Prevalence, Trends, and Determinants of at Least Four Antenatal Visits in Malawi: Analyses of the Malawi Demographic and Health Surveys 1992–2016

Main Article Content

Martin Enock Palamuleni


This study aims to determine the prevalence, trends, and determinants of at least four antenatal visits in Malawi. The study used Demographic and Health Surveys from 1992 to 2016. The study population consisted of women who gave birth to at least one child within 60 months before the survey. Chi-square test and logistic regression analyses were used to establish the relationships between dependent and independent variables. The percentage of pregnant women who had at least four antenatal visits was 63.8% in 1992, 56.7% in 2000, 57.7% in 2004, 44.5% in 2010, and 50.6% in 2016. In 2016, the pregnant women less likely to have four or more antenatal visits were aged 15–19 years (OR = 0.51, 95% CI = 0.38–0.69), not using family planning (OR = 0.89, 95% CI = 0.80–0.98), not working (OR = 0.81, 95% CI = 0.76–0.88) and had no education (OR = 0.75, 95% CI = 0.65–0.87). Women residing in urban areas (OR = 1.28, 95% CI = 1.14–1.44), having 1–2 children ever born (OR = 1.30, 95% CI = 1.12–1.50), were more likely to have four or more antenatal visits. In 2010, women residing in the Northern Region (OR = 1.26, 95% CI = 1.05–1.52) were more likely to have four or more antenatal visits, whereas poor women (OR = 0.78, 95% CI = 0.69–0.88) were less likely. The study recommends that poor, uneducated, rural women with high parity should be encouraged to utilize antenatal care services through social and behavior change communication campaigns.


Download data is not yet available.

Article Details

Research Articles
Author Biography

Martin Enock Palamuleni, Population Studies and Demography & Population and Health Research Entity, North-West University, South Africa

Corresponding author


Abosse, Z., Woldie, M., & Ololo, S. (2010). Factors influencing antenatal care service utilization in Hadiya Zone. Ethiopian Journal of Health Sciences, 20(2), 75–82.

Acharya, D., Khanal, V., Singh, J. K., Adhikari, M., & Gautam, S. (2015). Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal. BMC Research Notes, 8, Article 345.

Adow, I., Mwanzo, I., Agina, O., Wanzala, P., & Kariuki, J. (2020). Uptake of antenatal care services among women of reproductive age in Mandera County, Kenya. African Journal of Health Sciences, 33(1), 56–69.

Ahuru, R. R., & Omon, I. J. (2019). Predictors of antenatal care utilization in primary healthcare centers in eight rural communities in Delta State, Nigeria. African Journal of Health Economics, 8(1), 1–22.

Akowuah, J. A., Agyei-Baffour, P., & Awunyo-Vitor, D. (2018). Determinants of antenatal healthcare utilisation by pregnant women in third trimester in peri-urban Ghana. Journal of Tropical Medicine, 2018, Article 1673517.

Arthur, E. (2012). Wealth and antenatal care use: Implications for maternal health care utilisation in Ghana. Health Economics Review, 2(1), Article 14.

Awusi, V. O., Anyanwu, E. B., & Okeleke, V. (2009). Determinants of antenatal care services utilization in Emevor Village, Nigeria. Benin Journal of Postgraduate Medicine, 11(1), 21–26.

Basha, G. W. (2019). Factors affecting the utilization of a minimum of four antenatal care services in Ethiopia. Obstetrics and Gynecology International, 2019, Article 5036783.

Bawa, S. B., Umar, U. S., & Onadeko, M. (2004). Utilization of obstetric care services in a rural community in southwestern Nigeria. African Journal of Medicine and Medical Sciences, 33(3), 239–244.

Bbaale, E. (2011). Factors influencing timing and frequency of antenatal care in Uganda. The Australasian Medical Journal, 4(8), 431–438.

Birungi, H., Nyarko, P., Armar-Klemesu, M., Arhinful, D., Deganus, S., Odoi-Agyarko, H., & Brew, G. (2006). Acceptability and feasibility of introducing the WHO focused antenatal care package in Ghana. (FRONTIERS Final Report). Population Council.

Birungi, H., & Onyango-Ouma, W. (2006). Acceptability and sustainability of the WHO Focused Antenatal Care package in Kenya. (FRONTIERS Final Report). Population Council.

Chanza, D., Chirwa, E., Maluwa, A., Malata, A., & Masache, G. (2012). Factors affecting the choice for home deliveries in Malawi. African Journal of Midwifery and Women's Health, 6(3), 125–130.

Chimatiro, C. S., Hajison, P., Chipeta, E., & Muula, A. S. (2018). Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District-Malawi. Reproductive Health, 15, Article 158.

