Abstract:
OBJECTIVES : We examine the individual- and community-level factors associated with the
utilization of antenatal care, following the adoption of the focused antenatal
care (FANC) approach in Zambia.
METHODS : Using the 2007 Zambia Demographic and Health Survey, linked with administrative
and health facility census data, we specify two multilevel logistic models to
assess the factors associated with (1) the inadequate use of antenatal care (ANC)
(defined as three or fewer visits) and (2) the non-use of ANC in the first trimester
of pregnancy.
RESULTS : Although all women in the selected sample had at least one ANC visit, 40% did
not have the minimum number required (four), whereas more than 80% of the
initial check-ups did not occur in the first trimester. At the individual level, the
woman’s employment status, quality of ANC received and the husband’s
educational attainment are negatively associated, while parity, the household
childcare burden and wealth are positively associated with inadequate utilization
of ANC. Both individual- and community-level characteristics influence inadequate
use and non-use of ANC in the first trimester; however, community-level
factors are relatively stronger in rural areas.
CONCLUSION : The results suggest that improving the content of care during ANC visits may foster
adequate use of ANC and encourage early initiation of ANC visits. Furthermore,
health promotion programmes need to further encourage male involvement in
pregnant women’s decision to seek ANC to encourage adequate use of services.
