Original Research
Factors influencing antenatal care attendance for Bakiga and Indigenous Batwa women in Kanungu District, Southwestern Uganda
AUTHORS
Vivienne Steele1 MSc, Student
Kaitlin Patterson2 PhD Candidate
Lea Berrang-Ford3 PhD, Professor
Nia King4 BSc, Research Assistant * 
Manisha Kulkarni5 PhD, Associate Professor
Didacus Bambaiha Namanya6 MPH, Health Geographer
Charity Kesande7 Community-based Researcher
Sabastian Twesigomwe9 Community-based Researcher
Grace Asaasira10 Community-based Researcher
Sherilee L Harper11 PhD, Associate Professor
AFFILIATIONS
1, 2 Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada
3 Priestly Centre for Climate Change, Leeds University, Leeds, York LS2 9JT, United Kingdom
4 School of Medicine, Queen’s University, Kingston, Ontario K7L 3L4, Canada; and School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
5 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
6 Ministry of Health, Kampala, Uganda; and Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
7, 9 Batwa Development Programme, Kanungu District, Uganda
10 Department of Psychology, Makerere University, Kampala, Uganda
11 Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada; and School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
ACCEPTED: 16 March 2021
early abstract:
Introduction: The number of maternal deaths remains high in sub-Saharan Africa. Effective antenatal care (ANC) reduces maternal morbidity and mortality; therefore, improved antenatal care service provision has been prioritized across sub-Saharan Africa. Yet, research is limited on the ANC experiences of Indigenous women in sub-Saharan Africa. This study characterized ANC attendance patterns at a hospital, and characterized factors influencing attendance among Bakiga and Indigenous Batwa women in Kanungu District, Uganda.
Methods: A community-based, mixed-methods approach was used. Quantitative data were collected from a local hospital (records for 2,299 ANC visits) and analysed using descriptive statistics and multivariable regression analysis. Qualitative data from 8 key informant interviews (n=10 healthcare providers) and 16 focus group discussions (n=120 Batwa and Bakiga women) were analysed using thematic analysis.
Results: Most ANC patients attended between one and three ANC visits per pregnancy (n=1,259; 92.57%), and few attended the recommended four or more visits (n=101; 7.43%). Distance from a woman’s home to the hospital was significantly associated with lower ANC attendance (p<0.05, 95%CI = 0.01-0.96), after adjusting for maternal age and number of previous pregnancies. The qualitative data revealed that many factors influenced ANC attendance for both Batwa and Bakiga: long distances from the home to a health centre, high direct and indirect costs of ANC, lack of power in household decision-making, and poor interactions with healthcare providers. While the types of barriers were similar amongst Batwa and Bakiga, some were more pronounced for Indigenous Batwa women.
Conclusions: This study partnered with and collected in-depth data with Indigenous Peoples who remain underrepresented in the literature. The findings indicated that Indigenous Batwa continue to face unique and more pronounced barriers to accessing ANC in Kanungu District, Uganda. Ensuring access to ANC for these populations requires an in-depth understanding of their experiences within the local healthcare context. To reduce health inequities that Indigenous Peoples experience, policy makers and healthcare workers need to adequately understand, effectively address, and appropriately prioritize factors influencing ANC attendance.