UNIVERSITY OF EDUCATION, WINNEBA

FACULTY OF SCIENCE EDUCATION

DEPARTMENT OF HEALTH ADMINISTRATION AND EDUCATION

PERCEPTION, AVAILABILITY AND UTILIZATION OF ANTENATAL CARE

SERVICES UNDER THE FREE MATERNAL HEALTHCARE POLICY. A

STUDY AMONG PREGNANT WOMEN IN ABREPO, KUMASI.

AGYEI EUNICE

2023
 UNIVERSITY OF EDUCATION, WINNEBA

FACULTY OF SCIENCE EDUCATION STUDENTS

DEPARTMENT OF HEALTH ADMINISTRATION AND EDUCATION

PERCEPTION, AVAILABILITY AND UTILIZATION OF ANTENATAL CARE

SERVICES UNDER THE FREE MATERNAL HEALTHCARE POLICY. A

STUDY AMONG PREGNANT WOMEN IN ABREPO, KUMASI.

BY

EUNICE AGYEI

(200016764)

THIS PROJECT WORK IS SUBMITTED TO THE UNIVERSITY OF

EDUCATION, WINNEBA, GHANA IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR THE AWARD OF FIRST DEGREE IN BACHELOR OF

SCIENCE IN HEALTH ADMINISTRATION AND EDUCATION.

SEPTEMBER, 2023

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 DECLARATION

I, Eunice Agyei hereby declare that with the exception of specific references which have

been duly acknowledged, this research is my own work put together under the

supervision of Dr. Richard Boateng and that this work has not been presented in part or

whole for the award of any other degree in any other University.

SIGNATURE: ………………………..………..

DATE: ……………………………….…………

Supervisor’s Declaration

I hereby declare that this Project Work on the topic “Perception, availability, and

utilization of antenatal care services under the free maternal health care policy among

pregnant women in the Abrepo community, Kumasi.’’ has been duly supervised by me

and all references have been duly acknowledged for the partial fulfilment of the

requirements for award of first degree in Health Administration and Education in the

University of Education, Winneba.

NAME OF SUPERVISOR: DR. RICHARD BOATENG

SIGNATURE: ………………………..………..

DATE: ……………………………….…………

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 DEDICATION

I exclusively dedicate this entire work to the Lord Almighty God for His full protection

and guidance throughout my stay on campus in pursuance of this undergraduate program.

I further dedicate it to the entire Agyei family for their immense support and guidance in

all dimensions toward the accomplishment of this task.

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 ACKNOWLEDGMENT

I express my utmost appreciation to the Lord Almighty God for bringing me this far in

my educational career.

I am sincerely grateful to my Supervisor, Dr. Richard Boateng, for the tireless support

and patience in supervising this research, offering various directions, suggestions, and

encouragement during the entire duration of the work.

I am also grateful to the University of Education, Winneba for giving me the opportunity

to undertake such a life transforming program (BSc. Health Administration and

Education).

I am most grateful to the lecturers in the Department of Health Administration and

Education for their advice, guide, patient, support and directions in all aspects as far as

my four years study in the University is concern.

I am also grateful to the following individuals: Dr. Emmanuel Kumah (Lecturer,

Department of Health Administration and Education), Mr. Samuel Ankomah (Health

Service Administrator, Komfo Anokye Teaching Hospital), Mr. Frank Mensah (Health

Service Administrator, Komfo Anokye Teaching Hospital), Mr. Samuel Osei-Bonsu and

Mr. Eric Anyimadu.

I duly acknowledge also the contributions of my friends and other colleagues especially

Frank Obeng Debrah who in one way or the other contributed so much to the success of

this work.

I am also indebted to the authors whose works were consulted in the course of this work

and also grateful to all other individuals who in one way or the other contributed

enormously to making this Project a success.

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TABLE OF CONTENTS
DEDICATION iv

ACKNOWLEDGMENT v

TABLE OF CONTENTS vi

LIST OF TABLES ix

ABSTRACT xi

CHAPTER ONE: INTRODUCTION 1

1.0 Background of the study 1

1.1 Problem statement 3

1.2 Research Questions 4

1.3 Objectives 5

1.4 Significance of the Study 5

1.6 Study Limitations and Delimitations 7

1.7 Organization of the study 7

CHAPTER TWO: LITERATURE REVIEW 8

2.0 Introduction 8

2.1 Theoretical Review 8

2.2 Perception of antenatal care (ANC) services 9

2.3 Availability of Antenatal Care Services 10

2.4 Utilization of ANC services 11

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2.5 Summary of Chapter 12

CHAPTER THREE: RESEARCH METHODOLOGY 13

3.0 Introduction 13

3.1 Background of the Study Area 13

3.2 Study design 14

3.3 Study Population 14

3.4 Data Collection Tools and Techniques 14

Pre-Testing and Review of Instrument 15

3.5 Data Analysis 15

3.6 Ethical Consideration 16

3.7 Conclusion 16

CHAPTER FOUR: PRESENTATION OF RESULTS AND DISCUSSIONS 17

4.0 Introduction 17

findings 17

4.1 Demographic characteristics of respondents 17

4.3 Perception of antenatal care services 19

4.4Availability and utilization of antenatal care services 23

4.5 Satisfaction with antenatal care services 26

4.6 Socio-Demographic Characteristics of Respondents 30

4.7 Perception of antenatal care services 31

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4.8 Availability and utilization of antenatal care services 32

4.9 Satisfaction with antenatal care services 33

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION 35

5.1 Introduction 35

5.2 Summary of the Study 35

5.3 Conclusion 35

5.4 Recommendations 36

REFERENCES 38

APPENDIX 40

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 LIST OF TABLES

Table 1.1: Socio-Demographic Characteristics of Respondents (n=50) 19

Table 1.2: Availability and utilization of antenatal care services 26

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 LIST OF FIGURES

Fig. 4.1 The quality of antenatal care services (ANC) being satisfactory 21

Fig. 4.2 : I feel comfortable discussing my health concerns with ANC healthcare

providers 21

Fig. 4.3: The ANC services are easily accessible in terms of location and transportation22

Fig. 4.4: The waiting times at ANC facilities are reasonable 23

Fig. 4.6: ANC services have improved since the implementation of the Free Maternal

Health Care Policy 24

Fig.4.7: Overall care received during ANC visits 27

Fig. 4.8: The attitude of healthcare providers during ANC visits 28

Fig. 4.9: The cleanliness and hygiene of ANC facilities 29

Fig. 4.10: The availability of privacy during consultations 30

Fig. 1.11 The comprehensiveness of health education provided during ANC visits. 31

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 ABSTRACT

This research focuses on the perception, availability, and utilization of antenatal care

services under the free maternal health care policy among pregnant women in the Abrepo

community, Kumasi. The study aims to explore the factors influencing pregnant women's

perception of antenatal care, assess the availability and accessibility of these services, and

examine the utilization patterns among pregnant women in the community. The study

adopted a cross-sectional descriptive survey using a pre-tested structured questionnaire to

assess 50 pregnant women’s perception and access to antenatal care services in Abrepo,

Kumasi, Ghana. It was also found that majority of the participants are willing to continue

utilizing the services of the antenatal care health facilities within the area.

It is anticipated that the study will shed light on the barriers and facilitators to antenatal

care utilization in the Abrepo community, identify gaps in service provision, and inform

policy and practice recommendations to enhance the effectiveness and efficiency of

antenatal care delivery. The study's implications and recommendations will be valuable

for policymakers, healthcare providers, and stakeholders involved in maternal health

programs and interventions. By addressing the factors influencing pregnant women's

perception, availability, and utilization of antenatal care services, this research endeavors

to contribute to improved maternal and child health outcomes in the Abrepo community,

Kumasi. Overall, this research seeks to provide insights that can contribute to the

development of effective strategies to enhance the perception, availability, and utilization

of antenatal care services under the free maternal health care policy, with the aim of

improving maternal and child health outcomes among pregnant women in the Abrepo

community, Kumasi.

