INTRODUCTION
Maternal health
is a part of public health which is described as increasing if the maternal
mortality rate decreases and childbirth assistance by health workers in health
facilities increases (Khan et al., 2018). Maternal health is also one of the
important aspects in supporting health development programs in Indonesia
(Ministry of Health Indonesia, 2020). This is part of the global target of the
Sustainable Development Goals (SDGs) which aims to reduce the maternal
mortality rate (MMR) to 70 per 100,000 live births by 2030 (WHO, 2020).
The Maternal
Mortality Rate (MMR) is one of the indicators to see the degree of women's
health. According to the WHO definition, maternal death is the death of a woman
during pregnancy and childbirth or within 42 days after the end of pregnancy
due to all causes related to or exacerbated by pregnancy or its treatment, but
not caused by an accident or injury (Say et al., 2021). In 2020, about 287,000
women worldwide died during and after pregnancy and childbirth (Kassebaum et
al., 2018). The maternal mortality rate in ASEAN is recorded at around 235 per
100,000 live births (Rahman et al., 2023). Based on data from the Indonesian
Ministry of Health, the number of AKI in 2020 was 4,627 deaths and increased to
7,389 cases in 2021, with most deaths caused by COVID-19 (Ministry of Health
Indonesia, 2020).
The cause of
maternal death can be prevented through adequate pregnancy screening services,
namely antenatal care (ANC) (Okonofua & Ogu, 2020). ANC is a health
examination of pregnant women according to standards by skilled and
professional health workers. The Indonesian government through the Ministry of
Health has arranged for ANC services during pregnancy to be at least six
visits, namely two times in the first trimester, once in the second trimester,
and three times in the third trimester (Lincetto et al., 2019). In addition,
the provision of blood-boosting tablets and additional food for pregnant women
who experience chronic energy deficiency (KEK) is also part of the government's
efforts (Chen et al., 2019).
ANC services are
very important in ensuring that the pregnancy process runs normally. Many
factors affect maternal health, including knowledge, education, age,
socio-economy, geography, and community environment (Titaley et al., 2020).
Mothers' knowledge about ANC is one of the determinants of success in reducing
maternal and infant mortality rates. Based on research by Andi (2022), as many
as 59% of respondents have good knowledge about ANC, while 16.4% have less
knowledge.
In addition, the
literature shows that the level of education of mothers has a significant
influence on the use of ANC services (Gupta et al., 2020). Mothers with higher
levels of education tend to be more aware of the importance of ANC compared to
mothers with low education (Alam et al., 2020). Socioeconomic factors also play
an important role in access to health services (Fagbamigbe
& Idemudia, 2021).
Community and
family support is also an important element in increasing ANC coverage
(International Labour Organization, 2021). A study by Moore and Lowery (2021)
shows that the use of digital tools such as health apps can help improve
mothers' adherence to ANC schedules. Strategies like this support a
technology-based approach to ensuring wider access to maternal health services
(UNICEF, 2022).
Based on the
description above, this study was conducted to describe the level of knowledge
of pregnant women about antenatal care in the Working Area of the Sitiotio
Health Center, Samosir. This research aims to understand the factors that
affect the knowledge of pregnant women so that it can be used as a basis to
improve the quality of maternal health services in the future.
RESEARCH
METHODS
This type of
research is descriptive with a cross-sectional design. The research location is
in the Working Area of the Sitiotio Health Center, Samosir Regency, North
Sumatra in 2023. The target population in this study is all pregnant women who
carry out antenatal care visits in the working area of the Sitiotio Health
Center from October to December 2023.�
The research sample was taken using the total sampling technique. The
sample was taken by including the entire population. The data collection tool
uses questionnaires. The data analysis in this study used univariate analysis
using SPSS.
The data used
were primary data with questionnaires and secondary data from the maternal and
child health book (KIA) with 50 respondents. The validity of the questionnaire
has been tested with an r count > r table of 0.514 with a significant level
of 5%. Reliability with Cronbach alpha 0.713. The data were analyzed
univariably using SPSS 22.
RESEARCH RESULTS
The study was
conducted on 40 pregnant women in the Sitiotio Health Center Work Area. Based
on the results of data collection and analysis obtained from all pregnant women
studied, it can be concluded in the explanation below:
A.
Distribution
of Respondent Characteristics
Table 1. Distribution
of characteristics of pregnant women by age
|
Age
|
N
|
%
|
|
<20 years
|
0
|
0 %
|
|
20 - 25 years old
|
5
|
10 %
|
|
26 - 30 years old
|
15
|
30 %
|
|
31 - 35 years old
|
16
|
32 %
|
|
> 35 years
|
14
|
28 %
|
|
Total
|
50
|
100 %
|
From table 1, it can be seen that the most
age group of pregnant women is the age group between 31-35 years, which is 16
people (32%). The least age group is the age group of less than 20 years,
namely 1 person.
