Women’s Beliefs about the Utilization of Antenatal Services and their Determinants: A Qualitative Study in Three Townships of Chin State, Myanmar

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Myo Tun
Sauwakon Ratanawijitrasin
Darunee Phukao
Seung Chung Paek


Although the health care resources in Chin State are comparable to those in other regions, the indicators of maternal health status there are the poorest in Myanmar. While the Myanmar government has initiated health care system reforms, the increase in service capacity alone is a necessary but insufficient condition to improve access. Because the effectiveness of antenatal care is critical in terms of reducing maternal mortality and serious morbidity, this study determines how womens beliefs affect the utilization of antenatal services. The qualitative study analyzes in-depth interviews with 25 women who had given birth during the past year in both rural and urban areas of three townships in Chin State. The results show that womens beliefs strongly influence the utilization of antenatal services. The women did not recognize pregnancy risks or the benefits of antenatal services. They also did not trust the staff in the formal health care sector, and their trust in traditional birth attendants served as a barrier to utilization of antenatal service. To improve utilization, policymakers must understand the sociocultural context of women, as well as their beliefs and trust related to antenatal care, and should design policy to address the relevant influencing factors.


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Tun, M., Ratanawijitrasin, S., Phukao, D., & Paek, S. C. (2018). Women’s Beliefs about the Utilization of Antenatal Services and their Determinants: A Qualitative Study in Three Townships of Chin State, Myanmar. Journal of Population and Social Studies [JPSS], 27(1), 23 - 38. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/134998
Author Biography

Myo Tun, Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Thailand and Department of Preventive and Social Medicine, University of Medicine, Myanmar

