J Korean Med Sci.  2019 Feb;34(7):e62. 10.3346/jkms.2019.34.e62.

What are the Barriers to Antenatal Care Utilization in Rufisque District, Senegal?: a Bottleneck Analysis

  • 1Institute for Environmental Health, Korea University, Seoul, Korea. shine@korea.ac.kr
  • 2Graduate School of Public Health, Korea University, Seoul, Korea.
  • 3Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
  • 4Better World Senegal Agency of Maternal and Child Health Grant, Rufisque, Senegal.
  • 5College of Life Science and Biotechnology, Korea University, Seoul, Korea.


This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers.
Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal.
Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization.
To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.


Senegal; Antenatal Care; Health Care Utilization; Maternal Health; Newborn Health

MeSH Terms

Abortion, Spontaneous
Community Health Workers
Focus Groups
Health Facilities
Health Information Systems
Infant Health
Infant, Newborn
Maternal Health
Patient Acceptance of Health Care
Pregnant Women
Social Distance
Social Stigma
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