An Analysis of Factors Contributing to Late Focused Antenatal Clinic (FANC) Booking for Pregnant Women Attending Hartcliffe Polyclinic in Harare, Zimbabwe

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Nyasha Christina Nyereyemhuka
Greanious Alfred Mavondo
Obadiah Moyo
Francis Farai
Mkhwanazi, Blessing Nkazimulo
Ottiniel Chavani
Audrey Judith Chamisa


Introduction: Expectant mothers are recommended and encouraged to book for focused antenatal care on or before the 12th week of pregnancy or within the first trimester to prevent or manage pregnancy-associated challenges. Booking late is when a pregnant woman reports for focused antenatal care for the first time after the first trimester. Focused antennal care is an individualized and quality care provided to pregnant woman for good outcomes. Antenatal care registers at Hartcliffe Polyclinic indicated that the majority of pregnant women were booking late for antenatal care which means they booked after the first trimester against the recommendations. Booking late in pregnancy suggests missed antenatal care as the woman is unlikely to have the recommended visits required of that pregnancy.  Without focused antenatal care, the wellbeing of the mother and in-utero child may be potentially to be negatively impacted. This study aims to establish the major factors that lead to late booking for focused antenatal care. Unmasking these factors may be an important precursor-step which may provide insight and trigger thoughts around mitigating strategies, which potentially will promote early booking for focused antenatal care services.

Methods: Fifty pregnant women, who had booked late for focused antenatal care, were randomly selected to participate in the study. Questionnaires were used to collect data from the participants and quantitative methods were used for data analysis.

Results: The majority of the pregnant women were not aware of the correct time of booking for focused antenatal care and were not aware of the recommended number of clinic visits per pregnancy. The major factors suggested to lead to late-booking were financial challenges, attitude of health personnel, quality of health service, further to cultural and religious beliefs.

Conclusion: Lack of knowledge, age, level of education, marital status, parity, financial difficulties, bad attitude and some cultural beliefs were noted to be the main drivers of late booking. It is envisaged that in future, if these main factors are addressed, potentially an increase in pregnant women registering early for FANC may proportionally be achieved.

Focused antennal care, Hartcliffe Polyclinic, pregnancy, maternal new-born and child health; late booking, first trimester.

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Nyereyemhuka, N. C., Mavondo, G. A., Moyo, O., Farai, F., Nkazimulo, M. B., Chavani, O., & Chamisa, A. J. (2020). An Analysis of Factors Contributing to Late Focused Antenatal Clinic (FANC) Booking for Pregnant Women Attending Hartcliffe Polyclinic in Harare, Zimbabwe. Asian Journal of Pregnancy and Childbirth, 3(2), 26-45. Retrieved from
Original Research Article


Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, et al. Sub-Saharan Africa's mothers, newborns and children: Where and why do they die? PLoS Med. 2010;7(6):e1000294.

Greco G, Powell-Jackson T, Borghi J, Mills A. Countdown to 2015: Assessment of donor assistance to maternal, newborn, and child health between 2003 and 2006. Lancet. 2008;371:1268-1275.

Musekiwa N, Mandiyanike D. Botswana development vision and localisation of UN Sustainable Development Goals. Commonwealth Journal of Local Governance. 2019;20:135-145.

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362: 65-71.

Darmstadt GL, Bhutta ZA, Cousens S, Adam T, NW. Evidence-based, cost-effective interventions: How many newborn babies can we save? Lancet. 2005;365: 977-988.

Sibeko S, JM. Health care patterns by pregnant women in Durban South Africa. SA Family Practice. 2006;48(10):59- 66.

WHO. The world health report. Make every mother and child count. Organisation WH, Editor. WHO: Geneva; 2005.

Bloom SS, Lippeveld T, Wypij D. Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. Health Policy Plan. 1999;14(1):38-48.

Gross K, Schellenberg JA, Kessy F, Pfeiffer C, Obrist B. Antenatal care in practice: An exploratory study in antenatal care clinics in the Kilombero Valley, South-Eastern Tanzania. BMC Pregnancy and Childbirth. 2011;11(1):36.

