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Table 1 Barriers to utilisation of antenatal care in Rumbek North County, South Sudan

From: Barriers to utilisation of antenatal care services in South Sudan: a qualitative study in Rumbek North County

Barrier Main findings
a. Access and resource availability
1. Transportation/access
1.1 Proximity of health facility Long distance to heath facilities aggravated by sparsely distributed population settlements. A semi-nomadic lifestyle which increased the distance to health facilities. Some nearby PHCUs not providing ANC.
1.2 Transport means availability Lack of commercial or private means of transportation.
1.3 Flooding and poor roads Floods and mud during the wet season, inability to swim, parts of roads being washed away, inaccessibility of health facilities for delivery of drugs and supplies, bumpy roads which predisposed women to excessive shaking if travelling by car or motorbike.
2. Costs Pregnant women being asked to pay money at some health facilities. Having been asked to pay for ANC in the past affecting current ANC service use. Transportation costs to health facilities.
b. Influence of sociocultural context and conflict
1. Domestic chores of women Lack of time to attend ANC due to the heavy burden of domestic work. Lack of someone to leave behind with children if a woman decides to visit a heath facility. Inability to arrive at the health facility on time due to domestic chores.
2. Influence of husbands/male partners Men unwilling to pay for costs associated with visiting a health facility, men restricting their partners from attending ANC, lack of emotional support and encouragement from men, lack of interest in maternal health by men. Men perceive ANC attendance to be unnecessary because foremothers never used to attend ANC.
3. Insecurity Frequent attacks by neighbouring tribes/clans. Constant fear of being attacked at any time by neighbouring tribe/clans. Women cannot leave children at home alone to attend ANC because of the insecurity. Husbands cannot allow their wives to attend ANC because of insecurity. Displacement after attacks exacerbated geographic inaccessibility.
c. Perceptions of pregnancy
1. Perceived benefit ANC perceived to be a new concept in the community, unfamiliarity with ANC and its significance, lack of prior contact with the formal heath system.
2. Perceived risk Low-risk perception due to no prior pregnancy-related complications and trivialization of health problems during pregnancy. ANC attendance not viewed as a routine exercise but linked to pregnancy complications.
d. Perceived quality of care and efficacy of medical treatment Dissatisfaction with ANC if medical treatment was not provided during the visit. Attendance of ANC influenced by whether the woman’s symptoms were relieved by treatment received during previous ANC visit.