Effect of a new antenatal care programme on the attitudes of pregnant women and midwives towards antenatal care in Harare

Abstract

Objective: The aim was to study the effect of a new antenatal care (ANC) programme on the attitudes of pregnant women and midwives towards antenatal care.

Design: This was a controlled trial in which the attitudes of women and staff using the standard programme of ANC were compared to those using a new one. The new programme contained fewer but objective oriented visits, and was designed to improve consumer and provider satisfaction with ANC.

Setting: Antenatal sessions at primary care clinics in Harare.

Subjects: 200 pregnant women and 65 midwives.

Main outcome measures: The satisfaction of pregnant women and staff with ANC, reasons for lack of satisfaction, and time spent waiting for consultations.

Results: The new programme did not make any impact on the time spent by women waiting to be seen at the clinics, nor on the time made available for the consultations. There was no significant impact on the degree of satisfaction with the care among the women. In the control clinics, significantly more staff wished the women to make fewer visits, and in the study clinics, significantly more staff thought the use of appointments was appropriate. The major problem limiting access to ANC was lack of money to pay for the booking fees. Other problems mentioned by the women were ignorance regarding the best time to book, lack of privacy and insufficient staff at the clinics.

Conclusions: The solutions to some of the problems identified require infrastructural changes at policy making level, rather than changes within the antenatal care programmes.

PIP: In an effort to increase client and staff satisfaction with antenatal services, a program was introduced in Harare, Zimbabwe, that reduced the number of antenatal visits from 12 to 6, eliminated routines such as urinalysis and weighing at each visit, and scheduled patients for a specific time rather than just a date. The impact of these programmatic changes was investigated in a comparative study of 200 low-income women randomized to attend Harare City Health Department clinics that offered either standard antenatal care or the modified program. There were no significant differences between the two groups of clinic clients in terms of their satisfaction with services received and communication with midwives. A comparison of responses from 28 midwives recruited from standard clinics and 37 assigned to the experimental program indicated those in the former group were significantly more likely to think pregnant women should be required to make fewer prenatal visits while those in the latter group were significantly more supportive of set appointment times; there were no differences in overall satisfaction, however. Observations at the clinics revealed women who were given set appointments ignored them and presented about 2 hours early to avoid waiting in line for their visit, which averaged only 3 minutes in both groups. Key problems identified by both clients and midwives included booking fees, inadequate numbers of midwives at the clinic, privacy concerns, and insufficient seating in the waiting rooms. Improvements in the satisfaction of providers and recipients of antenatal care may require infrastructural rather than programmatic changes.