺达妇女对阻碍她们坚持产前保健就诊的因素的看法。
这项探索性定性研究采用深入访谈从22名孕妇中收集数据。数据被记录、逐字转录，并采用主题分析法进行分析。
主题分析揭示了四个主题：a）耻辱动态，b）社会文化信仰和习俗，c）缺乏伴侣支持，以及d）医疗保健机构的挑战。意外怀孕、多胎妊娠和过早断奶被确定为参与者延迟接受产前保健的原因。将妇女置于家务中心的社会文化习俗和信仰、文化误解、代际行为的影响以及社会背景也被报告为接受或坚持产前保健就诊的障碍。由于存在家庭冲突、家庭暴力、伴侣在产前保健方面的个人优先事项相互竞争以及伴侣对艾滋病毒检测的恐惧，缺乏伴侣支持被报告为一个障碍。她们报告了几个结构性障碍，包括产前保健就诊的出勤和坚持、接受产前保健之前的强制要求、到医疗机构的距离远、医疗机构内分散的医疗服务、等待时间长以及医疗保健提供者的消极态度和行为。
在卢旺达等进步国家，已确定的阻碍孕妇参与产前保健就诊的因素是可以改变的。国家持续提供支持可以减少这些障碍，增加产前保健就诊率，并实现2030年可持续发展目标3。
