Barriers and facilitators to women's access to antenatal care in Savai’i.

Antenatal care (ANC) attendance appears to be a major problem in Savai’i, the biggest island of Samoa. An overall goal would be to increase the rate of early booking to ANC in Savai’i because the current rate, which is less than 30%, is too low. The Samoan protocol and guidelines for standard management in pregnancy and childbirth recommend that booking for ANC should ideally occur prior to 20 weeks’ gestation. The World Health Organisation recommends booking for ANC by 12 weeks' gestation. This research explored women’s experiences and views regarding antenatal care in Savai’i. In particular, the aims were as follows: 1. To explore the barriers and facilitators contributing to early and continued engagement with antenatal care in Savai’i and 2. To use this information to inform appropriate service development around antenatal care for women in Savai’i.

Semi-structured interviews were conducted with 17 women in Savai’i who self-identified as either booking for antenatal care before 20 weeks gestation as recommended by WHO, after 20 weeks gestation, or not at all (unbooked). The women were asked to share their stories related to pregnancy and antenatal care. Questions were structured around knowledge, attitudes, and behaviours with a focus on barriers and facilitators.

Four main themes emerged from the analysis. Theme One is ‘Discovery of Pregnancy’, with the sub-themes Knowing – Self, Knowing – Others, Positive Feelings (Happy, Excited), Negative Feelings (Fearful), Conflicting Feelings (Happy but shocked, Happy but Stressed, Uncertain. Theme Two is ‘Knowledge of Booking’, with sub-themes Previous Knowledge, Awareness of Costs of Service, Health Education and Health Promotion. The third theme is ‘Barriers to early booking for Antenatal Care and the final main theme is ‘Facilitators for early booking for Antenatal Care’.

The significance of this research was to determine the facilitators and barriers to early initiation of antenatal care in Samoa. This will provide insights into how early booking can be promoted and would help guide effective interventions, mitigate barriers related to the provision of health care services, and contribute to meaningful policies and procedures. This study can be utilised in other countries where Samoan people are residing.