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 CHAPTER ONE

INTRODUCTION

1.0 Background of the study

Maternal mortality remains a major public health issue worldwide with an estimated

810 women dying from pregnancy-related complications daily. At the global level,

previous successes in reducing maternal mortality that occurred during the

Millennium Development Goals (MDG) era have stagnated in the first five years of

the Sustainable Development Goal (SDG) era, from 2016 to 2020. In 2020, World

Health Organization (WHO) recorded that 287,000 women globally died from a

maternal cause, equivalent to almost 800 maternal deaths every day, and

approximately one every two minutes. 94% of these deaths occurred in low-and-

middle-income settings with sub-Saharan African (SSA) and Southern Asia

accounting for 86%. These have led to calls for more actions to curb the situation as

highlighted in the Sustainable Development Goal (SDG) three, which targets a

reduction in the global maternal mortality ratio to less than 70 per 100,000 live births

by 2030. Among the strategies to overcome this challenge is timely utilization of

antenatal care which remains paramount particularly in sub-Saharan Africa.

Antenatal care (ANC) refers to the healthcare services and support provided to

pregnant women before childbirth. It involves a series of regular check-ups,

screenings, and interventions to monitor the health of both the mother and the

developing fetus, detect and manage any potential complications, and promote a

healthy pregnancy and childbirth experience. ANC typically includes a range of

services such as physical examinations, blood tests, urine tests, ultrasounds,

vaccinations, nutritional counseling, education on pregnancy and childbirth, and

advice on healthy lifestyle practices. These services aim to ensure the well-being of

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the pregnant woman, promote the healthy growth and development of the fetus, and

identify and manage any existing or emerging health risks. The World Health

Organization (WHO) recommends eight antenatal care visits for all pregnant women

before delivery. Additionally, the Ghana National Safe Motherhood Protocol

recommends that all pregnant women make their first ANC visit within the first 12

weeks of gestation (hereafter, early ANC) and attend at least eight ANC visits before

delivery.

The Free Maternal Healthcare Policy was introduced in Ghana in 2008 to increase

access to quality maternal and child health services for all pregnant women.

According to the Ghana Maternal Health Survey (GMHS) 2017, maternal mortality in

Ghana accounted for 14% of all deaths; 10% from direct maternal causes and 4%

from indirect maternal causes.

Furthermore, the Ghana statistical services (2014) have indicated that ANC sought

from skilled providers is an important tool used to monitor pregnant women to reduce

morbidity and mortality associated with it. The Ministry of Health’s (MoH) Health

Sector Medium Term Development Plan (2018-2021) sets a target of at least 80% of

pregnant women attending early ANC visits. Studies have also shown that pregnant

women who utilize ANC Service are more birth prepared and complication ready

hence positive pregnancy outcome for both mother and child (Nsemo et al., 2016;

Nsemo, 2016). Timely and quality antenatal care (ANC) is an essential element of

universal health coverage and a key determinant for the prevention of maternal

mortality. Despite the policy's implementation, there are still concerns regarding the

perception, availability, and utilization of antenatal care services among pregnant

women in some communities.

Abrepo community, located in Kumasi, the Ashanti Region of Ghana, is one of the

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areas where these concerns exist. Studies have shown that despite the availability of

free antenatal care services, some pregnant women in the community still do not

utilize these services. The reasons for this include the perception that the services are

not of good quality, a lack of awareness of the services, and inadequate availability of

healthcare facilities. Therefore, the background of the study on the perception,

availability, and utilization of antenatal care services under the free maternal

healthcare policy among pregnant women in Abrepo community, Kumasi, aims to

understand the factors that influence pregnant women's decisions to use or not use

antenatal care services under the policy.

1.1 Problem statement

The implementation of free maternal health care policies has been considered a

crucial strategy to improve maternal and child health outcomes in many developing

countries, including Ghana. The Free Maternal Health Care Policy (FMHCP) in

Ghana aims to increase access to antenatal care (ANC) services by removing financial

barriers for pregnant women. According to the Ghana Demographic and Health

Survey 2021, the maternal mortality ratio in Ghana was 302 deaths per 100,000 live

births. It also revealed that 97% of pregnant women received antenatal care from a

skilled provider during their pregnancy.

According to Agyemang et al. (2018), the implementation of the Free Maternal Health

Care Policy (FMHCP) in Ghana was intended to improve access to and utilization of

antenatal care (ANC) services among pregnant women. However, there is a need to

examine the perception, availability, and utilization of ANC services under the

FMHCP specifically in the Abrepo community, Kumasi.

Despite the policy's intentions, research by Amoakoh-Coleman et al. (2016) indicates

that there may be challenges in the availability of essential supplies and equipment, as

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well as a shortage of skilled health workers, which can impact the utilization of ANC

services. Furthermore, Asamoah et al. (2019) found that the utilization of ANC

services in some rural areas of Ghana remains low. Factors such as distance to health

facilities, transportation costs, and limited awareness of the importance of ANC

services contribute to this low utilization rate. Also, research conducted by Owusu et

al. (2019) to assess the level of utilization of free antenatal care services and factors

affecting utilization among pregnant women showed that only 56% of pregnant

women in Kumasi utilized antenatal care services under the Free Maternal Health

Care Policy.

This study aims to investigate the perception, availability, and utilization of ANC

services under the FMHCP among pregnant women in the Abrepo community,

Kumasi. By identifying the barriers and challenges faced by pregnant women in

accessing and utilizing ANC services, this research seeks to provide valuable insights

and recommendations to improve the delivery and utilization of ANC services in the

community, ultimately contributing to the reduction of maternal and infant morbidity

and mortality rates (Danso et al., 2020).

1.2 Research Questions

1. What is the perception of pregnant women in Abrepo community towards the

free maternal healthcare policy?

2. Are antenatal care services available in the Abrepo Community?

3. What is the utilization rate of antenatal care services under the free maternal

healthcare policy among pregnant women in Abrepo community?

4. What are the challenges associated with accessing antenatal care services by

pregnant women in the Abrepo community?

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1.3 Objectives

1. To assess the perception of pregnant women in Abrepo community towards

the free maternal healthcare policy.

2. To assess the availability of antenatal care services in Abrepo community.

3. To determine the utilization rate of antenatal care services under the free

maternal healthcare policy among pregnant women in Abrepo community.

4. To identify the challenges associated with accessing antenatal care services by

pregnant women in the Abrepo community.

1.4 Significance of the Study

The study is expected to provide insights into the perception, availability, and

utilization of antenatal care services under the free maternal healthcare policy among

pregnant women in Abrepo community. The study will also contribute to the existing

literature on maternal and child health outcomes in Ghana. The results of this study

will inform policymakers and stakeholders on potential barriers to accessing antenatal

care services and guide interventions to improve access to antenatal care services.

1.5 Definition of terms

Perception: The way in which individuals or groups interpret, understand or make

sense of something based on their previous experiences, knowledge, beliefs, and

attitudes.

Availability: It refers to the physical accessibility of services, availability of

resources, and the ability to meet the demand for services.

Utilization: The degree to which individuals or communities use a particular service.

It refers to the extent to which people seek, obtain, and use services, and the factors

that affect their decision to use or not use such services.

Antenatal care services (ANC): Healthcare services provided to pregnant women

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before the birth of their child. It includes services such as physical check-ups,

screening for medical conditions, provision of health education, and counseling to

support healthy pregnancy and childbirth.

Free maternal healthcare policy (FMHCP): A policy implemented by the

government to provide free access to maternal healthcare services to pregnant women.

