CHAPTER ONE

INTRODUCTION

• Background to the study

Globally, the number of women dying due to complications during pregnancy and childbirth decreased by nearly 50% from 1990 to 2013 but the number of deaths remain unacceptably high especially in low-income countries where 99% of these deaths occur (Bustreo, Say, Koblinsky, Pullum, Temmerman, Pablos-Méndez; WHO, 2014). The SDG goals include reducing maternal and neonatal mortality and morbidity worldwide (Bhuttaet al., 2015). The strategies used to achieve these goals include family planning, skilled attendance during pregnancy (Antenatal Awareness) and safe delivery, and access to emergency obstetric care (UNFPA, 2010). Antenatal care (ANC) refers to the care of pregnant women using evidence-based interventions that are considered beneficial. WHO consider it essential that all women are offered tetanus toxoid immunization, screening and treatment of anemia and syphilis, and are examined for pregnancy related complications such as hypertensive disorders and mal-presentations. HIV screening is recommended in as a situational intervention, i.e. in endemic areas by (WHO, 2009). Client provider-interaction remains the core of clinical practice and a medium to enhance antenatal awareness and the care offered should be acceptable for both the health care professional and the client (Langer et al., 2002; Wilkinson & Callister, 2009). Clients’ health care seeking behavior worldwide has been assumed to be the result of clients’ individual characteristics, patients’ identified needs, health status, patients’ satisfaction, the structure of the health care system, and the external environment such as the infrastructure (Trinh et al., 2007; Bruce, 2007). Strengthening the competence of mid level providers and improving communicative skills can improve the quality of maternal health care and the response of expecting mothers towards antenatal (Jibril, 2017).

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