1.1 Introduction
Late Antenatal booking means that women may not have the opportunity to benefit from screening tests, antenatal education and health advice, or supported decision-making regarding the place and choice of delivery (Baker et al., 2012). The factors instigating late antenatal booking as a result of the delay in decision making, delay on the way due to lack of transportation and poor road networks and delay at clinic facility in instituting care service.Antenatal care is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins, which prevents potential health problems throughout the course of the pregnancy and promotes the mother and child's health alike. The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal infections and other preventable health problems (Wikipedia, 2021b).
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, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Late booking or registration into antenatal care might be dangerous towards the detection and treatment of pregnancy related complications and increase negative patient outcomes. Late booking has been linked to increased infant and maternal morbidity and mortality. When women book early into antenatal care, it makes it feasible for accurate estimation of gestational age (Baker et al., 2012). Early booking is when a pregnant woman accesses antenatal care (ANC) before 20 weeks of gestation. The World Health Organisation (WHO) recommends that women should access ANC as soon as they realise that they are pregnant and this should be before five months of gestation (Villar et al., 2002; WHO, 2003). Late booking means that women may not have the opportunity to benefit from screening tests, antenatal education and health advice, or supported decision-making regarding the place and choice of delivery (Baker et al., 2012).
Pregnancy as a physiologic state is expected to lead to a process of delivery within thirty six weeks (36) of gestation in a normal delivery but due to the different reasons such as variation in human body, sizes, races, external factors e.t.c, it can be a very unpleasant experience as women may have difficulties in being delivered of the pregnancy they have carried over many weeks.
Globally, women who do not utilize antenatal care services are about 45 million; and in sub-Saharan Africa, 68% of women reported at least one antenatal visit (WHO, 2003). Antenatal care is a key strategy to improving maternal and infant health globally. However, data from a survey done in sub-Saharan Africa showed that women often initiate ANC late; therefore they fail to meet the recommended number of ANC visits (Pell et al., 2013).
In order to fully understand women’s experiences and perceptions of antenatal booking a qualitative study design investigating early ANC booking was conducted. This study was critical in generating preliminary data to help improve maternal health outcomes consistent with the Sustainable Development Goal number five which aims to improve maternal health.
Delayed antenatal care booking is still common amongst women in developing countries even though there are advantages in early booking as revealed by several studies from researchers in Africa (Solarin et al., 2012). There are limited research studies explicating reasons for early or late entry into antenatal care services among women in The Gambia. Therefore, this study was conducted to increase our knowledge and understanding of the contributory factors related to late booking for ANC by women to inform the design and implementation of effective interventions to address this critical public health issue. Early booking to antenatal care services by Gambian women allows for physiological, psychological and cultural issues or concerns to be addressed. Additionally, maternal fetal well-being and the overall pregnancy status of the woman are monitored (Littleton et al., 2001).
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to determine the impact of Late Antenatal Booking and Its Predictions among Pregnant Women.
1.3 Statement of Problems
Investigation revealed that the late antenatal booking is still a problem making the accomplishment of WHO recommendation of eight contacts before delivery a big problem. Women affirmed that they appreciated when they were given a positive treatment by the nurses. This gave them confidence and they were able to confide in the nurses when they had problems. Hence ANC provided an avenue for information giving, establishing a positive provider/client relationship that brought about great understanding of whatever the women were experiencing.
Unpleasant nurses’ attitudes were reported by the women. They said that though not all nurses behaved negatively towards the women during ANC, a number of the nurses were “arrogant and they harassed” the women for coming late for antenatal visits. The nurses did not take the extra effort to find out what problems the women might have that led to their coming late. Women reported that there were instances they are shouted at when they asked questions or their antenatal cards were thrown back at them and were asked to come back at a later date for ANC care.
1.4 Aim and Objectives of Study
The aim of the study is to determine the impact of Late Antenatal Booking and Its Predictions among Pregnant Women. In achieving this aim, the following specific objectives were laid out as follows:
- To explore the perceptions of antenatal women towards late antenatal care access.
- To investigate the effect of late antenatal booking by pregnant women in Enugu State PHC.
- To identify barriers and facilitating factors to late antenatal care services booking by pregnant women.
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:
- Are there factors facilitating late antenatal care services booking by pregnant women?
- What are the perceptions of antenatal women towards late antenatal care access?
- What is the effect of late antenatal booking by pregnant women in Enugu State PHC?
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.
Hypothesis One
- H0: There are no significant factors facilitating late antenatal care services booking by pregnant women
- H1: There are significant factors facilitating late antenatal care services booking by pregnant women
1.7 Significance of Study
This study will be of immense benefit to Antenatal Mothers, Nurses, Midwifery students and other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of the research is focused on Late Antenatal Booking and Its Predictions among Pregnant Women in Enugu State Primary Health Care (PHC) Centre.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- 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.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- 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).
1.10 Operational Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Mortality: The number of death in a particular situation or period of time.
Perception: To notice something in a particular way or hold a view about something.
