Project – Assessing the knowledge and attitude of women Toward antenatal care in primary health care Karu Local Government Area of Nasarawa State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Antenatal care (ANC) plays a pivotal role in ensuring the health and well-being of both the mother and the unborn child. It offers a structured program through which pregnant women can receive essential medical attention, including screening for potential health risks, vaccination, nutritional guidance, and counseling on birth preparedness and emergency readiness (World Health Organization [WHO], 2016). These services are not only vital in preventing pregnancy-related complications but also serve to empower women with the knowledge necessary to manage their health during pregnancy and after delivery. The timely and regular utilization of ANC services is thus considered a cornerstone of safe motherhood and an effective strategy for reducing maternal and neonatal mortality rates globally.

Despite the global emphasis on ANC and its inclusion as a priority in the Sustainable Development Goals (SDGs), the utilization of these services remains alarmingly low in many developing countries, including Nigeria. The 2018 Nigeria Demographic and Health Survey (NDHS) revealed that only about 57% of pregnant women received antenatal care from skilled health providers, while a significant proportion either began ANC late or did not attend at all. Numerous factors contribute to this poor utilization, including inadequate knowledge of ANC benefits, negative cultural or religious beliefs, lack of female autonomy in health decision-making, long distances to health facilities, and financial constraints (Fagbamigbe & Idemudia, 2015). These issues are particularly pronounced in rural and peri-urban settings, where access to health information and services is often limited.

The situation in Karu Local Government Area (LGA) of Nasarawa State reflects many of these national trends. Though Karu is considered one of the most rapidly urbanizing LGAs in the state—due to its closeness to the Federal Capital Territory—it still exhibits characteristics of rural and peri-urban communities. While the area is served by several Primary Health Care (PHC) centers that offer antenatal services, reports from local health workers and community leaders suggest that attendance at these facilities is inconsistent. Many women are said to attend only one or two sessions during pregnancy, while others avoid ANC services altogether. This pattern raises concerns about the possible consequences on maternal and infant health outcomes in the region.

Knowledge and attitude are crucial behavioral determinants that influence ANC utilization. A woman’s understanding of the purpose, timing, and benefits of antenatal visits significantly affects whether she attends and adheres to scheduled appointments. Moreover, the attitude toward health institutions—shaped by previous experiences, cultural perceptions, and peer influence—can either motivate or deter ANC attendance. Women who perceive health workers as unfriendly or judgmental, or who have heard negative stories about hospital deliveries, are less likely to make regular ANC visits. In contrast, positive perceptions and supportive community narratives can encourage greater ANC uptake and improve maternal health behaviors.

Karu LGA is a unique case because it presents both challenges and opportunities for improving ANC utilization. Its proximity to Abuja allows for potential access to improved health infrastructure, yet many of its communities still struggle with underdevelopment, poverty, and inadequate health literacy. The presence of a mixed population—comprising both urbanized and traditional residents—makes it critical to understand the varying levels of awareness and attitudes among women in the area. Without such insight, health interventions may not effectively address the specific needs of the population, potentially limiting their impact on maternal health indicators.

This study therefore aims to assess the knowledge and attitude of women toward antenatal care in Primary Health Care centers across Karu LGA. By identifying the prevailing levels of understanding, cultural influences, and emotional or psychological barriers, the study seeks to uncover the underlying factors that affect ANC utilization. The findings are expected to inform health policy decisions, community education strategies, and service delivery improvements that can ultimately enhance maternal and child health outcomes in the area.

1.2 Statement of the Problem

Maternal mortality remains a significant public health concern in Nigeria, with the country accounting for a large proportion of maternal deaths globally. According to the World Health Organization (2022), Nigeria contributes approximately 20% of global maternal deaths, a figure largely influenced by preventable causes. One of the primary strategies to combat maternal mortality is the effective use of antenatal care (ANC) services, which are designed to detect and manage pregnancy-related complications early. However, poor utilization of these services continues to be a critical challenge, especially in semi-urban and rural communities. The lack of adequate and timely ANC often results in missed opportunities for life-saving interventions for both mothers and their unborn children.

