Exploring engagement: A Constructivist grounded theory study of pregnant woman’s engagement with antenatal care health services in rural India

Abstract

Background: Safe motherhood, a woman experiencing a healthy pregnancy experience, with a positive outcome and healthy living of women and newborns are an integral concern for global public health (WHO, 2016). The estimated global maternal mortality rate is 211 deaths per 100 000 live births and approximately 810 mothers died each day worldwide in 2017 from preventable maternal complications (WHO et al., 2019). Only 52% of women reported to have attended at least four ANC visits as per NFHS 4 (2015-16), along with 17% of Indian women who never contacted health facilities for visits (NFHS4a, 2017). Methodology: The research study has adopted Kathy Charmaz’s Constructivist Grounded Theory methodology. Methods: In-depth semi-structured interviews were conducted with eight initial purposive samples of pregnant women. The data was simultaneously analysed to gather preliminarily concepts which further guided the theoretical sampling of sixteen pregnant women and eight healthcare workers. All 32 interviews were audio-recorded with the permission and consent of the participant. The three stages of coding in Constructivist Grounded Theory methodology, Initial coding, Focused coding, and Theoretical coding were followed for data analysis. Findings: The core category consists of interrelated sub-categories; perceived Benefits and importance of Antenatal care health services; pregnant women and Health worker interaction and structural factors as a barrier to antenatal care. Pregnant women especially for a full and partial ANC, perceived ANC as an opportunity to gain assurance about their well-being. Family presence is crucial in women's ANC decision-making. A positive relationship with healthcare providers significantly influences ANC engagement. ASHA community health workers act as a crucial bridge between the community and the health system is one of the important social processes which encourage women. Women preferred the Ultrasound over complete ANC services and recognized it as a core component to reassure both the baby and the woman. Family members especially elder female strongly influenced women’s decision-making. Health worker-pregnant women interaction is pivotal, fostering trust and encouraging ANC acceptance. Conclusion: The study reveals varying perceptions of ANC among full, partial, and non-attenders, shaped by diverse factors influencing their engagement. A prevalent theme is the predominant view of ANC as curative rather than preventive care, reflecting a significant social process. Pregnancy is often seen as a normal, healthy event, affecting decision-making. Lack of autonomy emerged as a significant predictor for ANC utilization, highlighting the need for women-cantered care.