Exploring Perceptions about Enablers of Women’s Attendance and Adherence to the Recommended Antenatal Care Visits in Rwanda: A Qualitative Study

Abstract

Background Antenatal care (ANC) helps ensure the best health conditions of the mother and foetus during pregnancy. However, achieving optimal ANC attendance and adherence to the World Health Organization (WHO) recommendations remains a global challenge, with significant disparities in attendance rates. A qualitative study was conducted exploring pregnant women's perspectives of various enablers to their attendance and adherence to recommended ANC visits in Rwanda. Methods This exploratory qualitative study involved 22 pregnant women attending ANC in four public health centres in the Eastern province, of Rwanda. An interview guide with semi-structured questions was used to gather information about the moderators of ANC attendance and adherence among pregnant women. Data were audio-recorded and transcribed verbatim, and thematic analysis was used to categorize themes under the five-level Social Ecological Model (SEM). Results Early recognition of pregnancy, financial stability, and female participation in decision-making were identified as intrapersonal enabling factors of ANC attendance and adherence; spousal support was identified as an interpersonal enabling factor; community health workers, and community relationships as community enabling factors; availability and cost of ANC services as institutional enabling factors; and media campaign, community outreach as public policy enabling factors contributing to the pregnant women's attendance and adherence to ANC visits. Conclusion Enablers at multiple levels affect women’s attendance and adherence to ANC visits. It is essential to consider each level when implementing effective strategies to maximize ANC attendance and adherence to the WHO recommendations in order to improve maternal-foetal well-being in Rwanda.