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Timely utilization of parental care of young women

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Introduction

In health-related matters an antenatal care abbreviated as ANC is the health care given to a

pregnant woman by health professionals during her pregnancy. Pregnancy being a vital stage for

the expectant woman it’s a period where the mother experiences physical changes and therefore

she is expected for check up frequently. Hence during this period, this woman is offered a

number of appointments with the midwife so as to check her status. An ANC therefore aims at

ensuring that pregnant mothers have the best nutrition, acquire appropriate screening and testing,

and also the infants are given appropriate immunization as well. Furthermore, an ANC ensures

that pregnant women are educated on the relevance of proper breastfeeding, visiting clinics

frequently, offering proper care to the newborn as well, and the importance of safeguarding their

health during pregnancy and after.

An Antenatal care brings about various benefits since it can help women avoid or deal with

problems during pregnancy, and it can also help make sure their bodies are healthy as per

Heinonen, 2021 article.

According to the reports of World Health Organization of the year 2016, an expectant woman

should receive health care and access antenatal services at least four times during her pregnancy.

The prenatal period offers various opportunities for reaching pregnant women who need

intervention due to the health and well-being of their infants. Therefore, WHO states that if a

pregnant woman gets prenatal care at least four times, she is more likely to get maternal health

services. moreover, WHO proves that ANC not only focuses on positive pregnancy experiences

but also on the effective transition to successful childbirth and motherhood as per Tessema and

Minyihun, 2021 requirements. With all this, WHO therefore presents comprehensive guidelines

in ensuring that prenatal care services are offered without failure in all areas of the world.
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Following the report from Nasira Boi, Izudi and Atim (2022), timely utilization of prenatal care

is the ANC visit made by an expectant woman during her gestation period of less than four

months. Even though this practice is highly associated with a positive effect to the life of

pregnant mothers and their children, there also exist some of the factors that limit various

individuals and in various regions to reaching the needs in the correct way.in reference to a

study conducted by Nasira Boi, Izudi and Atim (2022), in South Sudan on the various factors

affecting timely ANC attendance, it was noted that most of the expectant women receive their

first antenatal services after 12 weeks of their gestation. furthermore, the study specified that the

main factors contributing to this challenge are level of education, low monthly income level,

antenatal history, available ANC services, husband’s level of education, maternal age, exposure

to the media, obstetric history, and lastly employment status. In addition to this, the various

factors were observed to be varying with the developing countries and the developed countries as

well.

In the other study performed in the rural areas of Ethiopia by the three: Suleman, Mulatu and

Abate, in the year (2021), results proved that regardless of the appealing benefits offered by

antenatal care, In the past few years, a number of 303000 women died because of problems

related to pregnancy or childbirth. And most of these casualties happen in countries that are still

developing, and Ethiopia is one of them. The study showed that there is very low utilization of

prenatal care in comparison to the WHO recommendations in Ethiopia (Suleman, Mulatu, and

Abate, 2021).The study found that 36.6% of pregnant women in the whole country had made at

least four antenatal visits in the whole country, and the low percentage was due to the mother’s

education, household wealth index, desire to have children, how often they read newspapers,
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where they lived, how often they listened to the radio, and how often they watched TV. The

factors were considered to cause low turnout in number of expectant women.

Besides that, South Africa, a developing country has progressed in the reduction of maternal

deaths. Coleman et al. (2020) argues that a population-based survey showed that about 87% of

women in South Africa went to all four prenatal care visits. And Lattof et al. (2020) also say that

the South African Health Ministry has recently improved the four-visit antenatal care model so

that it meets the 2016 recommendations of the World Health Organization about how many visits

a pregnant woman should have before giving birth. In April 2017, South Africa Health Ministry

began the implementation of the 8-contact antenatal care after ensuring nationwide training

programs were delivered successfully. additionally, the South African Health Ministry ensured

that women who are in need of prenatal care receive respectful care and clinical inquiry is made

or intimate partner violence. All these updates on Antenatal care were made to improve the

quality of Antenatal care so as to achieve good pregnancy care, outcomes, and women’s

experience as well.