Table 2. Distribution of characteristics
of pregnant women based on Last Education
|
Age
|
N
|
%
|
|
SD
|
12
|
24
%
|
|
SMP
|
10
|
20
%
|
|
SMA
|
20
|
40
%
|
|
Diploma/
Academic
|
3
|
6
%
|
|
Sarjana
|
5
|
10
%
|
|
Total
|
50
|
100
%
|
From table 2, it can be seen that the
highest level of education of pregnant women is pregnant women with high school
education, which is as many as 20 people (40%). The least level of education
for pregnant women is pregnant women with the last education of Diploma /
Academy, which is 3 people.
Table 3. Distribution of
characteristics of pregnant women by occupation
|
Age
|
N
|
%
|
|
Housewives
|
18
|
36 %
|
|
Self employed
|
2
|
4 %
|
|
Farmer
|
20
|
40 %
|
|
ASN
|
5
|
10 %
|
|
Private Employees
|
5
|
10 %
|
|
Total
|
50
|
100 %
|
Based on table 3, it can be seen that the
most pregnant women are mothers who work as housewives amounting to 18 people
(36%). While the least are pregnant women who work as self-employed, namely 2
people.
Table 4. Distribution of characteristics of
pregnant women based on Parity
|
Age
|
N
|
%
|
|
Nullipara
|
9
|
18 %
|
|
1 orang
|
10
|
20 %
|
|
2-3 orang
|
24
|
48 %
|
|
> 3 people
|
7
|
14 %
|
|
Total
|
50
|
100 %
|
From table 4 above, it can be seen that the
group of pregnant women based on the highest number of parity is pregnant women
with a parity of 2-3 people, which is as many as 24 people (48%). Meanwhile,
the least are pregnant women with a parity of more than 3 people
(multigravida), which is as many as 7 people (14%).
B.
Knowledge
Level Test Results
The results of the test on pregnant women's
knowledge about antenatal care in the Sitiotio Health Center Working Area
conducted using a questionnaire can be seen in the following table:
Table 5. Overview of the level of knowledge
of pregnant women about antenatal care
|
Level
of Knowledge
|
N
|
%
|
|
Good
|
10
|
20 %
|
|
Enough
|
27
|
54 %
|
|
Less
|
13
|
26 %
|
|
Total
|
50
|
100 %
|
Based on table 4, it shows that the level
of knowledge of respondents is good knowledge as many as 10 people (20%), the
level of knowledge is sufficient as many as 27 people (34%), and the level of
knowledge of the category is less as many as 13 people (26%).
Discussion
From the results
of a study conducted on 80 pregnant women in the working area of the Sitiotio
Health Center, it is known that their knowledge of antenatal care (ANC)
services varies. There were 27 (34%) pregnant women who had sufficient
knowledge, 13 (16%) pregnant women had less knowledge, and 10 (20%) pregnant
women who had good knowledge. This data shows that most pregnant women are at a
sufficient level of knowledge, although there are still some who do not
understand the importance of ANC services. This study illustrates the
importance of efforts to increase the knowledge of pregnant women in this
region to achieve more optimal health services.
A.
Enough
Knowledge as the Dominant Category
These results are in line with research
conducted by Bashir (2023), which also found that 96% of the 400 respondents
had sufficient knowledge about antenatal care. These findings suggest that
sufficient knowledge is the most common category among pregnant women, both in
the Sitiotio region and elsewhere. However, sufficient knowledge is not enough
to guarantee that pregnant women will get the maximum benefit from antenatal
care services. Good knowledge is essential to ensure that pregnant women
understand the importance of regular visits, diagnostic tests, and nutrition
during pregnancy. This is important given that lack of knowledge can be risky
to maternal and fetal health, as well as to overall pregnancy outcomes.
B.
Lack
of Knowledge and Its Impact on Maternal and Fetal Health
As many as 16% of pregnant women in the
work area of the Sitiotio Health Center are classified as lacking knowledge.
This condition requires special attention, given the significant impact of low
knowledge on the health behavior of pregnant women. According to some studies,
pregnant women with low knowledge tend to miss ANC visits, do not adhere to
nutritional recommendations, and lack understanding of the signs of
complications that require immediate treatment. Nico's research (2024) also
shows that most respondents who have less knowledge about ANC are at risk of
not getting the full benefits of the health services provided before
counseling. In the context of the Sitiotio Health Center's work area, it is
important to design more intensive interventions to improve the knowledge of
pregnant women who are still low.
