Pregnant Women’s Experiences with Midwifery-Led Antenatal Care Services in Peri-Urban Communities in Karachi, Pakistan

Abstract

Purpose

To understand pregnant women’s experience with midwifery-led antenatal care services using the Respectful Maternity Care charter in primary health centers in Karachi, Pakistan.

Methods

This cross-sectional study was at Rehri Goth and Ibrahim Hyderi, two peri-urban communities in Karachi, Pakistan, where women receive antenatal care services. All pregnant women in their third trimester who consented during the study period were included. The participants were asked about access to care, antenatal care experience, person-centered approach, and general satisfaction with the facility using a pre-designed questionnaire. These themes were mapped onto the universal Respectful Maternity Care charter. Descriptive statistics were used to summarize the findings in each of these themes. Multivariable logistic regression techniques to determine the relationship between the dependent and independent variables.

Results

There were 904 women who agreed to participate in this study during January to December 2021. Majority of the women (94%, n=854) were satisfied with the operating hours and cleanliness. More than 90% of the women reported positive experiences regarding privacy, respectful treatment by midwives, and non-discriminatory care. However, 40% (n=362) of the women reported not receiving adequate information and informed consent before a medical procedure, while 65% (n=587) reported poor counseling for birth preparedness. Maternal age, women’s occupation, women’s education, and parity were found to be significantly associated with respect provided, satisfaction with counseling and the consent process.

Conclusion

This study reported satisfaction of pregnant women with the facility’s ambiance, respect, and care; however, poor communication skills regarding consent and antenatal counseling were reported. The findings suggest the need for more efficient strategies, such as regular respectful maternity care and technical training to strengthen midwife-patient interactions and enhance overall satisfaction, thus improving maternal and newborn outcomes.

Keywords:

• antenatal care
• patient satisfaction
• Respectful Maternity Care
• Pakistan

Abbreviations

ANC, Antenatal care; PHC, Primary Health Centre; RMC, Respectful Maternity Care; LMICs, Lower-Middle-Income-Countries; PMMS, Pakistan Maternal Mortality Survey; CMW, Community Midwife; MMR, Maternal Mortality Ratio; SDG, Sustainable Development Goals; CEI, Client Exit Interview; DHS, Demographic Health Survey; SPA, Service Provision Assessment; BMGF, Bill & Melinda Gates Foundation; PRiSMA, Pregnancy Risk Stratification Innovation and Measurement Alliance.

Data Sharing Statement

Researchers may request access to anonymized participant-level data from the corresponding author.

Ethical Approval and Informed Consent

The Aga Khan University Ethics Review Committee approved the study (2021-5920-15518). Consent was obtained by the study participants prior to study commencement.

Acknowledgments

The authors are grateful to the participants who voluntarily took part in this study and the data collectors for their help in data collection.

Disclosure

The authors declare no competing interests.

Additional information

Funding

The PRiSMA study was funded by the Bill &Melinda Gates Foundation (BMGF) (INV-005776). The funders had no involvement in any stages, from study design to manuscript submission for publication.