Perceptions on acceptability of the 2016 WHO ANC model among the pregnant women in Phalombe District, Malawi – a qualitative study using Theoretical Framework of Acceptability

Background: World Health Organization introduced a new model of care, ‘The 2016 WHO ANC Model’ to overcome challenges encountered during the implementation of Focused Antenatal Care Approach. For any new intervention to achieve its objective, it has to be widely accepted by both the deliverers and recipients of that intervention. Malawi rolled out the model in 2019 without carrying out acceptability studies. The objective of this study was to explore the perceptions of the acceptability of 2016 WHO’s ANC model among pregnant women in Phalombe District, Malawi using the Theoretical Framework of Acceptability. Method: ology We conducted a descriptive qualitative study between May and August 2021. We used the Theoretical Framework of Acceptability to guide the development of study objectives, data collection tools, and data analysis. We purposively conducted 21 in-depth interviews (IDIs) among pregnant women, postnatal mothers, a safe motherhood coordinator and Antenatal care (ANC) clinic midwives and two focus group discussion (FGDs) among Disease Control and Surveillance Assistants. All IDIs and FGDs were conducted in Chichewa, digitally recorded, and simultaneously transcribed and translated into English. Data were analysed manually using content analysis. Results: The model is acceptable among most pregnant women and they reckoned that it would help reduce maternal and neonatal deaths. The major enabling factors for the acceptability of the model were the presence of support from husbands, peers, and health care providers. The major challenge was attendance to the increased number of ANC contacts which resulted in fatigue and increased transportation cost incurred by the women. Conclusion: Pregnant women have accepted the model despite facing numerous challenges. There is a need to strengthen the enabling factors and address the bottlenecks in the implementation of the model. Furthermore, the model should be widely publicised so that both intervention deliverers and recipients of care implement the model as intended. These will in turn help to achieve the model’s aim of improving maternal and neonatal outcomes and creating a positive experience with health care among pregnant women and adolescent girls.