Antenatal Care in The Gambia: Missed Opportunity for Information, Education, and Communication

This 7-page report, published by BioMed Central (BMC) Pregnancy and Childbirth, is the result of a study conducted to examine the provision of information and education in antenatal clinics from the perspective of pregnant women attending these clinics. The report suggests that information, education, and communication (IEC) during antenatal care in the largest health division are inadequate. Pregnant women are ill equipped to make appropriate choices especially when they are in danger. This contributes to the persistent high maternal mortality ratios in the country.

According to the authors, educated women have better pregnancy outcomes compared with uneducated women. This may be partly because they are better informed and able to make better choices. Literacy among women in many developing countries is low and there are socio-cultural beliefs and practices with adverse effects on pregnancy and birth even among educated women. Therefore, an appropriate programme of health literacy or behaviour change communication is highly desirable.

A cross-sectional survey of 457 pregnant women attending six urban and six rural antenatal clinics in the largest health division in The Gambia was undertaken. The women were interviewed using modified antenatal client exit interview and antenatal record review questionnaires from the World Health Organization (WHO) Safe Motherhood Needs Assessment kit. Differences between women attending urban and rural clinics were assessed using the Chi-square test. The questionnaires were translated into two local languages (Mandinka and Wolof) and back-translated to ensure consistency.

According to the report, diet and nutrition was the topic most likely to have been discussed in antenatal visits. However, only about one-third of the women reportedly benefited from this. Less than 25% of the pregnant women recalled having discussed childspacing or family planning with their antenatal provider. Provision of information, education, and communication (IEC) around what to do in an emergency was recalled by even fewer women. Awareness of danger signs during pregnancy and labour was low. The proportions of women that recognised signs of danger were 28.9% for anaemia, 24.6% for hypertension, 14.8% for haemorrhage, 12.9% for fever and 5% for puerperal sepsis. Prolonged labour was not recognised as a danger sign. Women attending rural antenatal clinics were 1.6 times more likely to recognise signs of anaemia and hypertension as indicative of danger compared to women attending urban antenatal clinics.

The authors note that information, education, and communication all require time. The new antenatal care model recommends 30–40 minutes for the first visit and 20 minutes for subsequent visits to carry out all activities including individual IEC. However, most women said they spent 3 minutes or less with their provider. Communicating effectively under this circumstance would be an enormous challenge and could explain the poor provider-client interaction. It was not surprising that in this "rushed" scenario very few women asked questions.

The report concludes that IEC activities during antenatal care in the largest health division are inadequate. Pregnant women are ill-equipped to make appropriate choices especially when they are in danger, and this contributes to the persistence of high maternal mortality ratios in the country. In addition, even if they are provided with information, pregnant women would be unable to make optimal use of it if services are not readily available. Therefore, improving access to services that they have been advised to make use of is vital. In the context of this study, this would mean improving access to skilled birth attendants, particularly for rural women.