EXPLORING ANTENATAL CARE UTILIZATION PATTERNS AMONG URBAN SLUM DWELLERS IN PUNJAB: AN ETHNOGRAPHIC STUDY

Abstract

Background: Pakistan’s population is estimated to be 241 million. It ranks third among the ten high-burden countries and accounts for up to 7% of worldwide neonatal deaths. According to the World Health Organization (WHO 2010) health profile, only 28% of Pakistani women have used antenatal care services (4 plus visits), whilst 39% of reported births in Pakistan had used skilled birth attendant services, whereas 59% fell within the WHO’s regional average. There is also a significant disparity, reported by the WHO, in terms of inequity between the poor and the rich in the use of skilled birth attendant services: 16% and 77% respectively.

Objective: This ethnographic study explores the perceptions about the need for antenatal care (ANC) in a disadvantaged population in the Punjab, Pakistan.

Method: This is an Ethnographic study which makes use of standard methods such as non-participant observation, semi-structured interviews, and documentary review. Data was collected over 4 months and was analyzed thematically. Key informants assisted in understanding the community norms. Open-ended answer options were used in the questionnaire.

Setting: The community in this case was an urban squatter settlement by the name of Shamspura Colony, Lahore, which is the neighborhood of the poor people.

Results: A significant proportion of women (63%) do not perceive antenatal care (ANC) as beneficial, and only 41% of husbands are very supportive of ANC. The majority of women (83%) prefer institutional deliveries, with 51% opting for hospitals and 32% preferring clinics with skilled birth attendants, but knowledge about ANC benefits is limited (29% aware, 51% limited knowledge, and 20% no knowledge). Husbands (43%) and mothers-in-law (31%) play a significant role in healthcare decision-making, while women's autonomy is low, with only 3% making decisions about their own healthcare.

Conclusions: This is a qualitative study which helps to explore perceptions and attitudes of women towards ANC, through contextual data. The study shows that denied access to ANC services is a result of lack of resources, limited mobility and cultural factors.