It aims to reduce maternal and infant mortality rates and improve maternal and child

health outcomes.

Methodology

Study design: The study will adopt a cross-sectional descriptive survey using a pre-

tested structured questionnaire to assess the pregnant women’s perception and access

to antenatal care services in Abrepo, Kumasi, Ghana.

Population of study and sampling technique: Purposive sampling will be used to

recruit 50 pregnant women who are attending antenatal clinic during the period of the

study. Out of 100 of them, 50 who will be available and also give their consent to the

study will be recruited.

Data collection and analysis: A semi-structured and pretested questionnaire will be

used to collect data from eligible participants. Those who cannot read nor write will

be assisted by the researchers who speak the local dialect. The instruments will be in

sections A to D covering socio-demographic data, perception of ANC services and

challenges to access ANC services, as well as opinions on measures for improvement,

comprising both closed and open-ended questions. The data collected were

thoroughly checked for completeness, accuracy and internal consistencies and finally

entered using appropriate variable definitions and analyzed with Excel Software.

Frequencies and percentages were particularly used to summarize descriptive

statistics; a cross-tabulation and figures were used to relate dependent and

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independent variables before the presentation. The analysis was made from the charts

and tables presented.

1.6 Study Limitations and Delimitations

This research was limited to only pregnant women who were attending antenatal care

services at the time of study in the Abrepo community. Electronic questionnaires were

preferably used because respondents were assumed to be busy with their schedules

and therefore convenient option was considered ultimate so they can attend to it

during their leisure times. Hence the study was limited to only those who can read and

write.

1.7 Organization of the study

This study is organized into five chapters. Chapter one introduces the background

information of the study, statement of the problem, objectives of the study, research

questions, significance of the study, scope of the study, the organization of the study

and the limitations of the study. Chapter two presents a review of pertinent and related

literature of the study, the theory behind it, and the conceptual framework. The

methodology, and approach to the study will be presented in chapter three. Chapter

four presents the results of the study and the detailed discussions of the findings with

other findings. Chapter five presents the summary, conclusion, and recommendations.

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

In this chapter, earlier studies relating to the research topic will be reviewed. This
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chapter aims to provide relevant literature on the perception, availability and

utilization of antenatal care services under the free maternal healthcare policy.

2.1 Theoretical Review

WHO outlined that a woman’s ability to access antenatal care services is influenced

by several factors that include distance or time taken to travel to a health facility,

availability of ANC services, social and cultural factors that can serve as barriers to

access, economic status, costs related with utilization of services, and the ANC

quality of services provided. Several models have been developed over the last few

decades to identify factors influencing healthcare service utilization, and the most

widely used is the Anderson Behavioral Health care model known as Behavioral

Model of Health Services. This study is conducted based on the Andersen's

Behavioral Model of Health Services Use.

Andersen's Behavioral Model of Health Services Use is a widely recognized

framework that explains individuals' healthcare utilization behaviors. It elucidates the

complex interplay of predisposing, enabling, and need factors that influence

healthcare utilization (Andersen, R. M. 1995).

Predisposing factors include individual characteristics that influence healthcare-

seeking behavior. These factors encompass demographic characteristics, socio-

cultural factors, health beliefs, and knowledge. These factors shape an individual's

inclination to use healthcare services.

Enabling factors comprise community resources and personal resources that

facilitate or hinder individuals' access to healthcare. Community resources encompass

healthcare infrastructure, healthcare workforce, and availability of health insurance.

Personal resources consist of socioeconomic status, social support, and educational

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attainment.

Need factors refer to the perceived or evaluated level of an individual's health

conditions necessitating healthcare utilization. This involves an individual's subjective

assessment of health status and evaluation of the severity of health issues.

Andersen's model predicts that healthcare utilization, measured by the frequency and

intensity of healthcare services sought, is influenced by the interplay of predisposing,

enabling, and need factors. These factors collectively shape an individual's decision to

utilize healthcare services, ultimately impacting their health outcomes.

2.2 Perception of antenatal care (ANC) services

Perception plays a vital role in pregnant women's decision-making process regarding

antenatal care utilization. Several studies have highlighted the significance of

perception in determining the uptake of these services. Factors influencing perception

include the quality of care, communication with healthcare providers, cultural beliefs,

and previous experiences. This section reviews relevant studies that have explored

pregnant women's perceptions of antenatal care services in similar settings.

A study by Atinga et al. (2015) in the Ashanti Region of Ghana found that pregnant

women had a positive perception of ANC services, but there were still barriers to

accessing the services, such as long waiting times and inadequate staff. Another

study by Owoo et al. (2019) in the Greater Accra Region found that pregnant women

had a generally positive perception of the free maternal health care policy, but there

were still concerns about the quality of care and the availability of essential medicines

A study conducted by Asundep et al. (2014) in the Northern Region of Ghana found

that the majority of pregnant women had a positive perception of ANC services, and

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they recognized the importance of ANC in ensuring a healthy pregnancy and

childbirth. However, the study also found that access to ANC services was limited,

particularly in rural areas, and there were significant gaps in the quality of care

provided.

Similarly, a study conducted by Adatara et al. (2018) in the Upper East Region of

Ghana found that while the majority of pregnant women had knowledge of ANC

services, there were still significant gaps in the availability and accessibility of ANC

services. The study also found that the quality of care provided during ANC visits was

often inadequate, with healthcare providers failing to conduct necessary tests and

provide appropriate counseling.

2.3 Availability of Antenatal Care Services

Access to antenatal care services is influenced by the availability of healthcare

facilities, trained personnel, and essential resources. This section reviews studies

examining the availability of antenatal care services under the Free Maternal Health

Care Policy in Ghana. It explores issues such as the adequacy of healthcare

infrastructure, staffing, medical supplies, and equipment in the Abrepo community.

Additionally, it addresses challenges faced by pregnant women in accessing these

services, such as long waiting times, distance to health facilities, and transportation

issues.

A study by Atinga et al. (2015) found that the availability of ANC services in the

Ashanti Region was limited, with some health facilities lacking essential equipment

and supplies. Another study by Adanu et al. (2016) in the Volta Region found that the

availability of ANC services was generally good, but there were still challenges, such

as inadequate staffing and poor infrastructure.

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2.4 Utilization of ANC services

Utilization of antenatal care services refers to the extent to which pregnant women

engage with the provided services. This section reviews studies that have investigated

the factors influencing antenatal care utilization in Ghana, focusing on the Abrepo

community. It examines socioeconomic factors, including income levels, educational

attainment, and employment status, as well as cultural factors, such as beliefs and

norms. Additionally, it discusses the role of social support networks, community

engagement, and awareness campaigns in promoting antenatal care utilization.

The utilization of ANC services is a key indicator of the effectiveness of the free

maternal health care policy. A study by Atinga et al. (2015) found that the utilization

of ANC services in the Ashanti Region was low, with only 38% of pregnant women

attending the recommended four or more visits. The study identified several barriers

to utilization, including long waiting times, inadequate staffing, and lack of transport.

Another study by Adanu et al. (2016) in the Volta Region found that the utilization of

ANC services was higher, with 62% of pregnant women attending four or more visits.

However, the study also identified barriers to utilization, such as inadequate staffing

and poor infrastructure.

A similar study from BMC Pregnancy and Childbirth, 2019 found that accessibility to

healthcare facilities plays a significant role. Women in urban areas or closer to

healthcare facilities are more likely to seek antenatal care compared to those in remote

areas.

