Determinants of Antenatal Care Utilization Among Pregnant Women: A Qualitative Study

Hasni; Saman; Novica Ariyanti Putri; Sova Evie; Enggar

doi:10.35816/jiksh.v15i1.254

Authors

Hasni Diploma in Midwifery Poso, Poltekkes Kemenkes Palu, Central Sulawesi https://orcid.org/0000-0002-8253-2398
Saman Department of Nursing, Poltekkes Kemenkes Palu, Central Sulawesi https://orcid.org/0000-0001-7054-970X
Novica Ariyanti Putri Department of Nursing, Poltekkes Kemenkes Palu, Central Sulawesi
Sova Evie Diploma in Nursing Tolitoli, Poltekkes kemenkes Palu, Central Sulawesi https://orcid.org/0000-0002-6968-2383
Enggar Politeknik Cendrawasih Palu, Central Sulawesi https://orcid.org/0000-0003-4741-8351

DOI:

https://doi.org/10.35816/jiksh.v15i1.254

Keywords:

Antenatal Care, Health Services Accessibility, Maternal Health, Pregnancy

Abstract

Introduction: Antenatal care (ANC) plays a critical role in preventing pregnancy-related complications and improving maternal and neonatal outcomes. Despite expanded maternal health services, inadequate utilization of ANC remains a significant challenge in many settings. Understanding the contextual factors that influence women’s decisions to seek antenatal services is essential for improving maternal healthcare delivery. This study aimed to explore the determinants influencing antenatal care utilization among pregnant women.

Research Methodology: This study employed a qualitative exploratory design. Data were collected through in-depth interviews with pregnant women who had experience accessing antenatal services. Participants were selected using purposive sampling to ensure inclusion of individuals with relevant experiences. Data collection continued until thematic saturation was achieved. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis to identify patterns and themes related to antenatal care utilization.

Results: The analysis identified four major themes influencing antenatal care utilization: maternal knowledge and awareness of pregnancy care, accessibility of health services, family support and decision-making dynamics, and socio-cultural beliefs regarding pregnancy. Women who had better knowledge of antenatal care benefits were more motivated to attend routine visits. However, structural barriers such as distance to health facilities, transportation constraints, and long waiting times sometimes limited-service utilization. Family encouragement, particularly from husbands, facilitated antenatal care attendance, while cultural perceptions that pregnancy is a natural process occasionally reduced the perceived need for routine check-ups.

Conclusion: Antenatal care utilization is shaped by a complex interaction of individual, social, and health system factors. Strengthening maternal health education, improving accessibility of primary healthcare services, and promoting family involvement in pregnancy care are essential strategies to increase ANC utilization. Policies and interventions addressing these multidimensional determinants are necessary to improve maternal health outcomes.

References

Aga, M. A. (2026). Machine learning-based identification of determinants of pulse pressure in pregnant women. Global Epidemiology, 11, 100245. https://doi.org/10.1016/j.gloepi.2026.100245

Akalanka, K. H. M., Lin, K., & Sun, J. (2025). Trends and determinants of preterm birth and neonatal mortality in Ghana (2008–2022): a WHO antenatal care guidelines analysis. Global Health Journal, 9(4), 344–354. https://doi.org/10.1016/j.glohj.2025.11.005

Al-Zubayer, M. A., Shanto, H. H., Kundu, S., Sarder, M. A., & Ahammed, B. (2024). Utilization levels and associated factors of WHO-recommended antenatal care visits in South Asian countries. Dialogues in Health, 4, 100175. https://doi.org/10.1016/j.dialog.2024.100175

Al Agili, D. E., Ayoub, S., Naavaal, S., Mirza, L., Aman, N., & Naamani, S. (2025). Utilization of Oral Health Services by Pregnant Women Attending Primary Healthcare Centers in Jeddah, Saudi Arabia. The Open Dentistry Journal, 19(1). https://doi.org/10.2174/0118742106384593250714073450

Anumudu, S. I., Uhegwu, C. C., & Anumudu, C. K. (2025). A scoping review of maternal mortality, its health determinants, and factors that influence care utilization in women of childbearing age in Nigeria. Global Health Journal, 9(3), 185–199. https://doi.org/10.1016/j.glohj.2025.10.004