Corresponding author


• Abrahams, N., Jewkes, R. & Mvo, Z. (2001). Health care–seeking practices of pregnant women and the role of the midwife in Cape Town, South Africa. Journal of Midwifery & Women’s health, 46(4), 240-247.
• Agus, Y., Horiuchi, S. & Porter, S. E. (2012). Rural Indonesia women’s traditional beliefs about antenatal care. BMC research notes, 5(1), 589.
• Andersen, R. M., McCutcheon, A., Aday, L. A., Chiu, G. Y. & Bell, R. (1983). Exploring dimensions of access to medical care. Health services research, 18(1), 49.
• Atuoye, K. N., Dixon, J., Rishworth, A., Galaa, S. Z., Boamah, S. A. & Luginaah, I. (2015). Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana. BMC health services research, 15(1), 333.
• Bilanceri, S. (2015). Chin State still struggling with the effects of the flood. Retrieved from http://www.mizzima.com/news-features/chin-state-still-struggling-effects-flood
• Bredesen, J. A. (2013). Women’s use of healthcare services and their perspective on healthcare utilization during pregnancy and childbirth in a small village in Northern India. American Internal Journal of Contemporary Research, 3(6), 1-9.
• Carroli, G., Rooney, C. & Villar, J. (2001). How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol, 15 Suppl 1, 1-42.
• Chiang, C., Labeeb, S. A., Higuchi, M., Mohamed, A. G. & Aoyama, A. (2013). Barriers to the use of basic health services among women in rural southern Egypt (Upper Egypt). Nagoya J Med Sci, 75(3-4), 225-231.
• Chou, W. Y., Prestin, A., Lyons, C. & Wen, K. Y. (2013). Web 2.0 for health promotion: reviewing the current evidence. Am J Public Health, 103(1), e9-18. doi:10.2105/AJPH.2012.301071
• Choudhury, N. & Ahmed, S. M. (2011). Maternal care practices among the ultra poor households in rural Bangladesh: A qualitative exploratory study. BMC Pregnancy Childbirth, 11(1), 1.
• Department of Population of Myanmar. (2015). Department of Population, Ministry of Immigration and Population, The Republic of the Union of Myanmar: The 2014 Myanmar Population and Housing Census - Chin State: Census Reposrt Volume 3-D. Retrieved from http://www.dop.gov.mm/moip/index.php?route=product/product&path=54&product_id=89
• Elo, S. & Kyngas, H. (2008). The qualitative content analysis process. J Adv Nurs, 62(1), 107-115. doi:10.1111/j.1365-2648.2007.04569.x
• Ganle, J. K., Parker, M., Fitzpatrick, R. & Otupiri, E. (2014). A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy Childbirth, 14(1), 1.
• Health, M. O., Sports - MoHS/Myanmar & ICF. (2017). Myanmar demographic and health survey 2015-16. Retrieved from Nay Pyi Taw, Myanmar: http://dhsprogram.com/pubs/pdf/FR324/FR324.pdf
• Janz, N. K. & Becker, M. H. (1984). The health belief model: A decade later. Health Education & Behavior, 11(1), 1-47.
• Jat, T. R., Ng, N. & San Sebastian, M. (2011). Factors affecting the use of maternal health services in Madhya Pradesh state of India: a multilevel analysis. International journal for equity in health, 10(1), 1.
• Lama, S. & Krishna, A. (2015). Barriers in utilization of maternal health care services: Perceptions of rural women in Eastern Nepal. Kathmandu University Medical Journal, 12(4), 253-258.
• Mathole, T., Lindmark, G., Majoko, F. & Ahlberg, B. M. (2004). A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe. Midwifery, 20(2), 122-132.
• Mehretie Adinew, Y. & Abera Assefa, N. (2017). Experience of facility based childbirth in rural Ethiopia: An exploratory study of women's perspective. J Pregnancy, 2017, 7938371. doi:10.1155/2017/7938371
• Ministry of Immigration and Population. (2015). The 2014 Myanmar population and housing census: Chin state. Census Report Volume 3-D.
• Ministry of National Planning and Economic Development, Ministry of Health, & UNICEF. (2011). Myanmar multiple cluster indicator survey 2009 - 2010: Monitoring the situation of children and women
• Ministry of National Planning and Economic Development, & UNICEF. (2012). Ministry of National Planning and Economic Development, UNICEF: Situation analysis of children in Myanmar. Retrieved from https://www.unicef.org/eapro/Myanmar_Situation_Analysis.pdf
• Mubyazi, G. M., Bloch, P., Magnussen, P., Olsen, Ø. E., Byskov, J., Hansen, K. S. & Bygbjerg, I. C. (2010). Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services: a qualitative study from two districts in rural Tanzania. Malaria journal, 9(1), 1.
• Myanmar Institute for Integrated Development, Chin State Government & UNICEF. (2014). Child focused local social plan Chin state: A policy document supporting Chin state’s comprehensive 5-year development plan and annual planning 2016 – 2021.
• Myanmar. Department of Population. (2016). The 2014 Myanmar population and housing census: Thematic report on maternal mortality. Nay Pyi Taw: UNFPA.
• Myanmar. Ministry of Health. (2010). Myanmar health statistics 2010. Retrieved from http://www.myanmarhdc.org/Myanmar%20Health%20Statistics%202010.pdf
• Myanmar. Ministry of Health. (2014). Health in Myanmar 2014. Retrieved from http://mohs.gov.mm/content/publication/list?category=Health%20in%20Myanmar&pagenumber=1&pagesize=40
• Myer, L. & Harrison, A. (2003). Why do women seek antenatal care late? Perspectives from rural South Africa. Journal of Midwifery & Women’s health, 48(4), 268-272.
• Oladapo, O. T. & Osiberu, M. O. (2009). Do sociodemographic characteristics of pregnant women determine their perception of antenatal care quality? Matern Child Health J, 13(4), 505-511. doi:10.1007/s10995-008-0389-2
• Penchansky, R. & Thomas, J. W. (1981). The concept of access: definition and relationship to consumer satisfaction. Medical care, 19(2), 127-140.
• Pretorius, C. & Greeff, M. (2004). Health-service utilization by pregnant women in the greater Mafikeng-Mmabatho district. Curationis, 27(1), 72-81.
• Silal, S. P., Penn-Kekana, L., Harris, B., Birch, S. & McIntyre, D. (2012). Exploring inequalities in access to and use of maternal health services in South Africa. BMC health services research, 12(1), 1.
• Simkhada, B., Porter, M. A. & Van Teijlingen, E. R. (2010). The role of mothers-in-law in antenatal care decision-making in Nepal: a qualitative study. BMC Pregnancy Childbirth, 10(1), 1.
• United Nations. (2008). Fact sheet: High-level event on the millennium development goals, United Nations Headquarters, New York, 25 September 2008. Retrieved from http://www.un.org/millenniumgoals/2008highlevel/pdf/newsroom/Goal%205%20FINAL.pdf
• United Nations. (2015). United Nations: The millennium development goals report 2015 Retrieved from http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201).pdf
• Withers, M., Kharazmi, N. & Lim, E. (2018). Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery, 56, 158-170. doi:10.1016/j.midw.2017.10.019
• Worku, A. G., Yalew, A. W. & Afework, M. F. (2013). Factors affecting utilization of skilled maternal care in Northwest Ethiopia: a multilevel analysis. BMC international health and human rights, 13(1), 1.
• World Health Organization. (2016a). World Health Organization, Media centre: maternal mortality. Retrieved from http://www.who.int/mediacentre/factsheets/fs348/en/
• World Health Organization. (2016b). World Health Organization, Media centre: pregnant women must be able to access the right care at the right time, says WHO. Retrieved from http://www.who.int/mediacentre/news/releases/2016/antenatal-care-guidelines/en/
• World Health Organization. (2016c). World Health Organization, Sexual and reproductive health: What matters to women during pregnancy - a different approach to antenatal care. Retrieved from http://www.who.int/reproductivehealth/topics/maternal_perinatal/anc/en/
• Yakob, B. & Ncama, B. P. (2016). A socio-ecological perspective of access to and acceptability of HIV/AIDS treatment and care services: A qualitative case study research. BMC public health, 16, 155. doi:10.1186/s12889-016-2830-6

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