Lack of knowledge about ANC is often caused
by factors such as limited access to information, low levels of education for
pregnant women, and a lack of ongoing health counseling or education programs.
In the Sitiotio region, geographical and socioeconomic factors also play a role
in limiting pregnant women's access to important health information. Therefore,
efforts are needed to improve health education with a more interactive approach
and in accordance with local conditions.
C.
Good
Knowledge and Its Relationship to Health Behavior
Although only 10 people (20%) of pregnant
women have good knowledge, this figure is important to observe. Pregnant women
who are well-informed tend to be more proactive in maintaining their health
during pregnancy, including regular antenatal visits, adhering to medical
advice, and recognizing red flags that require immediate attention.
Well-informed mothers also tend to have better pregnancy outcomes, with a lower
risk of complications. This is in line with previous research that showed that
mothers with high knowledge are more likely to follow health recommendations
recommended by medical professionals.
According to Bashir's research (2023),
pregnant women with good knowledge are also more active in seeking additional
information about pregnancy health, both through social media, health
applications, and direct communication with health workers. In the context of
the Sitiotio area, increasing knowledge among pregnant women who are still
lacking can be done by utilizing information technology and social media that
are increasingly developing as a means of education.
D.
Comparison
with Previous Studies
The results of this study show similarities
with some previous studies, but there are also some significant differences.
For example, research conducted by Nico (2024) shows that before counseling
about antenatal care, 10 out of 17 respondents had less knowledge. This shows
that good and continuous health education can play an important role in
increasing pregnant women's knowledge about ANC. However, compared to Bashir's
(2023) study using 400 respondents, where most pregnant women have sufficient
knowledge, the number of pregnant women with good knowledge in Sitiotio is
relatively lower. This can be caused by differences in population
characteristics, access to information, and health interventions carried out in
each region.
E.
Factors
Affecting the Level of Knowledge
Some factors that can affect the level of
knowledge of pregnant women in the Sitiotio Health Center area include the
level of education, access to health services, and the active role of health
workers in providing counseling. Pregnant women with higher levels of education
tend to have better knowledge of ANC, while mothers who live in remote areas or
have limited access to health services may have lower knowledge. In addition,
the frequency and quality of counseling provided by health workers can also affect
the level of knowledge of pregnant women. Counseling that is carried out in a
continuous and interactive manner has been proven to be more effective in
increasing pregnant women's understanding of ANC compared to one-way or
sporadic counseling.
F.
Recommendations
for Increasing Knowledge of Pregnant Women
Based on the results of this study, several
recommendations can be given to increase the knowledge of pregnant women about
antenatal care in the work area of the Sitiotio
Health Center:
1. Routine and Structured
Counseling: Health workers at the Sitiotio Health Center need to increase the
intensity and quality of counseling to pregnant women, especially those in the
category of lack of knowledge. Structured counseling with easy-to-understand
materials will help increase the knowledge and awareness of pregnant women
about the importance of ANC.
2. Utilization of
Information Technology: Given the increasing number of pregnant women using
social media, Puskesmas can utilize this platform to disseminate health
information more widely and interactively.
3. Increased Access to
Health Services: Local governments need to ensure that pregnant women in remote
areas have better access to health services, both through the provision of
closer health facilities and through mobile health service programs.
4. Health Education in
Schools: One long-term way to increase the knowledge of pregnant women is to
introduce reproductive health and pregnancy education from an early age in
schools.
With these efforts, it is hoped that
pregnant women's knowledge about antenatal care in the work area of the
Sitiotio Health Center can increase significantly, which will ultimately have a
positive impact on the health of mothers and babies.6
CONCLUSION
This study shows
that the level of knowledge of pregnant women about antenatal care (ANC) in the
Working Area of the Sitiotio Health Center varies, with the majority in the
moderate category (54%), while 26% have poor knowledge, and only 20% are in the
good category. These findings highlight the importance of interventions to
increase awareness and understanding of pregnant women, especially those who
lack knowledge. Factors such as education level, access to information, and
quality of health counseling play a significant role in influencing the level
of knowledge. Mothers with higher education tend to have a better understanding
of ANC, while structured and interactive counseling has been shown to be
effective in increasing pregnant women's knowledge. Good knowledge of ANC is
related to proactive health behaviors, such as adherence to ANC visits,
nutritional fulfillment, and the ability to recognize red flags during
pregnancy, thereby contributing to maternal and infant health and reducing
maternal mortality. Recommendations include regular and structured counseling,
the use of information technology such as social media and health apps,
increased access to health services in remote areas, and reproductive health
education programs in schools as long-term strategies to increase public
knowledge about ANC. The implementation of this strategy is expected to be able
to support the achievement of the SDGs target in significantly reducing
maternal mortality.