Even though the South African Health Ministry seen improvement in the health measures and

facilities for the citizens and more so expectant women, challenges and other struggles faced by

these women that make them not enjoy the services. Human rights-based research found that

there were barriers to antenatal care in South Africa, which included a lack of patient privacy and

consent at health facilities, a lack of information and knowledge about sexual and reproductive

health, and the issues with the availability and cost of transportation. However, the need for

understanding the exact socio-demographic factors and family characteristics that affect the

utilization of antenatal care is of great importance in the planning. hence, findings focus on
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finding out the main factors that contribute to women not receiving antenatal care as

recommended measures by the health ministry in South Africa.

Objective

The main objective of this report is to find out the timely utilization of antenatal care services of

women in the reproductive age group by socio-demographic variables and by their

husbands/partner characteristics. The findings use the survey data for women collected during

the 2016 survey and the analysis is performed using the SPSS statistical software.

The methodology

For this report will use various statistical techniques. At first, a descriptive analysis will be

performed so as to have a good description of the data set. This type of analysis refers to the

process of analyzing and describing a dataset using various statistical techniques to shorten and

visualize the main features and patterns in the data. The aim of descriptive analysis is to gain an

understanding of the distribution, central tendency, variability, and other key characteristics of

the data. This analysis is always the first step in data analysis and can provide valuable insights

into the data and help to recognize potential patterns or trends that may guarantee further

investigation. It can also be used to summarize and convey findings to others in a clear and

concise way. Also, in this case, we shall be focused on understanding the nature of the various

variables that we have and specifying the variables of interest.

All of the variables in the set of data will be put into two groups: that is dependent and

independent variables. The value of the dependent variable changes when the independent

variable(s) change. An independent variable is a variable that is changed or controlled to see how

it affects the dependent variable. The independent variable is thought to be the cause or predictor
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of the dependent variable. The researcher often changes the independent variable to see what

effect it has on the dependent variable.

Chi-Square test of association

This is a statistical test used to decide whether there is a significant association between two

categorical variables. It is used to analyze the relationship between two variables in a

contingency table, which is a table that displays the frequency distribution of two categorical

variables. The null hypothesis of the chi-square test of association is that there is no association

between the two variables, and the alternative hypothesis is that there is a significant association.

In this report, this test will be useful in determining whether there is an existing association

between two categorical variables such as “husband/partner level of education and timing of 1 st

antenatal check-up

Testing for correlation

In statistics Correlation refers to the relationship between two variables. There are several

statistical tests that can be used to test for correlation. the most commonly used are the Pearson

correlation coefficient and spearman correlation coefficient. These two coefficients test the

correlation between different types of variables, the Pearson test for the relationship between two

continuous variables, and the Spearman correlation test for categorical variables. In this finding,

we shall explore whether there exists a relationship between the husband’s age and the number of

times a woman attends Antenatal care, and the timing of the first antenatal check
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Multinomial Logistic Regression Modeling

Multinomial logistic regression is a statistical method used to model and study the relationship

between a categorical dependent variable with more than two categories and one or more

independent variables. Because of the nature of the dependent variables, a Multinomial Logistic

regression model will be appropriate for the regression analysis

It is a variation of logistic regression that is used when the dependent variable has three or more

unordered categories. The model estimates separate sets of coefficients for each independent

variable and for each pair of categories of the dependent variable, resulting in a set of equations

that describe the relationship between the independent variables and the probabilities of each

category of the dependent variable. The coefficients are estimated using maximum likelihood

estimation. However, in this case, there will be the need for creating new variables for the

outcome variable so as to have a good model and perform the relationship test perfectly. The

variable “M13$1” which indicates the timing of the first antenatal check in months, will be

recoded into a categorical variable of < 3, 3 – 6, and 6+ months. Also, the variable “M14$1”

which indicates the number of antenatal visits during pregnancy will be recoded into similar

categories as the other variable. Therefore, having the two variables transformed into new

categorical variables would be appropriate to use the multinomial logistic model. The method to

be used for the above process of transforming these two variables into new variables is the

recoding into different variables method. The Record into Different Variables method in SPSS

allows one to create a new variable based on the values of an existing values. And hence is very

crucial when you one want to group or transform the values of a variable into a new variable