DOI: 10.1186/1471-2393-11-36

Guliani H, Sepehri A, John Serieux J. Determinants of prenatal care use: Evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America. Health Policy and Planning. 2014;29:589-602.
DOI: 10.1093/heapol/czt045

Trujillo JC, Carrillo B, Iglesias WJ. Relationship between professional antenatal care and facility delivery: An assessment of Colombia Health Policy and Planning. 2014;29(4):443-449.

Matunhu J. A critique of modernisation and dependency theories in Africa. African J History, Culture. 2011;3(5):65-72.

McHenga M, Burger R, von Fintel D. Examining the impact of WHO’s focused antenatal care policy on early access, underutilisation and quality of antenatal care services in Malawi: A retrospective study. BMC Health Services Research. 2019;19(1):295.
DOI: 10.1186/s12913-019-4130-1

Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan-Koru JA, Stevenson R, et al. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS ONE. 2014;9(7):e101893.


Basha GW. Factors affecting the utilization of a minimum of four antenatal care services in Ethiopia. Obstetrics and Gynecology International. 2019;5036783:6. DOI:

Cader AA, Perera L. Understanding the impact of the economic crisis on child and maternal health among the poor: Opportunities for South in Asia ADBI Working Paper 293. Tokyo: Asian Development Bank Institute: Tokyo; 2011.

Okedo-Alex IN, IAkamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal care utilisation in Sub-Saharan Africa: A systematic review. BMJ Open. 2019;9:e031890.

Friberg IK, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MOO, Bergh A-M, et al. Sub-Saharan Africa's mothers, newborns, and children: How many lives could be saved with targeted health interventions? PLoS Med. 2010;7(6):e1000295.
DOI: 10.1371/journal.pmed.1000295

Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: Examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85(10):812-819.

Guddissa Damme T, Workineh D, Gmariam A. Time of antenatal care booking and associated factors among pregnant women attending Ambo Town health facilities. J Gynecology Obstetrics. 2015;5(3):132-142.

Stanton C, Lawn JE, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: Delivering estimates in 190 countries. Lancet. 2006;367:1487-1494.

ZNASP. Zimbabwe National HIV and AIDS Strategic Plan 2015-2018. Zimbabwe National HIV AIDS Network: Harare, Zimbabwe; 2015.

Collins D. Pretesting survey instruments: An overview of cognitive methods. London: Kluwer Academic Publishers; 2001.

Bryman A. Social research methods. 3rd Ed. New York, NY: Oxford University Press; 2008.

Tibaijuka AK. Report on the fact finding Mission to Zimbabwe to assess the scope and impact of operation Murambatsvina by the UN Special Envoy on Human Settlements Issues in Zimbabwe. United Nations: New York, NY; 2005.

UNICEF. Programming for safe motherhood: Guidelines for maternal and neonatal survival. UNICEF, Editor. UNICEF: New York; 1999.

WHO. The World Health Report 2005: Make every mother and child count. WHO: Geneva; 2005.

WHO. Mother-baby package: Implemen-ting safe motherhood in countries. Organization WH, Editor. Maternal Health and Safe Motherhood Programme Division of Family and Health, WHO Geneva; 1996.

Bale JR, Stoll BJ, Lucas AOE. Improving birth outcomes: Meeting the challenge in the developing world. Reducing Maternal Mortality and Morbidity, Ed. Outcomes IoMUCoIB. Washington (DC): National Academies Press (US); 2003.

Banda I, Michelo C, Hazemba A. Factors associated with late antenatal care attendance in selected rural and urban communities of the Copperbelt Province of Zambia. Medical J Zambia. 2012;39(3):29-36.

Tekelab TT, Berhanu B. Factors associated with late initiation of antenatal care among pregnant women attending antenatal clinic at Public Health Centers in Kembata Tembaro Zone, Southern Ethiopia. Sci Technol Arts Res J. 2014;3(1):108-115.

Chisholm DK. Factors associated with late booking for antenatal care in central Manchester Author Links Open Overlay Panel Diana K. Chisholm. Public Health. 1989;103(6):459-466.

Simkhada BD, Van Teijlingen ER, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: Systematic review of the literature. J Advanced Nursing. 2008;61(3): 244-260.

Oladokun A, Oladokun R, Morhaso-Bello I, Bello AF, Adedokun B. Proximate predictors of early antenatal registration among Nigerian women. Annals of African Medicine. 2010;9(4):222-225.