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 Conceptual framework adapted from Andersen’s behavioral model for health

service use (Andersen, 1995)

Enabling Factors Health related Individual

Predisposing
Availability of need factors reasons
factors
health facility Pregnant related for ANC
Age
conditions utilization
Marital status
Educational Distance of health
facility Perceived health For check-up
status
Occupational status
NHIS Nurses advices
status
Number of
Availability of ANC Normal routine
children
services during
Family type
pregnancy

Facility Community based

barriers/factors factors

Waiting time Religious beliefs

Interpersonal relation Cultural beliefs

Adequacy of ANC
Unavailability of service
Regular ANC visits

Number of ANC
attendance

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2.5 Summary of Chapter

This literature review provides an overview of existing research on the perception,

availability, and utilization of antenatal care services under the Free Maternal Health

Care Policy. It emphasizes the importance of understanding pregnant women's

perspectives, addressing barriers to access, and leveraging community resources to

enhance utilization. The findings of this review will inform future research and policy

interventions aimed at improving maternal health in the Abrepo community and

similar settings.

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This chapter presents the background of study area, study design, research Population,

sampling process, data collection, data analysis method and ethical considerations.

3.1 Background of the Study Area

Abrepo is a community located in the city of Kumasi, which is the capital of the

Ashanti Region in Ghana. The community is situated in the southern part of the city

and is known for its vibrant and diverse population. Abrepo is a residential area that is

home to a mix of families, professionals, students, and individuals from various socio-

economic backgrounds. The community features a combination of residential

buildings, small businesses, educational institutions, and public facilities.

In terms of infrastructure, Abrepo has developed over the years with amenities such as

schools, hospitals, religious institutions, markets, and recreational areas to cater to the

needs of its residents. It is also the location for Kumasi Girls Senior High School and

County Hospital. The community is well-connected to other parts of Kumasi through

road networks and public transportation. Abrepo offers a range of services and

commercial activities to its residents. It has shops, local markets, and small

enterprises that provide daily essentials, food, and other goods. Additionally, there are

educational institutions, including primary and secondary schools, serving the

community and contributing to the overall development of the area. As with any

community, Abrepo has its own social dynamics, cultural practices, and community

organizations that foster a sense of belonging and community engagement. The

residents of Abrepo actively participate in community events, festivals, and initiatives

that promote unity and cultural heritage.

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Overall, Abrepo is a lively and thriving community within Kumasi, playing a

significant role in the social fabric and contributing to the broader dynamics of the

city.

3.2 Study design

Research design, as defined by Creswell (2014), encompasses the various types of

inquiry employed in qualitative, quantitative, or mixed methods approaches. It offers

explicit guidance for the procedures carried out in a research study and encompasses a

systematic plan outlining how data will be collected, processed, and interpreted to

address the research questions or objectives.

The study adopted a cross-sectional descriptive survey and used a pre-tested

structured questionnaire to assess the pregnant women’s perception and access to

antenatal care services in Abrepo, Kumasi, Ghana. According to Creswell (2014), the

researcher only gathers data in quantitative design to provide a good image of the

situation.

3.3 Study Population

Purposive sampling was used to recruit 50 pregnant women who were attending

antenatal clinic during the period of the study. The inclusion criteria were pregnant

women in the community who were attending Antenatal clinics.

3.4 Data Collection Tools and Techniques

The use of a questionnaire was chosen for the study because data collection using this

method is quicker since information is collected from several people with peculiar

opinions about the topic at the same time. (Abili K., 2009). Electronic questionnaires

were preferably used because respondents were assumed to be busy with their

schedules and therefore convenient option was considered ultimate so they can attend

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to it during their leisure times.

The study made use of a quantitative research approach with questionnaires of both

open-ended and close-ended questions in order to get the required information from

respondents. The open-ended questions were meant to allow respondents to express

themselves and come up with issues the researcher might not have as well thought of.

The close-ended questions had possible answers out of which the respondents were

required to select appropriately as it applies to them. The questions reflected the

objectives of the study, and the participants had the opportunity to fill out the

questionnaire on their own and at their own convenient time. The questionnaires

actually helped in easy data collection, data quantification, and analysis and were also

cost-effective.

Pre-Testing and Review of Instrument

The questionnaires were tested by the principal investigator and the research

assistants who were recruited and trained for the data collection purpose. The

questions that seem inconsistent were reviewed and modified to achieve the intended

goals of the study.

3.5 Data Analysis

The data collected were thoroughly checked for completeness, accuracy and internal

consistencies and finally entered using appropriate variable definitions and analyzed

with Excel Software. Categorical variables were measured as percentages and

expressed to portray a clear picture of the data distribution. Descriptive statistics

(frequencies and percentages) were used to analyze the findings of the study.

Frequencies and percentages were particularly used to summarize descriptive

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statistics; a cross-tabulation and figures were used to relate dependent and

independent variables before the presentation. The analysis was made from the charts

and tables presented

3.6 Ethical Consideration

In respect of ethical consideration and research ethics, verbal consent was obtained

before scheduling interviews with respondents. Respondents' anonymity was ensured,

and any information that may reveal their identity was avoided and confidentiality

maintained.

3.7 Conclusion

This chapter comprised the methodology deployed for the accomplishment of the

study. It also provided information about the study area as well as the sampling

techniques. A non-probability sampling technique was used to obtain data for the

study. Descriptive statistics were used to analyze the results obtained.

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 CHAPTER FOUR

PRESENTATION OF RESULTS AND DISCUSSIONS

4.0 Introduction

This chapter focuses on the presentation and discussion of the study results. It begins

with analysis and discussion of respondent’s socio-demographic information,

perception of antenatal care services, availability and utilization of antenatal care

services, satisfaction with antenatal care services and any additional comments from

respondents.

findings

4.1 Demographic characteristics of respondents

This section provides information on the respondents' age category (in years),

educational level, religion, marital status and number of children, a total of 50

respondents were employed in the study as shown in table

In terms of age range, the most represented participants were between the ages of 19

to 23 years (n=19, 38%). The participants aged 24 to 28 years were the next most

represented (n=14, 28%). This was followed by participants aged 29 to 33 years (n=8,

16%). For those aged 34 to 38 years, 6 participants took part in the study, representing

12% and finally, participants between the ages of 39 to 45 years (n=3, 6%).

With regards to the educational level of the participants, those with tertiary

qualifications dominated in this study (n=35, 70%). This was followed by secondary

school graduates (n= 11, 22%). Next to this, 3 participants were not educated,

representing 6% and finally, 1 person with a basic education (n=1, 2%).

An overwhelming majority of the participants were Christians (n= 44, 88%). Next to

that were Muslims (n=4, 8%). 1 traditionalist participated in the survey, representing

2% and finally, 1 participant opted not to reveal the religion, representing 2% of the

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total participants.

In terms of marital status of the respondents, majority of the participants were single

(n=20, 40%). 16 of the participants were married representing 32%. Followed by

those who were courting (n=11, 22%) and finally 3 of the participants were divorced

representing 6%.

With regards to the number of children, an overwhelming majority of the participants

were having one child (n=34, 68%). Next to that were participants who had two

children (n=6, 12%). Followed by participants with 3 children (n= 5, 10%), 4 of the

participants had four children, representing 8% and finally, 1 participant had five or

more children representing 2%. The table below presents the distribution of

respondents’ socio-demographic characteristics as obtained from the field.

Table 1.1: Socio-Demographic Characteristics of Respondents (n=50)

Characteristics Frequency Percentage (%)

Age range
19 to 23 years 19 38
24 to 28 years 14 28
29 to 33 years 8 16
34 to 38 years 6 12
39 to 45 years 3 6
Respondent’s level of education
Tertiary 35 70
Secondary 11 22
Basic 1 2
Not educated 3 6
Religion
Christian 44 88
Muslim 4 8
Traditionalist 1 2
None 1 2

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 Marital status
Single 20 40
Married 16 32
Courting 11 22
Divorced 3 6
Number of children
One 34 68

Two 6 12

Three 5 10

Four 4 8

Five or more 1 2

Source: Field data, August 2023.