Outcomes
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Here on the findings, all the outputs obtained from the analysis are presented and briefly

interpreted as to what they mean. This follows the procedure that was presented in the methods

used part. In first place, we take a look at the data description of the data set being dealt with,

using the descriptive statistics option

measures of dispersionn
N Minimum Maximum Mean Std. Deviation
Respondent's current age 14144 15 49 36.13 8.155
Valid N (listwise) 14144

From the above outcome, it can be seen that the total number of respondents in the survey was

about 14144 individuals between the age of 15 and 49. nevertheless, some of the other variables

had some missing values due to the cases where the respondent did not answer some of the

questions or had given “don’t know” response.

From the bar graph above it clearly shows the distribution of the timing of the first antenatal

check for the 2884 respondents who gave the feedback. Also, the distribution appears to be an

asymmetric normal distribution.

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For the bars above, visualizes the number of respondents who made a specific number of

antenatal visits during their pregnancy. The majority of the individuals are observed to have

made around 3 to 8 antenatal visits which is too low.

relationship between Timing of 1st antenatal check(months) and the Husbands level of

education

The above figure is a crosstabulation for the frequencies of the specific partner’s education level

and the timing of 1st antenatal visit. It can be noted that the highest number of women who made

their first antenatal visit below 3 months had their partner’s level of education at the Secondary

level.
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From the results above, we see the p-value of the likelihood ratio which (0.000) is less than 0.05

specified level of significance, therefore we reject the null hypothesis and conclude that there is a

strong association between the partner’s level of education and the timing of 1st antenatal check

Relationship between Timing of 1st antenatal check(months) and the Husband/partner age

The above outcome shows the Pearson correlation between the partner’s age and the timing of 1 st

antenatal check. It can be observed that there is a Pearson correlation of 0.054 which suggests

that there is a slight tendency for the two variables to increase or decrease together, but the
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relationship is weak. This means that a change in one variable is not necessarily associated with a

significant change in the other variable.

Association between the number of antenatal visits during pregnancy and partner’s level of

education

Timing of 1st antenatal check (months) * Husband/partner's education level Crosstabulation

Count
Husband/partner's education level
No education Primary Secondary Higher Don't know Total
Timing of 1st antenatal check 0 0 0 3 5 0 8
(months) 1 2 1 80 27 0 110
2 10 17 129 37 0 193
3 10 43 210 36 0 299
4 7 27 173 15 1 223
5 11 15 88 12 0 126
6 4 14 72 4 1 95
7 4 5 17 4 0 30
8 0 1 12 1 0 14
9 0 0 7 1 0 8
10 0 0 1 0 0 1
Don't know 3 4 5 0 0 12
Total 51 127 797 142 2 1119

We see that the above crosstab, it can be observed that most women who received the

recommended number of prenatal visits (at least 4), had partners/husbands with a secondary

education level.
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From the chi-square test output, it can be confirmed that, since the p-value of Pearson Chi-square

is less than 0.05, we conclude that there is an association between the partner’s education level

and the number of prenatal visits the women make during their pregnancy.

Relationship between the number of antenatal visits during pregnancy and

husband/partner’s age

Correlations
Number of
antenatal visits
during Husband/
pregnancy partner's age
Spearman's rho Number of antenatal visits Correlation Coefficient 1.000 -.032
during pregnancy Sig. (2-tailed) . .264
N 3036 1218
Husband/partner's age Correlation Coefficient -.032 1.000
Sig. (2-tailed) .264 .
N 1218 2841

In this case, a Spearman correlation of -0.07 suggests that the two variables have a weak negative

correlation, meaning that as one variable increases, the other tends to decrease, but the
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relationship is not very strong. Therefore, we can conclude that the relationship between the

number of antenatal visits during pregnancy and the partner’s age is not significant.

Logistic Multinomial modeling

here, we shall look into the significance of the other socio-demographic factors to the outcome

variables, which are the number of antenatal visits during pregnancy and the timing of 1 st

antenatal check. We shall treat these two outcome variables differently, with an aim of

understanding the general objective of timely utilization of prenatal services.