Balta, B., Degefu, S., Tamirat, E., Yaya, H., Nigusie, M., & Bogale, A. (2026). Prevalence and associated factors of anemia among pregnant women attending antenatal care at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia. International Journal of Africa Nursing Sciences, 24, 100978. https://doi.org/10.1016/j.ijans.2026.100978

Banti, B. Y., Dhabi, B. M., & Regasa, D. W. (2026). Determinants of maternal transportation mode and travel time for timely emergency obstetric care in selected public hospitals, Addis Ababa, Ethiopia, 2025. AJOG Global Reports, 6(1), 100612. https://doi.org/10.1016/j.xagr.2026.100612

Bragg, A., Markcrow, S., Monk, S., Minehan, M., & Knight-Agarwal, C. R. (2025). Unveiling the Craving: A systematic review of pregnant women’s desires for expert nutrition care in Australia. Midwifery, 140, 104210. https://doi.org/10.1016/j.midw.2024.104210

Fatiah, M. S., Tambing, Y., Allo Bela, S. R., Afelya, T. I., Mollet, G. C. C., Florensia, W., Irjayanti, A., Irmanto, M., & Ilmidin. (2026). Survival analysis of syphilis infection in pregnant women of Papuan and non-Papuan ethnicities in Jayapura City and Regency, Papua, Indonesia. Clinical Epidemiology and Global Health, 38, 102278. https://doi.org/10.1016/j.cegh.2025.102278

Gedef, G. M., Girma, B., Andualem, F., Gashaw, A., & Tibebu, N. S. (2024). Antenatal care utilization and its determinants in fragile and conflict-affected situations in Sekota Zuria District, Northern Ethiopia, 2022: A community-based cross-sectional study. Midwifery, 129, 103906. https://doi.org/10.1016/j.midw.2023.103906

Hatijar, H., Rahmadani, R. A., & Akib, A. (2025). Maternal factors influencing complete basic immunization: A Scoping Review. Jurnal Ilmiah Kesehatan Sandi Husada, 14(2), 284–295. https://doi.org/10.35816/jiskh.v14i2.1315

Heyi, W. D., Macharia, P. M., Asefa, A., Beňová, L., Olagunju, O. S., & Mekonnen, W. (2025). Geographic disparities in antenatal care utilization in Addis Ababa city, Ethiopia, using demographic and health survey data: A small area estimation approach. Sexual & Reproductive Healthcare, 46, 101156. https://doi.org/10.1016/j.srhc.2025.101156

Jackson, I. L., Akpan, M. R., Akwaowoh, A. E., & Sampson, V. I. (2024). The attributes and determinants of herbal medicine use among pregnant women attending antenatal clinics at three hospitals in Uyo, Nigeria. Journal of Herbal Medicine, 46, 100891. https://doi.org/10.1016/j.hermed.2024.100891

Markos, Z., Kassegn, A., Tesfaye, D., Samuel, A., & Dinkneh, R. (2026). Delayed initiation of antenatal care and its determinants in Ethiopia: A systematic review and meta-analysis. Midwifery, 156, 104734. https://doi.org/10.1016/j.midw.2026.104734

Omar, M. A., Hassan, Y. S. A., Ali, A. S., & Ahmed, M. M. (2026). Socioeconomic and regional determinants of optimal antenatal care utilization among women in South and Central Somalia. Global Epidemiology, 11, 100239. https://doi.org/10.1016/j.gloepi.2025.100239

Rishard, M., Ziyad Mohamed, A. F., De Abrew, A., Senanayake, H., Wijesinghe, M. S. D., & Lazzerini, M. (2026). Improving person-centered maternity care in Sri Lanka through co-creation: Utilizing women’s perceptions and stakeholder opinions. Midwifery, 153, 104689. https://doi.org/10.1016/j.midw.2025.104689

Ritu, R. K., Rani, P., Kaur, A., & Kaur, H. (2025). Dissecting socioeconomic inequalities in antenatal care utilization in India: a Blinder–Oaxaca decomposition approach. International Journal of Sociology and Social Policy, 45(11–12), 1043–1065. https://doi.org/10.1108/IJSSP-03-2025-0156

