A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe

Objective: to describe the perspectives and experiences of women in their use of antenatal care and in their reasoning on specific antenatal care routines. Design: two qualitative methods including focus group discussions and individual interviews were combined. Setting: a rural district in Zimbabwe where a randomised control trial had been undertaken to introduce a new antenatal care package. Participants: forty-four women and twenty-four men participated in the study. Findings: women were observed to take actions contrary to those assumed professionally acceptable in antenatal care generally and in some specific changed routines. Visits were to be reduced and weighing was to be omitted, but women, especially younger women, said they preferred more than the stipulated five goat oriented visits. One reason for this was the importance of being assured that the fetus was growing well. They considered that visits spaced too widely would make it difficult for service providers to help, should complications develop. On the other hand, older women (above 35 years old), a group professionally considered to be at high risk, were not so concerned with the visits. All the women said they wanted to be weighed at all the visits. The antenatal care visits are simply known as 'going for scale'. The health care providers complied by weighing the women without recording. Cultural beliefs had great influence, especially on the time a pregnancy is acknowledged and reported. It is believed that pregnant women and the pregnancy are vulnerable to witchcraft during the early period of pregnancy. Conclusions and implications for practice: we concluded that, whether in its traditional or new form, antenatal care ignores the experiences and views of women and the way they make sense of pregnancy and the care of pregnancy. The importance of understanding the perspectives of different stakeholders as the key to effective change is underlined. (C) 2004 Elsevier Ltd. All rights reserved.