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The model above looks for the effect of all the other variables with respect to the outcome

variable which in this case is the number of prenatal visits made during pregnancy. It can be

observed that only a few variables are significant to the model, comparing their p-value with the

level of significance of 0.05. The significant variables have a p-value less than 0.05 and they

include; Type of place of residence, Region, frequency of watching television, and has an

account in a bank or any financial institution. All these variables appear to have an effect on the

number of prenatal visits a pregnant woman makes during her pregnancy.

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The above figure shows the logistic multinomial model for the timing of 1 st prenatal visit

variable and all the other socio-demographic variables. It can be observed that the few variables

that are significant to the model include, type of residence, source of drinking water, use of the

internet, and whether ever had a terminated pregnancy. These factors appeared to be contributing

some significant effect on the outcome variable.

Discussion and Conclusion of the results

As from the outcomes evidenced in the findings, we can now ascertain that the given responses

are accurate answers to the general question under research. In relation to the general question

which was about whether the indicated socio-demographic factors and the husband’s

characteristics cause some effect on the timely utilization of prenatal services. first, it was seen

that there is a very strong interconnection between the timing of the first prenatal visit of a

respondent and the partner’s level of education as well as their age. This probably suggests that

education is among the very crucial aspect of the life of the people in South Africa. It is very

essential to ensure that, the citizens in the nation receive a quality education so as to also achieve

improved health measures for the families. additionally, the outcomes also proved that at some

degree of significance, the age of the partner causes some effect on the timely utilization of

antenatal services. hence, in conclusion, it can be noted that the various characteristics of the

husband affect the pattern of how a pregnant woman receives prenatal services.
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instead, it was noticed that most of the socio-demographic factors included in the survey were

not very much effective to the pattern of how pregnant women received antenatal services in

South Africa. At the start, the main factors contributing to some effect on the timely utilization of

antenatal services were; type of residence, source of drinking water, use of the internet, ever had

a terminated pregnancy, Region, frequency of watching television, and an account in a bank or

any financial institution. These variables have been noticed to be having some degree of

effectiveness to the outcome variable which is the timely utilization of the antenatal services.

These responses are notted to be supported mostly by the various study performed as indicated in

the introduction. For example, the study performed in Ethiopia proved that some of the factors

that contributed to various patterns of prenatal attendance included to be, partner’s level of

education, exposure to the media, and cost of living. In general, the study findings disclose that

some of the socio-demographic factors and the characteristics of the partners have a significant

impact on the timely utilization of antenatal services for pregnant mothers. nevertheless,

interventions could be made to improve the timely utilization of antenatal care by giving

education and creating awareness for both women and their partners.

References

Coleman, J., Black, V., Thorson, A.E. and Eriksen, J., 2020. Evaluating the effect of maternal

mHealth text messages on uptake of maternal and child health care services in South Africa: a

multicentre cohort intervention study. Reproductive Health, 17(1), pp.1-9

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Heinonen, K., 2021. Strengthening antenatal care towards a salutogenic approach: a meta-

ethnography. International Journal of Environmental Research and Public Health, 18(10),

p.5168.

Jinga, N., Mongwenyana, C., Moolla, A., Malete, G. and Onoya, D., 2019. Reasons for late

presentation for antenatal care, healthcare providers’ perspective. BMC health services research,

19, pp.1-9.

Lattof, S.R., Tunçalp, Ö., Moran, A.C., Bucagu, M., Chou, D., Diaz, T. and Gülmezoglu, A.M.,

2020. Developing measures for WHO recommendations on antenatal care for a positive

pregnancy experience: a conceptual framework and scoping review. BMJ open, 9(4), p.e024130.

Nasira Boi, A., Izudi, J. and Atim, F., 2022. Timely Attendance of the First Antenatal Care among

Pregnant Women Aged 15–49 Living with HIV in Juba, South Sudan. Advances in Public

Health, 2022.

Suleman Hassen, S., Mulatu Teshale, B. and Abate Adulo, L., 2021. Identifying factors

associated with barriers in the number of antenatal care service visits among pregnant women in

rural parts of Ethiopia. The Scientific World Journal, 2021.