In Karu Local Government Area (LGA) of Nasarawa State, the situation mirrors the national trend. Despite the presence of numerous Primary Health Care (PHC) centers that provide antenatal services—many of which are free or heavily subsidized—reports suggest that a substantial number of women either delay their first ANC visit or do not attend at all. Health workers in the area have consistently observed that women often present late in pregnancy, sometimes only seeking medical attention during emergencies or labor. This delay in seeking care reduces the effectiveness of antenatal services, which are most beneficial when started early and followed consistently throughout the pregnancy.

One of the major factors contributing to this underutilization is the limited knowledge women have regarding the importance and purpose of antenatal care. Many women are unaware of the recommended number of visits, the types of services offered during ANC, or the potential risks of neglecting care. In addition to this knowledge gap, negative attitudes—shaped by cultural beliefs, fear of medical procedures, distrust in the healthcare system, or previous unpleasant experiences with healthcare providers—further discourage attendance. These factors operate within a broader socio-economic and educational context that either facilitates or hinders women’s access to maternal health services.

Given these realities, it is evident that improving ANC utilization in Karu LGA requires more than just making services available—it demands a deeper understanding of the perceptions and attitudes of the women themselves. Interventions that fail to consider local beliefs, knowledge levels, and behavioral patterns may not achieve the desired impact. For example, health campaigns that emphasize only the availability of services without addressing the reasons behind poor uptake may not resonate with the target population. Hence, targeted research is necessary to identify the root causes of low ANC attendance specific to this locality.

This study, therefore, seeks to fill that gap by assessing the knowledge and attitudes of women toward antenatal care in Karu LGA. By generating empirical data, the research will provide evidence on the level of awareness among women and the socio-cultural or personal factors that influence their health-seeking behavior during pregnancy. Such insights will be valuable for policymakers, healthcare providers, and community-based organizations seeking to design effective strategies to improve ANC attendance and ultimately reduce maternal mortality in the area.

1.3 Objectives of the Study

The main objective of this study is to assess the knowledge and attitude of women toward antenatal care in primary health care centers in Karu LGA of Nasarawa State. Specifically, the study seeks to:

1. Assess the level of knowledge of women about antenatal care.
2. Examine the attitude of women toward antenatal care services.
3. Determine the relationship between women’s knowledge and their attitude toward antenatal care.
4. Identify the socio-demographic factors influencing women’s knowledge and attitude toward ANC.

1.4 Research Questions

The research questions are buttressed below:

1. What is the level of knowledge of women about antenatal care in Karu LGA?
2. What is the attitude of women toward antenatal care in Karu LGA?
3. Is there a significant relationship between women’s knowledge and their attitude toward antenatal care?
4. What socio-demographic factors influence women’s knowledge and attitude toward ANC in Karu LGA?

1.5 Hypothesis

The hypothetical statement of the study is buttressed below:

H₀: There is no significant relationship between women’s level of knowledge and their attitude toward antenatal care in Karu LGA of Nasarawa State.

H1: There is significant relationship between women’s level of knowledge and their attitude toward antenatal care in Karu LGA of Nasarawa State.

1.6 Significance of the Study

This study holds considerable significance for a wide range of stakeholders involved in maternal and child health. For health policymakers at the local, state, and national levels, the findings from this research will provide much-needed empirical evidence on the specific knowledge gaps and attitudes that influence the utilization of antenatal care (ANC) services in Karu Local Government Area of Nasarawa State. Understanding these factors is essential for designing policies and interventions that are contextually relevant and responsive to the unique needs of women in this community. With data-driven insights, policymakers can allocate resources more effectively and craft messages that resonate with the target population.

Healthcare practitioners, particularly those working in Primary Health Care (PHC) centers, will also benefit from this study. Often, healthcare workers are the first point of contact for pregnant women and play a crucial role in influencing their health-seeking behavior. By understanding the common misconceptions, fears, or barriers faced by women regarding ANC, these practitioners can tailor their communication approaches, improve service delivery, and foster more trust-based relationships with clients. This can lead to more consistent and early attendance of ANC services, which is vital for monitoring and ensuring safe pregnancies.

