“All These Methods Complement Each Other”: Antenatal Care Acceptability in Contexts of Antenatal Care Pluralism in Rural Manicaland, Zimbabwe

Abstract

Many current studies focus on the acceptability and utilization of biomedical antenatal care (ANC), neglecting indigenous African ways of providing ANC. Drawing on interviews with 30 health professionals, and consultations, focus groups, and storyboarding with 71 community-level key informants and adult caregivers, we critically examined how ANC is delivered and utilized in Mafararikwa in rural Zimbabwe. We found that families in Mafararikwa actively engage with and utilize ANC from traditional, faith-based, and biomedical health-care systems, usually concurrently, based on their quality-of-care perceptions and local sociocultural factors. Efforts to enhance ANC must consider families’ ANC preferences and promote collaboration between different ANC systems.

Keywords:

• Antenatal care
• acceptability
• antenatal care pluralism
• Ubuntu
• Zimbabwe

Acknowledgements

We thank staff at the District Medical Office of the MoHCC in Mutare for opening their doors to us into their district and for their overall guidance in implementing this study. We thank the Health Centre Committee in Mafararikwa for allowing us to conduct this study in their ward and for their mobilization and strategizing wisdom in implementing this study. We are grateful to all the professionals, ward-level key informants, and parents or legal guardians for gifting us with their knowledge and experiences around our study topic. We also thank Family AIDS Caring Trust Zimbabwe for their logistical support, Dr. Geoff Foster for his supervision of our fieldwork, and Scarlet Zhangazha, Winnie Chiriya, and Blessing Nyatsanza for their support in collecting, transcribing, and validating the data reported in this article.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Notes

1 The term ANC is mostly applied in biomedical care contexts. Many studies define indigenous African forms of ANC as “traditional midwifery” (Tati, 2018). However, a growing body of literature demonstrates that this term is narrow and does not fully capture the wide range of indigenous African forms of care (Hlatywayo, 2017; Nyanzi et al., 2007). Therefore, unless otherwise specified, we use the term ANC inclusively in this study.

2 “Skilled provider” means different things in different health-care/ANC contexts. The two references mentioned here identify indigenous African and biomedical conceptions of this term, respectively, and these are just two of many other understandings. Hence, unless specified otherwise, we use this term inclusively.

3 ANC coverage refers to the proportion of women ages 15–49 who received four or more ANC contacts by any provider during the pregnancy of their most recent live birth in a given period.

4 Under-five mortality rate is the probability of a child dying before age 5 years within a specified time frame.

5 Derived from the concept of medical pluralism, which Sundararajan et al. (2020) define as “utilization of multiple therapeutic modalities,” ANC pluralism is our adapted term to describe the use of multiple forms of care for health and wellness during pregnancy and childbirth (p. 1).

6 Unlike most current studies, we do not categorize these sociocultural factors into subthemes because participants’ responses demonstrated that they are intricately interrelated. As our findings in this section (hopefully) illustrate, it is difficult, if not impossible, to separate social from traditional, cultural from religious, traditional from cultural, etc.

Additional information

Funding

This study received funding from the Fonds de recherche du Québec—Société et culture (award number 2021-B2Z-292404) and International Development Research Center (IDRA 109120-028) awarded to the first author. Neither funding agency played any role in the study’s design or implementation. The views expressed in this article are solely the coauthors’ and do not reflect the positions of the funding agencies.