Determinants and barriers of adequate antenatal care among Afghan women in Iran; findings from a community-based survey in Iran

Abstract Background: Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. There are several factors that affect the access and utilization of such services among Afghan women. Therefore, in the present study, we aimed to explore the sociodemographic determinates and potential barriers of adequate ANC among Afghan women in Iran.Methods: A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18-45 years old at three health centers in south Tehran. A questionnaire was developed based on a preceding qualitative study and literature review. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis. The STATA software version 14 was used for data analysis.Results: Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The respondent’s age, education, employment, family income, length of stay, and legal status were the most important determinates of adequate ANC among Afghan women. In multivariate analysis, after adjustment for other variables, only the poor knowledge and attitude toward ANC; poor quality of services; and to some extent, the difficulties in access were the main obstacles in having adequate ANC among the study population. Conclusion: Our study emphasized the important role of specific sociocultural and demographic characteristics on access to ANC among Afghan women in Iran. In fact, these factors need to be considered in future policies and interventions in order to improve the maternal and child health and reduce the birth complications among Afghan population. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services for Afghan women in Iran.