Paul Mkandawire1, Odwa Atari2, Joseph Kangmennaang3, Godwin Arku4, Isaac Luginaah4, Josephine Etowa5. 1. Institute of Interdisciplinary Studies, Human Rights Program, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada. Electronic address: Paul.Mkandawire@carleton.ca. 2. Department of Geography, Nipissing University, 100 College Drive, Box 5002, North Bay, ON, P1B 8L7, Canada. Electronic address: odwaa@nipissingu.ca. 3. Department of Geography and Environment, University of Waterloo, 200 University Avenue West, N2L 3G1, Ontario, Canada. Electronic address: jkangmen@uwaterloo.ca. 4. Department of Geography, The University of Western Ontario, Department of Geography, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. 5. University of Ottawa School of Nursing, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Abstract
BACKGROUND: With antenatal care (ANC) coverage now widely seen as a success story in Sub-Sahara Africa (SSA), attention has begun to shift towards exploring the full life-saving potential that ANC holds. OBJECTIVES: This study examines association between pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda, where ANC coverage is nearly universal. METHODS: We use survival analysis and apply the lognormal model in Stata SE 15 to compute time ratios (TR) that provide a direct metric for time to first ANC check-up. RESULTS: Despite nearly universal coverage, only 25% of pregnant mothers start ANC within the timeframe recommended by WHO. Women with unintended pregnancies are even more likely to delay ANC (TR = 11.4%, Z = 2.48, p < 0.05) than women with intended pregnancies. The effect of pregnancy intention on time to first ANC accentuates when we control for parity in the hazard models. There is also educational divide, with early start of ANC limited to pregnant women with secondary education or higher. Interaction effects suggest significant interaction between parity (≥ 4) and unintended pregnancy (TR = 11.1%, Z = -2.07, p < 0.05) on gestational age at first ANC. Other predictors of time to first ANC are contact with health care provider and perceived barriers. CONCLUSION: With near universal coverage, the next big challenge to harness the full life-saving potential of ANC in Rwanda would be ramping up prompt start of prenatal care, timeliness of successive checkup intervals, and adherence to recommended number of visits, as opposed to simply increasing attendance. Preventing unwanted pregnancies in multiparous mothers through family planning would also significantly to the goal of universal ANC coverage in Rwanda.
BACKGROUND: With antenatal care (ANC) coverage now widely seen as a success story in Sub-Sahara Africa (SSA), attention has begun to shift towards exploring the full life-saving potential that ANC holds. OBJECTIVES: This study examines association between pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda, where ANC coverage is nearly universal. METHODS: We use survival analysis and apply the lognormal model in Stata SE 15 to compute time ratios (TR) that provide a direct metric for time to first ANC check-up. RESULTS: Despite nearly universal coverage, only 25% of pregnant mothers start ANC within the timeframe recommended by WHO. Women with unintended pregnancies are even more likely to delay ANC (TR = 11.4%, Z = 2.48, p < 0.05) than women with intended pregnancies. The effect of pregnancy intention on time to first ANC accentuates when we control for parity in the hazard models. There is also educational divide, with early start of ANC limited to pregnant women with secondary education or higher. Interaction effects suggest significant interaction between parity (≥ 4) and unintended pregnancy (TR = 11.1%, Z = -2.07, p < 0.05) on gestational age at first ANC. Other predictors of time to first ANC are contact with health care provider and perceived barriers. CONCLUSION: With near universal coverage, the next big challenge to harness the full life-saving potential of ANC in Rwanda would be ramping up prompt start of prenatal care, timeliness of successive checkup intervals, and adherence to recommended number of visits, as opposed to simply increasing attendance. Preventing unwanted pregnancies in multiparous mothers through family planning would also significantly to the goal of universal ANC coverage in Rwanda.
Authors: Judith Yargawa; Kazuyo Machiyama; Victoria Ponce Hardy; John Cleland; Yeetey Enuameh; Edward Galiwango; Kassahun Gelaye; Kaiser Mahmud; Sanne M Thysen; Damazo T Kadengye; Vladimir Sergeevich Gordeev; Hannah Blencowe; Joy E Lawn; Angela Baschieri Journal: Popul Health Metr Date: 2021-02-08