Dowswell, T., Carroli, G., Duley, L., Gates, S., Gülmezoglu, A. M., Khan‐Neelofur, D., & Piaggio, G. (2015). Alternative versus standard packages of antenatal care for low‐risk pregnancy. Cochrane Database of Systematic Reviews, 2015(7), Article CD000934.

Edward, B. (2011). Factors influencing the utilisation of antenatal care content in Uganda. The Australasian Medical Journal, 4(9), 516–526.

Efendi, F., Chen, C.-M., Kurniati, A., & Berliana, S. M. (2017). Determinants of utilization of antenatal care services among adolescent girls and young women in Indonesia. Women & Health, 57(5), 614–629.

Gajate-Garrido, G. (2013). The impact of adequate prenatal care on urban birth outcomes: An analysis in a developing country context. Economic Development and Cultural Change, 62(1), 95–130.

Gebremeskel, F., Dibaba, Y., & Admassu, B. (2015). Timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch Town and Arba Minch District, Gamo Gofa Zone, South Ethiopia. Journal of Environmental and Public Health, 2015, Article 971506.

Girum, T., & Wasie, A. (2017). Correlates of maternal mortality in developing countries: An ecological study in 82 countries. Maternal Health, Neonatology and Perinatology, 3, Article 19.

Guliani, H., Sepehri, A., & Serieux, J. (2014). Determinants of prenatal care use: Evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America. Health Policy and Planning, 29(5), 589–602.

Hossain, B., & Hoque, A. A. (2015). Women empowerment and antenatal care utilization in Bangladesh. The Journal of Developing Areas, 49(2), 109–124.

Joshi, C., Torvaldsen, S., Hodgson, R., & Hayen, A. (2014). Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data. BMC Pregnancy and Childbirth, 14, Article 94.

Kazanga, I., Munthali, A. C., McVeigh, J., Mannan, H., & MacLachlan, M. (2019). Predictors of utilisation of skilled maternal healthcare in Lilongwe District, Malawi. International Journal of Health Policy and Management, 8(12), 700–710.

Kitui, J., Lewis, S., & Davey, G. (2013). Factors influencing place of delivery for women in Kenya: An analysis of the Kenya demographic and health survey, 2008/2009. BMC Pregnancy and Childbirth, 13, Article 40.

Kurniati, A., Chen, C. M., Efendi, F., & Berliana, S. M. (2018). Factors influencing Indonesian women's use of maternal health care services. Health Care for Women International, 39(1), 3–18.

Kuuire, V. Z., Kangmennaang, J., Atuoye, K. N., Antabe, R., Boamah, S. A., Vercillo, S., Amoyaw, J. A., & Luginaah, I. (2017). Timing and utilisation of antenatal care service in Nigeria and Malawi. Global Public Health, 12(6), 711–727.

Lungu, F., Malata, A., Chirwa, E., & Mbendera, I. (2011). Quality assessment of focused antenatal care services in Malawi. African Journal of Midwifery and Women's Health, 5(4), 169–175.

Machira, K. (2017). Determinants of maternal health care services utilization in Malawi. [Unpublished doctoral dissertation]. North-

West University.

Mamba, K. C., Muula, A. S., & Stones, W. (2017). Facility-imposed barriers to early utilization of focused antenatal care services in Mangochi District, Malawi – A mixed methods assessment. BMC Pregnancy and Childbirth, 17, Article 444.

Manda-Taylor, L., Sealy, D. A., & Roberts, J. (2017). Factors associated with delayed antenatal care attendance in Malawi: Results from a qualitative study. Medical Journal of Zambia, 44(1), 17–25.

Mchenga, M., Burger, R., & von Fintel, D. (2019). Examining the impact of WHO’s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi: A retrospective study. BMC Health Services Research, 19, Article 295.

Mekonnen, Y., & Mekonnen, A. (2003). Factors influencing the use of maternal healthcare services in Ethiopia. Journal of Health, Population, and Nutrition, 21(4), 374–382.

Ministry of Health, & ICF International. (2014). Malawi Service Provision Assessment (SPA) 2013–14. Ministry of Health and ICF International.[Oct-7-2015].pdf

Mrisho, M., Obrist, B., Schellenberg, J. A., Haws, R. A., Mushi, A. K., Mshinda, H., Tanner, M., & Schellenberg, D. (2009). The use of antenatal and postnatal care: Perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy and Childbirth, 9, Article 10.

Mulat, G., Kassaw, T., & Aychiluhim, M. (2015). Antenatal care service utilization and its associated factors among mothers who gave live birth in the past one year in Womberma Woreda, North West Ethiopia. Epidemiology S2, Article 003.

National Statistical Office. (1994). Malawi Demographic and Health Survey 1992. National Statistical Office.

