Association between antenatal care service utilization and birth preparedness among Tanzanian pregnant women: A cross-sectional study

Abstract

BACKGROUND: Improving pregnant women's birth preparedness to influence their choice of institutional birth is crucial for reducing pregnancy-related mortality in Tanzania. Attending antenatal care (ANC) may benefit birth preparedness, as women could learn how to prepare better for giving birth during the ANC. However, the epidemiological data is limited in Tanzania. This study aimed to investigate the association between ANC utilization and birth preparedness among Tanzanian pregnant women. METHODS: We performed a cross-sectional analysis using baseline data of 656 pregnant women who participated in an educational app intervention study from November 2021 to February 2022 in Dar es Salaam, Tanzania. High utilization of ANC was defined as ANC visits ≥ 4 and initiating ANC in the first trimester. Birth preparedness was evaluated using the 24-item Birth Preparedness Questionnaire, with a pre-defined cut-off point of the top 20 percentile to indicate a high level of birth preparedness. We used multivariable logistic regression models to examine the association between ANC utilization and birth preparedness. RESULTS: The mean (SD) age of participants was 27 (5) years old. The proportion of high utilization of ANC was 66.5 %, and the median (IQR) birth preparedness total score was 68 (68-70) points. Compared with women who had low ANC utilization, those who had high ANC utilization were significantly associated with an increased likelihood of a high level of birth preparedness (unadjusted OR=1.70, 95 % CI = 1.20 - 2.40). This association remained statistically significant after adjustment for potential covariates (adjusted OR=1.76, 95 % CI= 1.23 - 2.52). Subgroup analysis revealed that the association between ANC utilization and birth preparedness didn't vary by parity. CONCLUSION: High utilization of ANC was associated with increased birth preparedness, independent of parity, suggesting the importance of addressing barriers to accessing ANC and promoting early and active ANC attendance for planned institutional birth with skilled birth attendants (SBAs).