4.3 Perception of antenatal care services

Out of the 50 participants in this current study, a greater majority agreed that the

quality of antenatal care (ANC) services was satisfactory (n=35, 70%). Next to that,

10 of the participants strongly agreed that the quality of antenatal care (ANC) services

was satisfactory, representing 20%. The remaining participants strongly disagreed that

the quality of antenatal care services was satisfactory (n= 4, 8%) whilst one of the

participant disagreed to the quality of antenatal care service being satisfactory. (n=1,

2%).

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Fig. 4.1 The quality of antenatal care services (ANC) being satisfactory

The quality of antenatal care services (ANC) being satisfactory

Disagree
Strongly disagree

Strongly agree

Agree

With regards to the comfortability in discussing health concerns with ANC health

providers, majority of the participants agreed that they felt comfortable in discussing

their health concerns with ANC health providers (n=28, 56%). 20 of the respondents

strongly agreed that they felt comfortable in discussing their health concerns with

ANC health providers, representing 40%. Finally, 2 participants strongly disagreed

that they felt comfortable in discussing their health concerns with ANC health

providers (n=2, 4%).

Fig. 4.2 : I feel comfortable discussing my health concerns with ANC healthcare

providers

I feel comfortable discussing my health concerns with ANC healthcare providers

Strongly disagree
4%

Strongly agree
40%
Agree
56%

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Out of the 50 participants included in the study, 27 of them agreed that the ANC

services were easily accessible in terms of location and transportation, representing

54%. Followed by 15 of them who disagreed that the ANC services were easily

accessible in terms of location and transportation, representing 30%. A number of the

participants strongly agreed that the ANC services were easily accessible in terms of

location and transportation (n=6, 12%). Finally, 2 of the participants strongly

disagreed that the ANC services were easily accessible in terms of location and

transportation, representing 4%.

Fig. 4.3: The ANC services are easily accessible in terms of location and

transportation

The ANC services are easily accessible in terms of location and transportation

Disagree 30%

Agree 54%
strongly agree 12%

strongly disagree 4%

With regards to the waiting times at ANC facilities being reasonable, an

overwhelming majority agreed that the waiting times at ANC facilities were

reasonable (n=30, 60%). Next to that, some of the participants disagreed to the fact

that the waiting times at ANC facilities were reasonable (n=9, 18%). In addition to

that, 6 of the participants strongly disagreed that the waiting times at ANC facilities

were reasonable, representing 12%. Finally, 5 of the participants strongly agreed to

the fact that the waiting times were reasonable, representing 10%.

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Fig. 4.4: The waiting times at ANC facilities are reasonable

The waiting times at ANC facilities are reasonable

Strongly agree
Strongly disagree 10%
12%

Disagree Agree
18% 60%

In terms of trusting the information and advice provided by ANC healthcare

providers, majority of the participants agreed that they trusted the information given

by the ANC healthcare providers (n=27, 54%). Also, a number of participants

strongly agree that they trusted the information and advice provided by health care

providers (n=22, 44%).%. Finally, 1 of the participants strongly disagreed that the

information given by ANC healthcare providers can be trusted. (n=1, 2%).

Fig.4.5 : I trust the information and advice provided by ANC healthcare

providers

I trust the information and advice provided by ANC healthcare

providers

strongly disagree 2%

strongly agree 22,

44%

Agree 27, [PERCENTAGE]

An overwhelming majority agreed that ANC services have improved since the

implementation of the Free Maternal Health Care Policy. (n= 35, 70%). A number of

PAGE \* MERGEFORMAT ii
the participants strongly agreed to the fact that ANC services have improved since the

implementation of the Free Maternal Health Care Policy (n=10, 20%). Moreover,

some of the participants disagreed that the ANC services have improved since the

implementation of the Free Maternal Health Care Policy (n= 4, 8%) whilst one of the

participants strongly disagreed to the fact that ANC services have improved since the

implementation of the Free Maternal Health Care Policy, representing 2%.

Fig. 4.6: ANC services have improved since the implementation of the Free

Maternal Health Care Policy

ANC services have improved since the implementation of the Free Maternal
Health Care Policy

Disagree
Disagree Strongly disagree

Strongly agree

Agree

4.4Availability and utilization of antenatal care services

One of the objectives of this study is to investigate the availability and utilization of

antenatal care services. Out of the 50 participants, a greater percentage were aware of

the free maternal healthcare policy (n=39, 78%). 14% of the participants were not

aware of the free maternal healthcare policy (n=7). 8% of the participants were

somehow aware of the free maternal healthcare policy (n=4).

In terms of the availability of antenatal care services, an overwhelming majority of the

participants knew that antenatal care services were available in the Abrepo

community (n=49, 98%). 1 of the participants did not know that antenatal care

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services were available in Abrepo Community, representing 2%.

With regards to the utilization of antenatal care services, 41 of the participants had

utilized antenatal care services during their current pregnancy, representing 82%. 9 of

the participants had not utilized antenatal care services during their current pregnancy,

representing 18%.

Concerning the number of ANC visits attended by the pregnant women, 32% of the

participants confirmed to have attended ANC visits twice during their current

pregnancy (n=16). This was followed by 28% of the participants who had attended

ANC visits four times during their current pregnancy (n=14). 24% of the participants

confirmed to have attended ANC visits six times during their current pregnancy

(n=12) and finally, 8 participants had not attended ANC visits during their current

pregnancy (16%).

With the availability of essential ANC resources (e.g., medications, equipment) at the

ANC facilities, a greater majority rated it from 20-50% (n=10, 20%). This was

followed by other participants who rated the availability of essential ANC resources

(e.g., medications, equipment) at the ANC facilities from 50-80% (n=28, 56%). 12

participants rated the availability of essential ANC resources from 80-100% (24%).

Concerning the usefulness of health education and counselling received during ANC

visits, participants rated it on a scale of 1 to 5. 16 of the participants rated the

usefulness of health education and counselling received during ANC visits on a scale

of 5, representing 32%. A number of the participants also rated the usefulness of

health education and counselling received during ANC visits on a scale of 4 (n=13,

26). Next to that, 28% of the participants also rated the usefulness of health education

and counselling received during ANC visits on a scale of 3 (n=14). This was followed

by 12% of the participants who also rated the usefulness of health education and

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counselling received during ANC visits on a scale of 2 (n=6). Finally, 1 of the

participants rated the usefulness of health education and counselling received during

ANC visits on a scale of 1, representing 2%. Table 1.8 displays all these findings.

Table 1.2: Availability and utilization of antenatal care services

Variables Frequency Percentage (%)

Are you aware of the Free Maternal Health Care Policy?

Yes 39 78
No 7 14
Somehow 4 8
Are antenatal care services available in the Abrepo Community?
Yes 49 98
No 1 2
Have you utilized ANC services during your current pregnancy?
Yes 41 82
No 9 18
How many ANC visits have you attended during your current pregnancy?
2 16 32
4 14 28
6 12 24
None 8 16
Did you experience any challenges in accessing ANC services?

Yes 2 18.2
No 4 36.4
Long waiting times 2 18.2
Lack of transportation 3 27.2
How would you rate the availability of essential ANC resources (e.g., medications,
equipment) at the ANC facilities?
20-50% 10 20
50-80% 28 56
80-100% 12 24
Have you received any health education or counselling during your ANC visits? If yes,
please rate its usefulness on a scale of 1 to 5.
1 1 2
2 6 12
3 14 28
4 13 26

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 5 16 32
Source: Field data, August 2022.

4.5 Satisfaction with antenatal care services

Participants rated their level of satisfaction with some aspects of ANC services on a

scale of 1 to 5, where 1= very dissatisfied, 2= satisfied, 3= neutral, 4= dissatisfied and

5 = very satisfied.

