ArticleInquiry : a journal of medical care organization, provision and financing
Lived Experiences of Pregnant Women Regarding Late Antenatal Care Bookings: A Phenomenological Study in Mangwe District, Zimbabwe.
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Abstract
Late initiation of antenatal care (ANC) remains a major obstetric care challenge in rural Zimbabwe, contributing to preventable maternal and neonatal complications. Although national ANC coverage is high, district records from Mangwe (2023-2024) indicate that over 90% of pregnant women initiate ANC after 20 weeks of gestation, well beyond the World Health Organization recommendation of booking within the first trimester. This study explored the lived experiences and perceptions of women who booked ANC late in Mangwe District. A descriptive phenomenological qualitative study was conducted. A target sample of 15 to 25 participants was estimated a priori; thematic saturation was achieved after in-depth interviews with 20 pregnant women who initiated ANC after 20 weeks of gestation. Five key informants (3 midwives and 2 nurses) were also interviewed to provide health system perspectives. Data were collected in May 2025 and analyzed using inductive thematic analysis. Women described delayed booking as a constrained response to poverty, distance, stigma, and health system frustrations rather than personal neglect. Many prioritized food and household survival over transport costs, concealed pregnancies to avoid community judgment, or perceived ANC as necessary only when unwell. Fear of reprimand and long waiting times further discouraged early attendance. Providers confirmed that late booking contributes to missed early diagnosis of HIV and hypertension, undetected fetal complications, and preventable stillbirths. Late ANC booking in Mangwe reflects structural vulnerability rather than maternal negligence. Interventions should strengthen respectful maternity care, community education, and physical access to promote timely ANC initiation.
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