Sani, J., Oluwagbemiga, A., & Ahmed, M. M. (2025). Machine learning-based prediction of optimal antenatal care utilization among reproductive women in Nigeria. Machine Learning with Applications, 21, 100698. https://doi.org/10.1016/j.mlwa.2025.100698

Shibeshi, A. H., Habtie, G. M., Arega, G. G., Hussen, N. M., Hamed, K. E., & Tareke, S. A. (2025). A multilevel analysis of receipt of adequate antenatal care and its determinants among pregnant women in 11 sub-Saharan African countries: insights from recent demographic and health surveys. Clinical Epidemiology and Global Health, 36, 102185. https://doi.org/10.1016/j.cegh.2025.102185

Shiferaw, A., & Minale, M. (2025). Husband’s involvement in maternal antenatal care and associated factors among pregnant women: study protocol for systematic review and meta-analysis. AJOG Global Reports, 5(3), 100532. https://doi.org/10.1016/j.xagr.2025.100532

Sichalwe, M. M., Charles, D. E., Kimaro, R. R., & Behera, M. R. (2026). Exploring factors influencing the use of herbal medicines among pregnant and birthing women in Tanzania: A scoping review. Clinical Traditional Medicine and Pharmacology, 7(1), 200267. https://doi.org/10.1016/j.ctmp.2026.200267

Silaen, M., Rahayu, S., Aryanti, I., Prasetyo, A., Wahyuni, S., Wahyono, T. T., Sumarno, Mumfangati, T., Irmawan, Saksono, H., Rachmadhani, A., Nur, Y. H., & Marannu, B. (2025). Health and socio-economic factors as determinants of antenatal care service access in Indonesia. Clinical Epidemiology and Global Health, 33, 102010. https://doi.org/10.1016/j.cegh.2025.102010

Suriyani, A., Arda, D., & Ishak, I. (2025). Effectiveness of simulation learning methods on improving the clinical skills of nursing students in midwifery care. Jurnal Edukasi Ilmiah Kesehatan, 3(3), 123–131. https://doi.org/10.61099/junedik.v3i3.149

Tilahun, B. D., Ayele, M., Lake, E. S., Molla, B., Yilak, G., Azmeraw, M., & Kitaw, T. A. (2026). Prevalence and factors associated with early antenatal care visit in Ghana: recent evidence from the 2022 Ghana Demographic and Health Survey. AJOG Global Reports, 6(1), 100605. https://doi.org/10.1016/j.xagr.2026.100605

Tolossa, T., Gold, L., Lau, E. H., Dheresa, M., & Abimanyi-Ochom, J. (2024). Association between quality of antenatal care service utilization and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis. Sexual & Reproductive Healthcare, 42, 101036. https://doi.org/10.1016/j.srhc.2024.101036

Wijayanti, Y. T., Nurhanifah, D., Asmi, A. S., Suprapto, S., Rahagia, R., & Millati, R. (2025). Perception of Nursing Students on Clinical Teaching and Learning of Public Health Nurses: A Descriptive Qualitative Approach. Malaysian Journal of Nursing, 16(04), 142–151. https://doi.org/10.31674/mjn.2025.v16i04.014

Wirawan, G. B. S., Kelly-Hanku, A., Adawiyah, R. Al, Wolter, A., Hegarty, B., Yuniar, Y., Ridwan, R., Januraga, P. P., Lestary, H., & Wulandari, L. P. L. (2026). Public and private antenatal care access and utilization as determinants of triple antenatal test for HIV, syphilis, and HBV: Evidence from the Indonesian Health Survey. Women and Birth, 39(1), 102153. https://doi.org/10.1016/j.wombi.2025.102153

Zeleke, A. M., Gonete, Y. A., Tassew, W. C., & Ferede, Y. A. (2025). Use of eight or more antenatal care contacts and determinants among healthcare providers in Ethiopia: systematic review and meta-analysis. AJOG Global Reports, 5(1), 100418. https://doi.org/10.1016/j.xagr.2024.100418