One of the aspects was the overall care received during ANC visits. Out of the 50

participants, majority of them were very satisfied with the overall care received

during ANC visits (n=17, 34%). 11 of the participants were dissatisfied with the

overall care received during ANC visits, representing 22%. Some of the participants

were also neutral with the overall care received during ANC visits (n=11, 22%) whilst

other participants were satisfied with the overall care received during ANC visits

(n=7, 14%). Lastly, 8% of the participants were very dissatisfied with the overall care

received during ANC visits (n=4).

Fig.4.7: Overall care received during ANC visits

O v er a l l c a r e r ec ei v ed d u r i n g A N C v i si t s

V e r y s a ti s fi e d 3 4 % 17

D i s s a ti s fi e d 2 2 % 11

Neu t r al 2 2 % 11

S a ti s fi e d 1 4 % 7

V e r y d i s s a ti s fi e d 8 % 4

Another aspect was the attitude of healthcare providers during ANC visits. 16% of the

participants were very satisfied with the attitude of healthcare providers during ANC

visits (n=8). This was followed by 32% of the participants who were dissatisfied with

the attitude of healthcare providers during ANC visits (n=16). Some of the

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participants were neutral with the attitude of healthcare providers during ANC visits

(n=19, 38%). 10% of the participants were also satisfied with the attitude of

healthcare providers during ANC visits (n=5). Finally, 2 of the participants were very

dissatisfied with the attitude of healthcare providers during ANC visits (4%).

Fig. 4.8: The attitude of healthcare providers during ANC visits

T h e a tti t u d e o f h ea l t h c a r e p r o v i d er s d u r i n g A N C v i si t s

19
16

8
5
2
V e r y d i s s a ti s fi e d 4 % S a ti s fi e d 1 0 % N eu t r al 3 8 % D i s s a ti s fi e d 3 2 % V e r y s a ti s fi e d 1 6 %

In terms of the cleanliness and hygiene of ANC facilities, 24% of the participants

were very satisfied with the cleanliness and hygiene of ANC facilities (n=12) whilst

40% of the participants were dissatisfied with the cleanliness and hygiene of ANC

facilities (n=20). Next to that, 20% of the participants were neutral with the

cleanliness and hygiene of ANC facilities (n=10). Some of the participants were also

satisfied with the cleanliness and hygiene of ANC facilities (n=6, 12%). Followed by

participants who were very dissatisfied with the cleanliness and hygiene of ANC

facilities (n= 2, 4%).

PAGE \* MERGEFORMAT ii
Fig. 4.9: The cleanliness and hygiene of ANC facilities

t HE CL E A N L IN E S S A N D HYGIE N E O F a n c FA CIL IT IE S

20

12
10
6
2
V e r y d i s s a ti s fi e d S a ti s fi e d 1 2 % N eu t r al 2 0 % D i s s a ti s fi e d 4 0 % V e r y s a ti s fi e d 2 4 %
4%

Regarding the availability of privacy during consultations, a number of the

participants were very satisfied with the privacy available during consultations (n=13,

26%). 38% of them were dissatisfied with the availability of privacy during

consultations (n=19). 6 of the participants were also neutral with the availability of

privacy during consultations, representing 12% whilst 22% 0f the participants were

satisfied with the availability of privacy during consultations (n=11). Finally, 2% of

the participants were very dissatisfied with the availability of privacy during

consultations (n=1).

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Fig. 4.10: The availability of privacy during consultations

T h e a v a i l a b i l i t y o f p r i v a c y d u r i n g c o n su l t a ti o n s

19

13
11

1
V e r y d i s s a ti s fi e d S a ti s fi e d ( 2 2 % ) Neu t r al (1 2 % ) D i s s a ti s fi e d ( 3 8 % ) V e r y s a ti s fi e d ( 2 6 % )
(2 % )

The last aspect of the pregnant women’s satisfaction with antenatal care services is

the comprehensiveness of health education provided during ANC visits. 13 of the

pregnant women were very satisfied with the comprehensiveness of health education

provided during ANC visits, representing 26%. 24 of the pregnant women were

dissatisfied with the comprehensiveness of health education provided during ANC

visits, representing 48%. 7 of the pregnant women were neutral with the

comprehensiveness of health education provided during ANC visits, representing

14%. 5 of the pregnant women were satisfied with the comprehensiveness of health

education provided during ANC visits, representing 10%. 1 pregnant woman was very

dissatisfied with the comprehensiveness of health education provided during ANC

visits, representing 2%.

PAGE \* MERGEFORMAT ii
Fig. 1.11 The comprehensiveness of health education provided during ANC

visits.

The comprehensiveness of health edu -

cati on provided during ANC visits

24

13
5 7
1
V e r y d i s s a ti s fi e d S a ti s fi e d ( 1 0 % ) N eu t r al (1 4 % ) D i s s a ti s fi e d ( 4 8 % ) V e r y s a ti s fi e d
(2 % ) (2 6 % )

Discussion of Results

4.6 Socio-Demographic Characteristics of Respondents

This section provides information about the 50 respondents in the survey such as their

age group, respondents' age category (in years), educational level, religion, marital

status and number of children.

The study revealed that most of the respondents were within the ages of 19-23 years

(38%). This is closely related to a similar study in Ghana where more than half of the

participants were aged 21-30 years (55%) Afaya et al. (2020).

Further to this is the religious affiliation of respondents, Christians dominated in this

study (88%). Muslims were next with 8% while 2% had no religious affiliation and

the remaining 2% were traditionalist. This confirms an earlier research in Ghana

which suggested majority of Ghanaians to be Christians, followed by Muslims and the

other religious affiliations (Ghana statistical Service; Population and Housing Census,

2021).

Considering the educational level, most of the participants had tertiary education

PAGE \* MERGEFORMAT ii
(70%) whilst 2% of the participants had basic education. This is similar to Idowu et

al. (2022) study on access, perceived quality and uptake of antenatal services in urban

communities of Osun state, Southwest Nigeria, which found that (51%) of the study

participants had tertiary education.

With regards to marital status of the respondents, majority of the respondents were

single (40%) and this is similar to Nsemo et al. (2020) study on pregnant teenagers’

perception and access to antenatal care services in a Ghanaian government hospital,

which found that 88% of the study participants were single.

Concerning the number of children each participant had, the study found out that

majority of the participants had one child (68%) and this is similar to Afaya et al.

(2020) study on women’s knowledge and its associated factors regarding optimum

utilization of antenatal care in rural Ghana, which found that 76.1% of the study

participants had 1-2 children.

4.7 Perception of antenatal care services

This study found out that, out of the 50 participants in this current study, an

overwhelming majority agreed that the quality of antenatal care (ANC) services was

satisfactory (70%). This was closer to an earlier research work where 74% of the

participants were satisfied with antenatal care services rendered in public health

institutions of Hossana town, Dagmawit Birhanu Kebede et al. (2020). Majority of the

participants agreed that they felt comfortable in discussing their health concerns with

ANC health providers (56%) whilst 4% of the participants strongly disagreed that

they felt comfortable in discussing their health concerns with ANC health providers.

27 out of the 50 participants agreed that the ANC services were easily accessible in

terms of location and transportation (54%) whilst 30% disagreed that the ANC

services were easily accessible in terms of location and transportation. This is similar

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to an earlier research work which found that 70% of the respondents took less than 30

minutes to reach the health facility. This was supported by the qualitative finding as

one participant said that “it only took me around ten minutes to reach to the health

institution it is very important that facilities were near to my home if I get seek or in

need of immediate care it will be easy to reach”, Dagmawit Birhanu Kebede et al.

(2020).

