Utilization, satisfaction, and barriers to antenatal care among pregnant women in Gadarif State during the Sudan war: a cross-sectional study

Background Healthcare services during wartime face significant challenges. Pregnant women seeking antenatal care (ANC) during the Sudan conflict encounter numerous barriers, impacting their access and satisfaction. This study assessed ANC utilization, satisfaction, and barriers faced by pregnant women in Gadarif State during the ongoing war. Methods This cross-sectional study was conducted at Gadarif Hospital for Obstetrics and Gynecology from September to November 2024, targeting women who had given birth at the hospital. A questionnaire with four sections assessed utilization, satisfaction, and barriers with ANC during wartime. Cross-tabulations and chi-square tests analyzed associations between categorical variables, with p-values < 0.05 considered significant. Results A total of 345 pregnant women participated in this study. ANC utilization was reflected in a median of 4.0 visits (IQR = 2.0), with the first visit occurring at a median of 13 weeks (IQR = 13). Overall, 90.4% of participants reported being satisfied with ANC services, although satisfaction with interpersonal communication skills was the lowest at 6.4%. Barriers to access included lack of privacy (33.3%) and irregular facility operating hours (21.4%), while the primary reasons for missing ANC visits were transport challenges and the absence of night-duty staff. Conclusion This study revealed a surprisingly high level of satisfaction with ANC services, despite key barriers such as lack of privacy and irregular health facility operating hours. While ANC attendance was relatively good, visits tended to start later than recommended. Interventions should focus on addressing these barriers by improving service accessibility and ensuring consistent care. Enhancing early engagement with ANC is also critical to improving maternal health outcomes.