Perceived and Real Costs of Antenatal Care Seeking and their Implications For Women’s Access to Intermittent\ud
Preventive Treatment of Malaria in Pregnancy in Rural Tanzanian Districts
Debate about the influence of costs of seeking Antenatal Care (ANC) on the maternal health service utilization in Africa has remained controversial and generally inconclusive, calling for more systematic, robust and reliable evidence. A study was done to assess the influence of real and perceived costs of ANC seeking on pregnant women’s access to Intermittent Preventive Treatment in Pregnancy (IPTp) against malaria in two rural districts in Tanzania. Exist interviews were administered to 823 pregnant women leaving ANC clinics, among which 417 and 406 came from Mkuranga and Mufindi districts, respectively. Data analysis was executed using STATA 8 statistical software. Of all interviewees, 66.2% and 89.3% of respondents in Mkuranga and Mufindi, respectively, previously contacted government clinics during their current pregnancies; less than 20% and 15% of these districts, respectively, had contacted private clinics. Respondents reporting to have paid user-fees on the study day accounted for 36.7% and 7.0% in both districts, respectively. Few (<2%) of the respondents in each district reported unofficial payments asked of them by clinic staff for the services sought. In both districts, long travel distance was identified as the main disappointing factor against ANC seeks, followed by health care user-fees. Apparently, perceived low quality of care at particular clinics had more influenced the respondents found in public clinics to visit private clinics than it had influenced those found at private clinics to contact public ones. Respondents from wealthier families and those with decision-making autonomy for spending family income were less likely to have faced user-fee payment hardship than those without such opportunities. Lack of money for user-fees or transport delayed 12.6% and 12.4% of the respondents in Mkuranga and Mufindi, respectively to register for the ANC and receive IPTp during the recommended period. Evidently, real and perceived costs together with perceived quality of care influence rural women to seek ANC and determine their chance to access malaria IPTp in Tanzania