A greater percentage of the participants agreed that the waiting times at ANC

facilities are reasonable (60%). This finding is similar to the findings of a study by

Negussie, (2018) whose study revealed that participants perceived good the efficiency

of services rendered as treatment was given without delay and maintained good

coordination with other staff. 54% of the participants agreed that they trusted the

information given by the ANC healthcare providers whilst 2% of the participants

strongly disagreed that the information given by ANC healthcare providers can be

trusted. An overwhelming 70% of the participants confirmed that ANC services have

improved since the implementation of the Free Maternal Health Care Policy.

Consistent with this study, Alhassan and colleagues found that there has been an

increase in the trends of ANC service utilization in Ghana in the past decade Duodu et

al. (2022).

4.8 Availability and utilization of antenatal care services

This study established that a greater percentage of the respondents were aware of the

Free Maternal Health Care Policy (78%) and an overwhelming majority knew that

antenatal care services were available in the Abrepo Community (98%).

While majority of the respondents indicated that they have utilized ANC services

during their current pregnancy (82%), another minority of 18% participants had not

utilized ANC services during their current pregnancy. This is similar to research study

PAGE \* MERGEFORMAT ii
by Fulpagare et al. (2019) which found that 83.9% of pregnant adolescent women

registered their current pregnancy as compared to adult pregnant women. 16 out of the

50 participants had attended ANC visits twice (2) during their current pregnancy

(32%). This is contrary to a study which found that 56% of the study participants has

attended ANC services more than four (4) times during their current pregnancy

Nsemo et al. (2020). Concerning challenges associated with assessing ANC services,

a number of the participants stated long waiting times as their challenge whilst other

participants had challenges with transportation.

The availability of essential ANC resources (e.g., medications, equipment) at the

ANC facilities was rated from 20-50% by 10 of the participants (20%) whilst 12

participants rated the availability of essential ANC resources from 80-100% (24%).

Majority (32%) of the participants found the health education and counselling

received during ANC visits to be useful and minority of the participants found the

health education and counselling received during ANC visits to be useful (2%)

4.9 Satisfaction with antenatal care services

This study established that 34% respondents generally were very satisfied with the

overall care received during antenatal care services and 8% of the respondents were

very dissatisfied with the overall care received during antenatal care services. This is

similar to Dagmawit Birhanu Kebede et al. (2020) study on maternal satisfaction with

antenatal care and associated factors among pregnant women in Hossana Town,

which found that around three-fourths of the respondents were satisfied with the

service that they received. Moreover, some of the participants were very satisfied with

the attitude of health care providers during antenatal care visits (16%). This is similar

to the findings of a study that revealed that clients respected by health care providers

were significantly associated with satisfaction Dagmawit Birhanu Kebede et al.

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(2020). With regards to cleanliness and hygiene of antenatal care facilities, majority

of the participants were dissatisfied with the cleanliness and hygiene of antenatal care

facilities (40%) whilst a minority were satisfied with the cleanliness and hygiene of

antenatal care facilities (12%). This is contrary to the study which found that 87.5% of

the respondents were satisfied with the cleanness of antenatal care facilities.

“Cleanness of the institution is also an independent predictor of satisfaction; those

who feel that the institution is clean were more likely to be satisfied than those who

said that the institution is not clean” Dagmawit Birhanu Kebede et al. (2020).

Concerning the availability of privacy during consultations, a number of the study

participants were very satisfied with the privacy that existed during consultations

(26%). This is similar to the research study which revealed that 91.4% of the study

participants were satisfied with the privacy that existed during consultations. “Study

subjects whose privacies were maintained were more likely to be satisfied than those

whose privacy was not maintained" Dagmawit Birhanu Kebede et al. (2020).

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 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Introduction

This chapter comprises summary, conclusion and recommendations of the study

relating to the perception, availability and utilization of antenatal care services under

the free maternal healthcare policy, a study among pregnant women in Abrepo,

Kumasi and some suggestions made for future studies.

5.2 Summary of the Study

The study was carried out among the residents of Abrepo community who are aged 19

years and above, aiming to assess the perception, availability and utilization of

antenatal care services under the free maternal healthcare policy. a study among

pregnant women in Abrepo, Kumasi. The study recruited 50 respondents where

majority of the respondents were below 45 years. The most represented respondents

were those who had tertiary education with the least being those who had basic

education. The study revealed that most of the residents in Abrepo community are

Christians and single as well.

The result from the study indicated that most of respondents were aware of the Free

Maternal Healthcare Policy and also almost all the respondents knew that antenatal

care services were available in the Abrepo Community. Majority of the respondents

had utilized antenatal care services during their current pregnancy. A few of the

respondents indicated that long waiting times and transportation in terms of accessing

antenatal care facilities were their challenge.

5.3 Conclusion

The study sorts out to access the perception, availability and utilization of antenatal

care services under the free maternal healthcare policy, a study among pregnant

PAGE \* MERGEFORMAT ii
women in Abrepo, Kumasi. The results from the study revealed that the respondents

had good perception of antenatal care services and utilization of antenatal care

services was high among the respondents of the study. Most of the respondents had

one to two children. Most of the respondents also felt comfortable discussing their

health concerns with ANC healthcare providers.

Few of the respondents hold the notion that there is the need to improve certain things

in the antenatal health facilities such as; cleanliness of antenatal care facilities and the

waiting times. However, majority of the respondents confirmed that they were

satisfied with antenatal care services in the Abrepo Community and are willing to

continue utilizing the services.

5.4 Recommendations

Based on the findings of this study, the following recommendations are made:

1) Government should continue with the Free Maternal Health Policy and there

should be more antenatal care facilities to improve the health of pregnant

women.

2) There is the need to assess the existing antenatal health care facilities in

Abrepo Community and invest in necessary infrastructure improvements to

ensure a conducive environment for antenatal care provision.

3) Enhancing the knowledge and skills of healthcare providers regarding

antenatal care guidelines and best practices.

4) The ANC services are good for the wellbeing of the mother and the unborn

baby hence there should be more education for pregnant women on attending

Antenatal Care. There were some suggestions that online education should be

added.

5) Barriers to accessibility such as long distances to healthcare facilities and

PAGE \* MERGEFORMAT ii
transportation issues should be addressed. Exploring strategies such as mobile

clinics or satellite antenatal care centers to increase accessibility for pregnant

women in remote areas of the community.

PAGE \* MERGEFORMAT ii
 REFERENCES

Agyemang, R., Boateng, D., & Dsane, P. (2018). Perception of pregnant women
towards antenatal care services under the free maternal health care policy in
the Kumasi Metropolis, Ghana. BMC pregnancy and childbirth, 18(1), 71.

Amoakoh-Coleman, M., Ansah, E. K., Agyepong, I. A., Grobbee, D. E., & Kayode,
G. A. (2016). The effect of free maternal health care on utilization of obstetric
services in rural northern Ghana: a community-based cluster randomized trial.
PloS one, 11(11), e0160460.

Asamoah, B. O., Agardh, A., Pettersson, K. O., & Östergren, P. O. (2019). Magnitude
and factors associated with utilization of antenatal care services in the
Northern and Central regions of Ghana: a cross-sectional study. BMC
pregnancy and childbirth, 19(1), 371.

Danso, K. A., Ofori, A. A., & Kuganab-Lem, R. (2020). Utilization of antenatal care
services under the free maternal health care policy in Ghana. International
journal of reproductive medicine, 2020.

Naariyoug, S., Poudel, C. K., and Yasuoka, J. (2012) Quality of Antenatal Care
Services in the Birim North District of Ghana: Contribution of the
Community-Based Health Planning and Services Program. Springer, 1573-
6628.

Ghana Health Service/Reproductive and Child Health (2012). Reproductive and Child
Health Annual Report.

Brown, H. C., Smith, H. J., Mori, R., and Noma, H. (2015). Giving women their own
case notes to carry during pregnancy. Cochrane Database of Systematic
Reviews, (10). Chaibva, C. N. (2008). Factors influencing adolescents’
utilization of Antenatal care services in Bulawayo. Zimbabwe-2009-
umkndsp01. unisa. ac.

