Indian Medical Gazette

101

MARCH 2013

Original Study

Knowledge and Practice of Ante-natal Care

in an Urban Area
Jalina Laishram, PGT,
Usha Devi Thounaojam, PGT,
Jina Panmei, PGT,
Salona Mukhia, PGT,
H. Sanayaima Devi, Associate Professor
Department of Community Medicine, Regional Institute of Medical Sciences,
Lamphelpat, Imphal, Manipur.
Abstract

Keywords

Antenatal care (ANC) among pregnant women is one

of the important factors in reducing maternal morbidity
and mortality. Unfortunately, many women in developing
countries do not receive such care. So, the present study
was carried out to evaluate the knowledge and practice of
ANC among married women in the age group of 15-49
years and also to assess the association of knowledge of
ANC with some selected variables of interest. A crosssectional study was conducted between January 2012 to
March 2012 among 429 married women who had a delivery
in the last five years in an urban area in Imphal East. Women
were interviewed using structured questionnaire regarding
socio-demographic characteristics, knowledge and
practices on ANC. The mean score of the knowledge on
ANC was 20.9+ 4.3 out of a total score of 36. However,
only 42.6% women got full ANC, and the main reasons for
not attending any antenatal check-up were thought of as
not necessary and financial constraints. It was found that
higher level of education, Hindu religion, age at marriage,
and living in owned house were statistically associated with
better knowledge (p<0.05). There is a need for enhancing
awareness about the importance of ante-natal care and for
motivating women to utilize maternal care services.

knowledge, practice, ante-natal care, mother, crosssectional study

Introduction
Antenatal care (ANC) is the care a woman receives
throughout her pregnancy in order to ensure that both the
mother and child remain healthy. A healthy diet and lifestyle
during pregnancy is important for the development of a
healthy baby and may have long-term beneficial effects on
the health of the child. Almost 90% of maternal deaths occur
in developing countries and over half a million women die
each year due to pregnancy and childbirth related causes1.
Proper ANC is one of the important ways in reducing
maternal and child morbidity and mortality. Unfortunately,
many women in developing countries do not receive such
care2. Understanding maternal knowledge and practices of
the community regarding care during pregnancy and delivery
are required for program implementation3. Data on this very
important issue are scarce in our state. Therefore, the
present study was carried out to evaluate the knowledge
and practice of ANC among married women of an urban
area of Imphal East and also to assess the association of

Address for correspondence: Dr H. Sanayaima Devi, Associate Professor, Wangkhei Lourembam Leikai, Near Durga Puja Lampak,
Imphal East 795 004. E-mail: drsanahj@gmail.com

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their knowledge on ANC and socio-demographic

characteristics.
Materials and Methods
A cross-sectional study was conducted during January
to March 2012 among reproductive age group of married
women who had a delivery in the last five years and residing
in an urban area of Imphal East, Manipur. House to house
visit was done for the data collection. All the eligible
members in the family were interviewed using structured
questionnaire which included socio-demographic profile and
questions pertaining to knowledge and practice regarding
ANC. Informed verbal consent was taken from each
participant. In case the respondent had more than one
delivery in the last 5 years, interview was taken about the
most recent delivery. Those women who refused to
participate and could not be contacted till the last day of
data collection were excluded from the study. At the end of
each day, data collected were checked for completeness
and consistency. Scoring of knowledge was also calculated.
Operational definitions:
Knowledge score: For every correct knowledge
response, a score of 1 was given while incorrect response
was given 0. The Maximum score a respondent could get
was 36 and a minimum score of 0. Adequate knowledge
was defined as those getting a score of 18 and above (50%
of the total score) and Inadequate knowledge as getting a
score of less than18.
Full ANC: It is defined as at least three visits for ANC
check up, at least one TT injection received and 100 IFA
tablets/syrup consumed4.
Statistical analysis: Data entry and analysis were done
by using SPSS-version 16. Descriptive statistics like mean
and percentage were used. Chi square test was used for
comparison between the groups. A p-value of <0.05 was
taken as statistically significant. Study approval was sought
from institutional ethics committee and confidentiality was
maintained.
Results
Total number of household visited was 648 from where
429 participants could be contacted and interviewed.
Response rate was 86.1%. Mean age of the respondents
was 29.5 years with a range of 18 to 47 years.