National Statistical Office, & ICF. (2017). Malawi Demographic and Health Survey 2015–16. National Statistical Office and ICF.

National Statistical Office, & ICF Macro. (2011). Malawi Demographic and Health Survey 2010. National Statistical Office and ICF Macro.

National Statistical Office, & ORC Macro. (2001). Malawi Demographic and Health Survey 2000. National Statistical Office and ORC Macro.

National Statistical Office, & ORC Macro. (2005). Malawi Demographic and Health Survey 2004. National Statistical Office and ORC Macro.

Nghargbu, R., & Olaniyan, O. (2019). Determinants of antenatal care utilization in Nigeria. (Working Paper No. 321). African Development Bank.

Ochako, R., & Gichuhi, W. (2016). Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya. Reproductive Health, 13, Article 51.

Okeshola, F. B., & Sadiq, I. T. (2013). Determinants of home delivery among Hausa in Kaduna South local government area of Kaduna State, Nigeria. American International Journal of Contemporary Research, 3(5), 78–85.

Osmani, A. K., Reyer, J. A., Osmani, A. R., & Hamajima, N. (2015). Factors influencing contraceptive use among women in Afghanistan: secondary analysis of Afghanistan Health Survey 2012. Nagoya Journal of Medical Science, 77(4), 551–561.

Osorio, A. M., Tovar, L. M., & Rathmann, K. (2014). Individual and local level factors and antenatal care use in Colombia: A multilevel analysis. Cadernos de Saúde Pública, 30(5), 1079–1092.

Ousman, S. K., Mdala, I., Thorsen, V. C., Sundby, J., & Magnus, J. H. (2019). Social determinants of antenatal care service use in Ethiopia: Changes over a 15-year span. Frontiers in Public Health, 7, Article 161.

Palamuleni, M. E. (1993). Population Dynamics in Malawi: A Re-examination of Existing Demographic Data. [Unpublished doctoral dissertation]. The University of London.

Palamuleni, M. E. (2011). Determinants of non-institutional deliveries in Malawi. Malawi Medical Journal, 23(4), 104–108.

Palamuleni, M. E. (2014). Social and economic factors affecting ethnic fertility differentials in Malawi. International Journal of Development and Sustainability, 3(1–2), 70–88.

Pandey, S., & Karki, S. (2014). Socio-economic and demographic determinants of antenatal care services utilization in Central Nepal. International Journal of MCH and AIDS, 2(2), 212–219.

Pulok, M. H., Sabah, M. N. U., Uddin, J., & Enemark, U. (2016). Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie? BMC Pregnancy and Childbirth, 16, Article 200.

Ram, F., & Singh, A. (2006). Is antenatal care effective in improving maternal health in rural Uttar Pradesh? Evidence from a district level household survey. Journal of Biosocial Science, 38(4), 433–448.

Saad–Haddad, G., DeJong, J., Terreri, N., Restrepo–Méndez, M. C., Perin, J., Vaz, L., Newby, H., Amouzou, A., & Barros, A. J. (2016). Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries. Journal of Global Health, 6(1), Article 010404.

Say, L., & Raine, R. (2007). A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bulletin of the World Health Organization, 85(10), 812–819.

Tsawe, M., Moto, A., Netshivhera, T., Ralesego, L., Nyathi, C., & Susuman, A. S. (2015). Factors influencing the use of maternal healthcare services and childhood immunization in Swaziland. International Journal for Equity in Health, 14, Article 32.

Tuladhar, H. (2009). Determinants of home delivery in a semi urban setting of Nepal. Nepal Journal of Obstetrics and Gynecology, 4(1), 30–37.

Umar, A. S. (2017). The use of maternal health services in Nigeria: Does ethnicity and religious beliefs matter? MOJ Public Health, 6(6), 442–447.

UNICEF. (April 2021). Antenatal care. [Data set]. UNICEF.

Villar, J., Ba’aqeel, H., Piaggio, G., Lumbiganon, P., Miguel Belizán, J., Farnot, U., Al-Mazrou, Y., Carroli, G., Pinol, A., Donner, A., Langer, A., Nigenda, G., Mugford, M., Fox-Rushby, J., Hutton, G., Bergsjø, P., Bakketeig, L., Berendes, H., Garcia, J., & WHO Antenatal Care Trial

Research Group. (2001). WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet, 357(9268), 1551–1564.

World Health Organization (WHO). (2002). WHO antenatal care randomized trial: manual for the implementation of the new model. World Health Organization.

World Health Organization (WHO). (2016). WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.

Zakar, R., Zakar, M. Z., Aqil, N., Chaudhry, A., & Nasrullah, M. (2017). Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan Demographic and Health Survey, 2012–13. Journal of Obstetrics and Gynecology, 37(3), 330–337.