Ofore-Adjei, D. (2007). Ghana’s free delivery care policy. Ghana Medical Journal.
41(3): 94-95. Reynolds, H.W., Wong, E.L, and Tucker, H. (2006).
Adolescents’ use of Maternal and Child Health Services in Developing
Countries. International Family Planning Perspectives; 23(1):6-16.

UNICEF. Antenatal care. 2018.

[Link] (accessed March
7, 2019).

B. Yohannes, M. Tarekegn, and W. Paulos, “Mothers’ utilization of antenatal care and

their satisfaction with delivery services in selected public health facilities of
Wolaita zone, Southern Ethiopia,” International Journal of Scientific &
Technology Research, vol. 2, no. 2, pp. 74–85, 2013.

Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal
care utilisation in sub-Saharan Africa: a systematic review. BMJ Open.

PAGE \* MERGEFORMAT ii
 2019;9(10): e031890. 6.

Mekonnen T, Dune T, Perz J. Maternal health service utilisation of adolescent

women in sub-Saharan Africa: a systematic scoping review. BMC Pregnancy
Childbirth. 2019;19(1):366. 7

Moller A-B, Petzold M, Chou D, Say L. Early antenatal care visit: a systematic
analysis of regional and global levels and trends of coverage from 1990 to
2013. Lancet Glob Health. 2017;5(10): e977–83

Afaya A, Dzomeku VM, Baku EA, Afaya RA, Ofori M, Agyeibi S, et al. Women’s
experiences of midwifery care immediately before and after caesarean section
deliveries at a public Hospital in the Western Region of Ghana. BMC
Pregnancy and Childbirth.

Negash, A. K., Negussie, D., and Demissie, A. F. (2014). Patients’ satisfaction and
associated factors with nursing care services in selected hospitals, Northwest
Ethiopia. American Journal of Nursing Science, 3(3), 34-42.

Negussie, B. B., Hailu, F. B., and Megenta, A. D. (2018). Knowledge and Practice of
Essential Newborn Care and Associated Factors among Nurses and Midwives
Working at Health Centers in Jimma Zone, Ethiopia, 2016. J Nurs Care,
7(446), 2167-1168

Nsemo, A. D., and Offiong, D. J. (2016). Knowledge of obstetric danger signs among
women of child-bearing age in the rural communities of Cross River State,
Nigeria. International Educational Scientific Research Journal, 2, 12.

P. H. Fulpagare, A. Saraswat, K. Dinachandra et al., “Antenatal care service

utilization among adolescent pregnant women– evidence from Swabhimaan
programme in India,” Frontiers in Public Health, vol. 7, 2019.

D. J. Onyeajam, S. Xirasagar, M. M. Khan, J. W. Hardin, and O. Odutolu, “Antenatal

care satisfaction in a developing country: a cross-sectional study from
Nigeria,” BMC Public Health, vol. 18, no. 1, pp. 1–9, 2018.

F. Chemir, F. Alemseged, and D. Workneh, “Satisfaction with focused antenatal care

service and associated factors among pregnant women attending focused
antenatal care at health centers in Jimma town, Jimma zone, South West
Ethiopia; a facility based cross-sectional study triangulated with qualitative
study,” BMC Research Notes, vol. 7, no. 1 pp. 1–8, 2014.

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 APPENDIX A

RESEARCH QUESTIONNAIRE ON THE TOPIC:

PERCEPTION, AVAILABILITY AND UTILIZATION OF ANTENATAL

CARE SERVICES UNDER THE FREE MATERNAL HEALTHCARE

POLICY. A STUDY AMONG PREGNANT WOMEN IN ABREPO, KUMASI.

INTRODUCTION

I’m a final year student at the University of Education, Winneba (UEW), conducting a

research on the topic: Perception, availability, and utilization of antenatal care (ANC)

services under the Free Maternal Health Care Policy among pregnant women in the

Abrepo community, Kumasi.

The aim of this questionnaire is to gather information about the perception,

availability, and utilization of antenatal care (ANC) services under the Free Maternal

Health Care Policy among pregnant women in the Abrepo community, Kumasi. I will

be most grateful if you could spend a few minutes of your time to answer the

questions below. Your responses will contribute to a better understanding of the

current state of ANC services and help identify areas for improvement. Please answer

the following questions to the best of your knowledge and experiences. Your

responses will be kept confidential and used for research purposes only.

Thank you for participating in this research study.

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 SECTION A: SOCIO-DEMOGRAPHIC DATA
(Please tick [√] as appropriate)

1. Age category
a) Less than 18 years [ ]
b) 19 -23years [ ]
c) 24 - 28 years [ ]
d) 29-33 years [ ]
e) 34- 38 years [ ]
f) 39 – 45 years [ ]

2. Educational level
a) Basic [ ]
b) Secondary [ ]
c) Tertiary [ ]
d) Not educated [ ]

3. Religion
a) Christians [ ]
b) Muslim [ ]
c) Traditional [ ]
d) Others_____

4. Marital status
a) single [ ]
b) courting [ ]
c) married [ ]
d) Divorced [ ]

5. Number of children
a) one [ ]
b) Two [ ]
c) Three [ ]
d) Four [ ]
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e) Five or more [ ]

SECTION B: PERCEPTION OF ANTENATAL CARE SERVICES

Please rate your level of agreement with the following statements (on a scale of 1 to 5,
where 1 = strongly disagree and 5 = strongly agree):
1. The quality of ANC services in Abrepo community is satisfactory [ ]

2. I feel comfortable discussing my health concerns with ANC healthcare

providers [ ]

3. The ANC services are easily accessible in terms of location and transportation.
[ ]

4. The waiting times at ANC facilities are reasonable [ ]

5. I trust the information and advice provided by ANC healthcare providers [ ]

6. ANC services have improved since the implementation of the Free Maternal
Health Care Policy [ ]

SECTION C: AVAILABILITY AND UTILIZATION OF ANTENATAL CARE

SERVICES
1. Are you aware of the Free Maternal Health Care Policy?
a) Yes [ ]
b) No [ ]
c) Somehow [ ]

2. Are antenatal care services available in the Abrepo Community?

a) Yes [ ]

b) No [ ]

3. Have you utilized ANC services during your current pregnancy?

a) Yes [ ]
b) No [ ]
If yes, please proceed to question 3. If no, please skip to the next section

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 4. How many ANC visits have you attended during your current pregnancy?
a) 2 [ ]
b) 4 [ ]
c) 6 [ ]
d) None [ ]

5. Did you experience any challenges in accessing ANC services?

a) Yes [ ]
b) No [ ]
If yes, please specify
___________________________________________________

6. How would you rate the availability of essential ANC resources (e.g.,
medications, equipment) at the ANC facilities?
a) 20-50% [ ]
b) 50-80% [ ]
c) 80-100% [ ]
7. Have you received any health education or counseling during your ANC
visits? If yes, please rate its usefulness on a scale of 1 to 5. _____________

SECTION D: SATISFACTION WITH ANTENATAL CARE SERVICES

Please rate your level of satisfaction with the following aspects of ANC services (on a
scale of 1 to 5, where 1 = very dissatisfied, 2= satisfied, 3= neutral, 4= dissatisfied
and 5 = very satisfied):

1. Overall care received during ANC visits [ ]

2. The attitude of healthcare providers during ANC visits [ ]

3. The cleanliness and hygiene of ANC facilities [ ]

4. The availability of privacy during consultations [ ]

5. The comprehensiveness of health education provided during ANC visits [ ]

SECTION E: ADDITIONAL COMMENTS
Please provide any additional comments or suggestions regarding the ANC services

or the Free Maternal Health Care Policy in the Abrepo community

_______________________________

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