Antenatal care in developing countries.

The problem of antenatal care in developing countries may be considered from two aspects: (a) areas where antenatal facilities are absent or are inadequate, and (b) areas where antenatal facilities are adequate but for some reasons are not adequately utilized. The solution to the first part of the problem would appear to be simple. The governments concerned should provide the required facilities. This obviously is not an easy task in many areas of the world, especially with the present profound economic depression in many developing countries. The people just have to use the facilities available to their best advantage, or do without the facilities. The second part of the problem presents more difficulties. Where antenatal facilities are available, inadequate utilization has been shown to be due to a number of factors: 1. The facilities are too distant or too expensive. It has been shown how the Nigerian authorities dealt with this problem in the Ibarapa district. However, it is a very expensive solution and few governments will be able to afford this. 2. Illiteracy or ignorance. The obvious solution to this difficulty is to educate the masses and a few governments have already embarked on these commendable programmes. Unfortunately, this procedure is expensive, may take a long time and, as already pointed out, even literate women may not use the antenatal services. 3. Traditional and cultural beliefs and prejudices. It has already been shown that this factor is a very important one in the population in developing countries, even among literate patients. The saying that 'old habits die hard' is probably apt here. Probably, with time, education and closer contact with the developed world, these prejudices will disappear. From the above observations, it would appear that an inexpensive short-term solution to the two parts of the problem mentioned above is for governments to train and use the TBAs who are already 'in our midst' and who already enjoy the confidence of the masses. The authorities, however, have to be very careful in integrating the TBAs into the health system. It has to be done very judiciously and tactfully, otherwise antagonism and unhealthy rivalry will be created between the TBAs and other members of the health team. They must be made to realize that they are a part of the health team.