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Thesis (M.A.). / Written for the Faculty of Religious Studies [with a specialization in Biomedical Ethics]. Title from title page of PDF (viewed 2008/07/28). Includes bibliographical references.

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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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Antenatal care (ANC) has been recognised as a way to improve health outcomes for pregnant women and their babies. Only 29% of pregnant women receive the recommended four antenatal visits in Nepal and reasons for such low utilisation of ANC are poorly understood. The main aim of this thesis is to explore opportunities and barriers in ANC uptake and the family’s role in decision-making in Nepal. In-depth interviews were conducted with 30 purposively selected prenatal or postnatal mothers (half users, half non-users of ANC), 10 husbands and 10 mothers-in-law in two communities (one semi-urban, one rural). There is no single factor that determines the use of ANC in the study area. Use of ANC is influenced by cultural norms and values. Culturally women have low status in the household and this contributes to the low uptake of ANC. Heavy workloads (inside and outside the home) are expected of all young women and challenge ANC uptake in rural areas. The findings suggest that husbands and mothers-in-law have a strong influence in the use of ANC. Mostly the mothers-in-law are pivotal family members who make decisions about ANC for their daughters-in-law. Educated husbands are reported to be positive towards ANC. Husbands’ lack of support in ANC is mostly related to alcoholic habit. Education had a positive effect on ANC uptake due to improved knowledge of its function. Perceptions regarding the need for ANC are shaped by previous experiences and severity of the condition of pregnancy. Some women did not go for ANC as pregnancy was seen as a normal condition. Similarly, perceived quality of care such as satisfaction towards the services, privacy and confidentiality, communication skills of the health worker are highlighted as important issues in ANC uptake. Factors related to affordability of care such as poverty and cost of the services are discouraging to some, especially poor families. Similarly, availability and accessibility of the services were highlighted as important issues in ANC uptake. Comprehensive health promotion and educational interventions could be positive actions but should target both women and their family members, particularly mothers-in-law and husbands.