1.1 Introduction
Antenatal care refers to the systematic supervision, education, and medical support provided to a woman during pregnancy with the primary aim of ensuring the health and wellbeing of both the mother and the unborn child. The World Health Organization defines antenatal care as the care received from skilled health personnel during pregnancy to monitor maternal and fetal health, identify potential complications, and provide preventive and promotive health interventions (WHO, 2016). Routine antenatal care includes scheduled clinic visits, physical examinations, laboratory investigations, nutritional counseling, immunization, health education, and preparation for safe delivery. It serves as a vital entry point into the health system for pregnant women and plays a key role in reducing maternal and neonatal morbidity and mortality.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Antenatal care is a fundamental aspect of maternal health services that contributes significantly to the reduction of pregnancy-related complications and deaths. According to the World Health Organization, antenatal care provides an opportunity for skilled health professionals to monitor pregnancy, detect complications early, and offer preventive and promotive health interventions that improve maternal and fetal outcomes (WHO, 2016). Routine antenatal care is designed not only to manage existing health conditions but also to educate pregnant women on healthy practices, danger signs, nutrition, birth preparedness, and the importance of skilled delivery.
Globally, maternal mortality remains a major public health challenge, particularly in developing countries. The World Health Organization reported that a large proportion of maternal deaths occur in low- and middle-income countries and are largely preventable through effective antenatal, intrapartum, and postnatal care services (WHO, 2019). These deaths are often associated with conditions such as hemorrhage, hypertensive disorders, infections, and anemia, many of which can be identified and managed during routine antenatal visits. This underscores the importance of not only the availability of antenatal services but also their utilization by pregnant women.
In sub-Saharan Africa, utilization of routine antenatal care remains inconsistent despite increased awareness of maternal health needs. Adedokun and Yaya (2021) asserted that factors such as poor knowledge, negative perception, cultural beliefs, and socioeconomic constraints continue to influence antenatal care attendance among pregnant women in the region. They affirmed that women who lack adequate understanding of the benefits and components of antenatal care are more likely to initiate care late or attend irregularly, thereby increasing the risk of adverse pregnancy outcomes (Adedokun and Yaya, 2021).
In Nigeria, antenatal care services are integrated into the primary health care system and supported by national maternal and child health policies. However, the National Population Commission and ICF stated that although a high proportion of women attend at least one antenatal visit, fewer complete the recommended number of visits or receive comprehensive care throughout pregnancy (NPC & ICF, 2019).
Several studies have examined the influence of knowledge on antenatal care utilization. According to Fagbamigbe and Idemudia (2017), women with higher levels of education and better understanding of pregnancy-related risks are more likely to utilize antenatal services appropriately. They reported that inadequate knowledge contributes to misconceptions about pregnancy being a normal condition that does not require medical supervision unless complications arise. Such beliefs reduce the perceived importance of routine antenatal care, especially among multiparous women who rely on previous pregnancy experiences.
Perception of antenatal care is equally important in determining utilization patterns. Bohren et al. (2019) contended that women's perceptions are shaped by their interactions with health care providers, quality of services received, waiting time, cost of care, and the general environment of health facilities. Negative experiences, including perceived disrespect or poor communication, can discourage pregnant women from attending antenatal clinics regularly. Conversely, positive perceptions foster trust in the health system and encourage continued use of maternal health services.
Urban settings such as Yaba Local Government Area of Lagos State present a complex maternal health landscape. Yaba is characterized by a dense population, diverse socioeconomic backgrounds, and the presence of both public and private health care facilities. According to Afulani et al. (2020), urban residence does not automatically translate to optimal use of maternal health services, as disparities in knowledge, perception, and affordability persist even in areas with relatively better access to health facilities. This study is set against the backdrop of the need to generate context-specific evidence on the knowledge and perception of pregnant women towards routine antenatal care in selected health care facilities in Yaba Local Government, Lagos State.
1.3 Statement of Problems
Investigation revealed that there is growing concern that pregnant women's knowledge and perception of routine antenatal care is inadequate, which negatively affects utilization of these services. Poor understanding of the purpose, benefits, and recommended frequency of antenatal visits is a significant barrier to effective use of maternal health services. Studies have reported that limited awareness of antenatal care components, misconceptions about pregnancy and reliance on informal sources of information contribute to irregular attendance and late booking for antenatal care (Afulani et al., 2020).