Non-governmental organizations (NGOs) and international health agencies such as UNICEF, WHO, and UNFPA will find the results of this study useful for planning and implementing grassroots interventions. These organizations often rely on localized data to develop community outreach programs, health education campaigns, and maternal health projects. By highlighting the behavioral and socio-cultural factors affecting ANC utilization, this study can inform the development of targeted strategies, including health talks, mobile clinics, peer education, and male involvement in maternal health—initiatives proven to be effective when adapted to local contexts.

The academic community also stands to gain from this research. As issues surrounding maternal health remain an important area of public health research in developing countries, this study adds to the growing body of literature focused on understanding barriers to ANC utilization. It provides a case study of a semi-urban Nigerian community and contributes valuable data that future researchers can build upon. This is particularly important in addressing regional disparities in maternal healthcare and exploring community-specific solutions that can be replicated or scaled.

Furthermore, the study may empower community members by raising awareness and encouraging dialogue about maternal health issues. When women and their families understand the importance of ANC and are made aware of the common barriers affecting their peers, it can spark behavioral change and increase demand for maternal health services. In this way, the research goes beyond data collection to serve as a tool for community mobilization and empowerment, ultimately fostering a culture that values and prioritizes maternal health.

In summary, the study is significant not only for advancing academic knowledge but also for informing practical interventions across various sectors. By offering a comprehensive understanding of women’s knowledge and attitudes toward ANC in Karu LGA, it will serve as a cornerstone for future health planning, programming, and research. Most importantly, the ultimate beneficiaries of this research will be the pregnant women themselves and their newborns, who stand to gain from better-informed, more accessible, and more responsive maternal healthcare services.

1.7 Scope of the Study

This study is limited to assessing the knowledge and attitude of women of reproductive age (15–49 years) attending primary health care centers in Karu LGA of Nasarawa State. The study focuses on ANC-related issues such as timing of the first visit, number of visits, services received, and perception of care.

1.8 Operational Definition of Terms

• Antenatal Care (ANC): Antenatal care refers to the comprehensive, routine healthcare services provided to pregnant women throughout the duration of their pregnancy. It includes scheduled visits to health facilities where expectant mothers undergo physical examinations, laboratory tests, and receive immunizations, nutritional advice, health education, and psychological support. The goal of ANC is to monitor the progress of the pregnancy, identify and manage potential complications early, and ensure the health and well-being of both the mother and the unborn baby. ANC also prepares women for childbirth and offers counseling on postnatal care and family planning options. The World Health Organization recommends a minimum of eight ANC visits to ensure optimal outcomes.
• Knowledge: In the context of this study, knowledge refers to the level of awareness and understanding that women have regarding antenatal care. This includes their familiarity with the recommended number and timing of ANC visits, the types of services offered during these visits, the benefits of early and regular attendance, and the consequences of neglecting antenatal care. Knowledge also encompasses awareness of danger signs during pregnancy and the importance of skilled birth attendance. Adequate knowledge is a key factor that influences a woman’s decision to seek and comply with ANC recommendations, ultimately contributing to safer pregnancy outcomes.
• Attitude: Attitude in this study denotes the feelings, beliefs, perceptions, and predispositions that women hold toward antenatal care services and providers. It reflects how women emotionally and mentally respond to the idea of attending ANC, which may be influenced by personal experiences, cultural or religious beliefs, peer influences, or interactions with healthcare workers. A positive attitude may lead to active participation in ANC programs, while a negative attitude—such as fear of hospitals, mistrust in medical professionals, or belief in traditional practices—can deter women from utilizing available maternal health services. Attitude is therefore a vital component in understanding health-seeking behavior during pregnancy.
• Primary Health Care (PHC): Primary Health Care refers to the first level of formal healthcare delivery and serves as the initial point of contact for individuals, families, and communities within the health system. PHC encompasses a broad range of services including preventive, promotive, curative, and rehabilitative care. In the context of maternal health, PHC centers provide antenatal care, skilled birth attendance, immunizations, health education, and referrals to higher levels of care when necessary. These centers are often the most accessible and affordable healthcare facilities for women in rural and semi-urban areas like Karu LGA, making them central to efforts aimed at improving maternal and child health outcomes.

Project – Assessing the knowledge and attitude of women Toward antenatal care in primary health care