Exploring Perceptions of Pregnant Women on Antenatal Care visit during their First Trimester at Area 25 Health Center in Lilongwe, Malawi – A Qualitative Study

Background: Initiation of antenatal care during the first trimester is crucial for reducing maternal and neonatal morbidity and mortality. Unfortunately, only 24% of pregnant women in Malawi initiate antenatal care during this time with even lower rates of 15% at Area 25 Health Centre in Lilongwe. Despite such cases, there is scarce literature on obstacles that prevent women from accessing first-trimester antenatal care in Malawi. Aim To explore perceptions of pregnant women and how they influence attendance during the first-trimester at Area 25 Health Centre in Lilongwe, Malawi. Methods We employed a qualitative exploratory study on 55 purposely identified pregnant women, aged between 18 and 42 years with gestational period of up to 36 weeks who were attending antenatal care at Area 25 Health Centre in Lilongwe urban, Malawi. Data was collected through a total of 15 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs) and were manually analyzed using thematic analysis, which included categorization and deductive theme identification with reference to the study objectives and the Health Belief Model (HBM). Results Pregnant women perceived that the first-trimester antenatal care visits are only for those experiencing ill health conditions like backache, headache, and HIV/AIDS during pregnancy. First trimester pregnancy was perceived as too small not worthy of seeking antenatal care, the women placed a low value on it. Majority of those who initiated antenatal care in the first trimester had previously experienced disorders and complications such as previous caesarean section and abortions. In addition to limited knowledge about the required total number of ANC visit, challenges such as long-distance, preoccupation with business, multiple antenatal visits, scheduling of antenatal care visits, negative attitude of health workers, adherence to COVID-19 containment measures, and inadequate partner support were identified as barriers to seeking early antenatal care. Conclusion Negative perceptions among pregnant women, coupled with various economic and infrastructure barriers, attribute to low attendance rates for first trimester antenatal care in Malawi. Addressing knowledge gaps and overcoming barriers related to economic, infrastructure and health care delivery can improve women’s early antenatal care visits. Future research should consider including pregnant women from diverse socioeconomic backgrounds to gain a better understanding of these perceptions and barriers.