Additionally, according to the World Health Organization, regular antenatal visits are associated with improved pregnancy outcomes, reduced maternal and neonatal morbidity, and increased uptake of skilled delivery services (WHO, 2016). In Nigeria, antenatal care services are widely available in public and private health facilities; however, maternal morbidity and mortality rates remain high, particularly in urban and semi-urban settings where socioeconomic disparities influence health-seeking behavior (National Population Commission [NPC] & ICF, 2019).
Furthermore, health system factors such as long waiting times, perceived poor attitude of health workers, cost of services, and overcrowding in public facilities influence pregnant women's attitudes toward routine antenatal care. When women associate antenatal clinics with stress, disrespect, or financial burden, their perception of care becomes negative, which is reflected in reduced attendance and preference for alternative care options (Bohren et al., 2019). In an urban area like Yaba, where diverse health care options exist, negative perceptions may discourage consistent use of formal antenatal services. It is against this backdrop that this study seeks to assess the knowledge and perception of pregnant women towards routine antenatal care in selected health care facilities in Yaba Local Government, Lagos State.
1.4 Aim and Objectives of Study
The aim of this study is to examine the knowledge and perception of pregnant women towards routine antenatal care in selected health care facilities in Yaba Local Government Area, Lagos State. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the level of knowledge of pregnant women regarding routine antenatal care.
- To examine the perceptions of pregnant women towards routine antenatal care services.
- To identify factors within the health care system that influence antenatal care utilization.
- To assess the relationship between pregnant women's knowledge, perception, and utilization of routine antenatal care services.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of knowledge of pregnant women regarding routine antenatal care in selected health care facilities in Yaba Local Government Area?
- How do pregnant women perceive routine antenatal care services in these facilities?
- What health system factors influence the utilization of antenatal care among pregnant women?
- Is there a relationship between pregnant women's knowledge, perception, and their utilization of routine antenatal care services?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- Null Hypothesis (H0): There is no significant relationship between pregnant women's knowledge and perception of routine antenatal care and their utilization of these services in selected health care facilities in Yaba Local Government Area.
- Alternative Hypothesis (H1): There is a significant relationship between pregnant women's knowledge and perception of routine antenatal care and their utilization of these services in selected health care facilities in Yaba Local Government Area.
1.7 Significance of Study
The outcome of this research will directly benefit the community under study, as improved antenatal care utilization contributes to healthier mothers and infants, reducing maternal and neonatal morbidity and mortality. The study will also help pregnant women accent the importance of routine antenatal care and encourage them to attend clinics regularly.
Furthermore, the study will assist health administrators and policymakers in designing and implementing targeted maternal health programs and interventions. In addition, the research will accentuate the importance of routine antenatal care and positive perception influence healthy pregnancy outcomes.
Lastly, the research outcome will be valuable to public health researchers, as it will add to the existing body of knowledge on maternal health, particularly in relation to knowledge and perception of routine antenatal care in urban Nigerian communities. The findings will serve as a reference for future studies and may stimulate further research on maternal health behaviors and service utilization in similar settings.
1.8 Scope of Study
The scope of the research is focused on the knowledge and perception of pregnant women towards routine antenatal care in selected health care facilities in Yaba Local Government Area of Lagos State, Nigeria.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Antenatal Care (ANC): Refers to the care provided to pregnant women by skilled health personnel to monitor the progress of pregnancy, prevent complications, and promote maternal and fetal health (WHO, 2016).
Knowledge: In this study, knowledge refers to the awareness and understanding that pregnant women have regarding the purpose, components, and recommended frequency of routine antenatal care visits (Adedokun & Yaya, 2021).
Perception: Perception is the way pregnant women interpret, evaluate, and form attitudes towards routine antenatal care services based on personal, cultural, and social experiences (Bohren et al., 2019).
Routine Antenatal Care Utilization: Refers to the consistent attendance and engagement of pregnant women with antenatal care services according to recommended schedules for monitoring and maintaining health during pregnancy (Fagbamigbe & Idemudia, 2017).
Pregnant Women: Women who are currently carrying a developing fetus and are within the gestational period, typically registered or attending antenatal care in health facilities (NPC & ICF, 2019).
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