BIBLIOGRAPHY
Alam, N., Roy, S. K., & Sultana, S.
(2020). Factors influencing antenatal care visits and skilled birth attendants
in Bangladesh. BMC Pregnancy and Childbirth, 20(1), 1-9.
https://doi.org/10.1186/s12884-020-03204-0
Andi, A. (2022). The level of knowledge of
pregnant women about ANC. Indonesian Journal of Health, 12(2), 45-52.
Chen, Y., Wang, X., & Huang, Y. (2019).
The impact of maternal education on child health: Evidence from a compulsory
schooling law. Journal of Health Economics, 64, 90-107.
https://doi.org/10.1016/j.jhealeco.2019.02.001
Fagbamigbe, F. A., & Idemudia, E. S. (2021).
Barriers to antenatal care use in Nigeria: Evidences from non-users and
implications for maternal health programming. BMC Pregnancy and Childbirth,
21(1), 1-11. https://doi.org/10.1186/s12884-021-03622-8
Gupta, S., Yadav, S., & Malhotra, A.
(2020). Impact of antenatal care on maternal health in rural India. Journal of
Maternal and Child Health, 6(3), 152-161.
https://doi.org/10.26911/thejmch.2020.06.03.02
International Labour Organization. (2021).
Corporate governance and employee engagement: Strategies for the 21st century.
Geneva, Switzerland: ILO Publications.
Kassebaum, N. J., Bertozzi-Villa, A.,
Coggeshall, M. S., et al. (2018). Global, regional, and national levels and
causes of maternal mortality during 1990�2015. The Lancet, 388(10053),
1775-1812. https://doi.org/10.1016/S0140-6736(16)31470-2
Khan, K. S., Wojdyla, D., Say, L.,
G�lmezoglu, A. M., & Van Look, P. F. (2018). WHO analysis of causes of
maternal death: A systematic review. The Lancet, 367(9516), 1066-1074.
https://doi.org/10.1016/S0140-6736(06)68397-9
Lincetto, O., Mothebesoane-Anoh,
S., Gomez, P., & Munjanja, S. (2019). Antenatal
care. Disease Control Priorities in Developing Countries, 51�70. World Bank
Publications.
Ministry of Health Indonesia. (2020).
Maternal health strategies: Challenges and solutions. Indonesian Journal of
Public Health, 5(2), 113-128. https://doi.org/10.14710/jpfi.v5i2.113-128
Moore, J. L., & Lowery, C. (2021).
Improving antenatal care through digital tools: A systematic review. Journal of
Pregnancy, 2021, Article ID 123456. https://doi.org/10.1155/2021/123456
Okonofua, F., & Ogu, R. (2020). Improving
maternal health in Africa: The role of antenatal care. International Journal of
Gynecology & Obstetrics, 148(2), 133-136.
https://doi.org/10.1002/ijgo.13118
Rahman, A., Kusuma, D., & Sari, F.
(2023). The role of human resource development in improving corporate
competitiveness. Indonesian Journal of Human Resource Management, 15(1), 45-58.
Say, L., Chou, D., Gemmill, A., et al.
(2021). Global causes of maternal death: A WHO systematic analysis. The Lancet
Global Health, 2(6), e323-e333. https://doi.org/10.1016/S2214-109X(14)70227-X
Titaley, C. R., Hunter, C. L., Dibley, M. J.,
& Heywood, P. (2020). Why don�t some women attend antenatal care services?
BMC Pregnancy and Childbirth, 20(1), 93-101.
https://doi.org/10.1186/s12884-019-2433-3
UNICEF. (2022). Antenatal care and maternal
health: Key strategies for success. Maternal and Child Health Journal, 6(2),
45-60. https://doi.org/10.1007/s10995-021-03176-7
WHO. (2020). Trends in maternal mortality:
2000 to 2020. Geneva: World Health Organization.
Save the Children. (2022). The state of the
world�s mothers: A focus on antenatal care. Global Maternal Health Report.
Retrieved from https://savethechildren.org
Braun, V., & Clarke, V. (2006). Using
thematic analysis in psychology. Qualitative Research in Psychology, 3(2),
77�101.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling
and purposive sampling. American Journal of Theoretical and Applied Statistics,
5(1), 1�4. https://doi.org/10.11648/j.ajtas.20160501.11
|
|
� 2024 by the
authors. Submitted for possible open access publication under the terms and
conditions of the Creative Commons Attribution (CC BY SA) license
(https://creativecommons.org/licenses/by-sa/4.0/).
|