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Majority of the respondents were in the age group of

20 to 29 years and studied upto 10 to 12 standard. Most of
them were housewives, Hindu by religion and got married
at 18-29 years of age. Equal number of the respondents
lived in nuclear and joint families while a quarter of them
lived in rented house. Around half of the respondents were
primipara (Table 1).

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Table 2 shows the knowledge of the respondents on

antenatal care. Majority of them responded that pregnant
women need to go for ante-natal check-up (97.9%).

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However, only 55.2% knew correctly the minimum antenatal check up during pregnancy. Mass media was cited as
the main source of information. Around ninety-nine percent

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of the study population responded that Injection tetanus

toxoid (TT) should be given during pregnancy but only
54.1% knew the correct dose. Also, 96.2% of them

Indian Medical Gazette

MARCH 2013

reckoned that Iron folic acid is necessary during pregnancy

but only 34.2% knew correct doses needed. Majority of
them (80.9%) had adequate knowledge with the mean score

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MARCH 2013

of 20.94.3. However, only 42.6% of them had got full

ANC and about half of them went to government facilities
for the check-up. Financial reasons, unavailability of
transport facility and thinking it is not necessary were the
main reasons for not accessing antenatal care.
Women having adequate knowledge on ANC was found
to be statistically associated with their educational status,
religion, age at marriage and ownership of the house
(p<0.05). With increase in the educational status, the
adequacy of knowledge also increased correspondingly (pvalue for Chi-square trend <0.000). However, respondents
age, occupational status, type of family and parity was not
found to be statistically associated with knowledge of ANC
as shown in Table 3.
Discussion
Our study found that maternal educational level is a
significant factor in determining the knowledge of ANC.
This finding is consistent with other studies5-9. Knowledge
not only transforms, but also empowers women and
improves their self-esteem. It is expected that educated
women are more likely to be aware about their health status
and seek health knowledge. Those respondents who got
married after 18 years had more knowledge than those who
got married earlier. This may be explained by the fact that
those who got married earlier had less schooling than those
who married later. However, a study conducted in Jordan
illustrated that age at marriage was not a significant predictor
of utilization of prenatal care8.
Another study from Bangladesh revealed maternal age
as one of the important predictors for ANC10. This was in
contrast to our study finding which shows that maternal
age was not statistically associated with ANC. Our study
found that Hindus had better knowledge compared with
other religion. This finding should be cautious because of
the small sample size. Those residing in nuclear family had
more knowledge than joint family though it was not found
to be statistically significant. However, in a study conducted
in North Bengal found that ANC was higher in nuclear
family 3. Those who lived in their owned houses had
significantly better knowledge as compared to those living
in rented house. This may be because those who live in
their owned house are more likely to know about the
availability of health services better than those who live in
rented house.

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Our study revealed that the primipara had more

knowledge than the multipara although it was not statistically
significant. However, the multiparaes were found to have
poorer knowledge on ANC in a study done by Zhao Q et
al5. This may be because the multiparaes are more likely to
have limited education and are more likely to get knowledge
of pregnancy from friends and relatives. Meanwhile, their
experience of pregnancy and delivery made them believe
their maternal health knowledge was adequate. However,
their knowledge might only be traditional beliefs and habits.
Poor antenatal care is an important risk factor for
adverse pregnancy outcomes among women 11. In the
current study, any antenatal care (ANC) visits were made
by 97.4% of women which was higher compared with the
study conducted in other parts of India (73.9 %)12. It may
be due to close proximity and therefore easier accessibility
of health facilities as stated by Magadi et al that the
frequency of antenatal care is also influenced by the
accessibility of antenatal care service13. Half of them went
to government health facilities for the ANC. In the present
study majority (91.6%) of women replied the purpose of
ANC visits were to know the health condition of the mother
and foetus. Among 429 participants, 91.8% (394)
completed the minimum three ANC visits which is very
high compared with the study done by Khatib et al (33.6%)14.
In our current study, iron tablets were taken by 94% of
women though only 45.3% completed the required 100
tabs which is lower compared with other studies15. The
reasons given were due to fear of side effect, due to not
knowing the importance of iron or simply dislike of taking
the tab. Almost all of the ANC attendees(99.6%) received
tetanus toxoid (TT) vaccine which is higher compared with
a study done in Karnataka16. The full ANC has increased
from DLHS-2 (16.4 percent) to DLHS-3 (18.8 percent).
In our current study, 42.6 % got full ANC which is higher
compared with the national average (18.8%)4.
The reasons for not attending antenatal check-up were
that it is not necessary (54.5%), financial reasons (27.2%)
and unaware about ANC (18.3%). This finding is consistent
with the findings of Sanjel S et al17. Another study in China
also reported financial difficulties as the most important
reason for not attending ANC.5 Poor women usually have
poor access to education, including health education due
to lack of financial resources, early marriage and pregnancy,
household responsibilities and unwillingness to invest in the
hidden costs of education (fees, transport, etc).

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The limitation of our study is that there might be chances

of recall bias among some of the respondents. Since this
study was done in an urban area, the study cannot be
representative of the whole state.

7.

Jimoh A.A. Utilisation of Antenatal Services at the

Provincial Hospital,Mongomo, Guinea Equatoria. African
Journal of Reproductive Health. 7(3):49-54, 2003.

8.

Obermeyer C.M., Potter J.E. Maternal Health Care

Utilization in Jordan: A Study of Patterns and
Determinants. Studies in Family Planning. 22 (3):177187,199.

9.

Nielson B.B., Liljestrand J., Thilsted S.H. et al.

Characteristics of antenatal care attenders in a rural
population in Tamil Nadu, South India; a community based
cross-sectional study. Health Soc Care Community.
9:327-333, 2001.

10.

Koenig M.A., Fauveaus V., Chowdhury A.I., Chakraborty

J. Maternal Mortality in Maltab, Bangladesh. Studies
in Family planning 197685. Studies in Family Planning;
[Internet] 1988. [cited 2011, August 20]. Available from:
http://www.who.int/whr/.../index1.html.

11.

Antenatal care in Developing country: An analysis of

trends, levels and differentials, 1990-2001. WHO 2003.
[cited 2011 Sep 09] Available from: http://www.who.int/
entity/making_pregnancy_safer/.../en/ index.html.

12.

Chandhiok N., Dhillon B.S., Kambo I., Saxena N.C.

Determinants of antenatal care utilisation in rural areas
of India : A cross-sectional study from 28 districts (An
ICMR task force study). J Obstet Gynecol India. 56(1):4752, 2006.

13.

Magadi M.A., Madise N.J., Rodrigues R.N. Frequency

and Timing of Antenatal Care in Kenya: Explaining the
Variations between Women of different Communities.
Social Science and Medicine. 51:551-561, 2000.

14.

Khatib N., Zahiruddin Q.S., Gaidhane A.M., Waghmare

L., Srivatsava T., Goyal R.C., et al. Predictors for
Antenatal services and pregnancy outcome in a rural
area: A prospective study in Wardha district, India. Indian
J Med Sci. 63(10):436-444, 2009.

15.

Singh P., Yadav R.J. Antenatal Care of Pregnant

Women in India. Indian J of Comm Med. 25(3):112-117,
2000.

16.

Madhavi L.H., Singh H.K.G. Nutritional States of Rural

Pregnant Women. Peoples Journal of Scientific
Research. 4(2):20-23, 2011.

17.

Sanjel S., Ghimire R.H., Pun K. Antenatal care practices

in Tamang community of hilly area in central Nepal.
Kathmandu Univ Med J. 34(2):57-61, 2011.

Conclusions
Knowledge of ANC was found to be adequate in the
study area. However, practices of ANC were found to be
unsatisfactory. Knowledge of ANC was found to be
associated with higher educational level, Hindu religion, age
at marriage and those living in owned house. To improve
community awareness on ANC, information, education and
communication activities should be increased on ANC
through community campaign and mass media like local
television channel, radio and local newspapers. There is a
need to motivate women to utilize maternal care services
which are freely available in all the government health setups.
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