Ressources numériques en sciences humaines et sociales OpenEdition Nos plateformes OpenEdition Books OpenEdition Journals Hypothèses Calenda Bibliothèques OpenEdition Freemium Suivez-nous

Beyond Autonomy: How Women Navigate Antenatal Care in Jimma Zone, Ethiopia

Beyond Autonomy: How Women Navigate Antenatal Care in Jimma Zone, Ethiopia

BY: DEMUMA AMDISA, PhD in Public Health, Health Communication and Health Behavior (CFEE Grant 2025)

 

Why some women start antenatal care early while others delay or discontinue the service, despite the fact that it is officially free, has been a longstanding concern. Efforts to answer with remarkable explanations that include lack of knowledge, distance to facilities, poverty, or cultural barriers are often recommended as “women’s empowerment” (1, 2). These factors still matter, yet they only tell part of the story, particularly how women are empowered in antenatal care utilization, where women are often portrayed either as empowered decision-makers or as passive victims of constraints or disempowered in maternal health research.

Notably, empowerment is a process with agency as a core component playing a substantial role. To understand this complexity, our study asked, “How do women understand and exercise agency in antenatal care uptake within their everyday lives in Jimma Zone, Ethiopia?”

Agency as a Process, Not a Moment

Using qualitative methods, including women’s narratives, group discussions, and perspectives from key stakeholders, we found that women’s agency in antenatal care is a multidimensional and negotiated process throughout pregnancy, rather than a single decision to attend or not attend care. Accordingly, agency emerges in how women recognize pregnancy, interpret, negotiate relationships, mobilize resources, and engage with health services, often under significant constraints. These actions are shaped by individual circumstances, family dynamics, social norms, and health system conditions.

Pregnancy Recognition

A critical dimension of agency is where women interpret bodily changes, such as missed periods, nausea, or fatigue, in different ways. Many experience doubt or ambivalence, and some intentionally delay confirmation, waiting for clearer signs like fetal movement. This delay is not simply a lack of knowledge; it often reflects fear of unintended pregnancy, concern about partner reactions, social norms discouraging early disclosure, or emotional uncertainty. For many women, delaying confirmation serves as a protective pause.

Meaning, Belief, and Identity Matter

Pregnancy also reshapes women’s identities and sense of responsibility. How women understand pregnancy and what it demands of them strongly influences whether they seek care. Some view ANC as a personal moral duty; others see pregnancy outcomes as entrusted to God, beheld as a period of vulnerability where emotional stability matters more deeply than service, yet many combine both beliefs.

Free of charge” Costs of the Services

Although antenatal care is officially free, women’s confidence in accessing services varies widely. Fear of indirect costs, transport, time away from work, childcare, or unexpected expenses, which often limit action. Uncertainty itself becomes a barrier. In contrast, practical support such as health insurance, cooperative household arrangements, or modest savings can significantly strengthen women’s sense of control and ability to seek care.

Decision Is Relational

Decisions about antenatal care are rarely made alone. Within marriage in particular, care-seeking is negotiated and situational. Women described using a range of strategies, including open discussion, calm persuasion, strategic silence, seeking mediation from relatives, or yielding to decisions to protect children, emotional safety, or family stability. Importantly, accepting a husband’s decision does not always signal disempowerment. In many cases, it represents strategic adaptation within constrained circumstances.

Health System Experiences Shape Sustained Engagement

Women’s experiences at health facilities strongly influence continued engagement with care. Respectful, reassuring encounters can build trust and motivation. Negative experiences, such as feeling dismissed, rushed, or disrespected, can silence women’s voices, delay visits, or lead to discontinuation, especially when ANC is perceived as repetitive or unnecessary. These experiences create a feedback loop: the quality of care today shapes women’s decisions tomorrow.

Why This Matters for Maternal Health Programs?

Women are not passive recipients of services; simplified classifications as “early” or “late” ANC attendees give a modest impression. They are active agents navigating pregnancy through emotion, belief, relationships, power, and experience within real constraints. Therefore, recognizing this complexity is essential for designing maternal health policies and programs in the contextual realities.

Key Implications and Recommendations

  • Rethink early ANC messaging
    Messages must address emotional ambivalence, social norms, and meanings attached to pregnancy—not just timing.

  • Move beyond information alone
    Reframing ANC messages and addressing misconceptions early can significantly influence care-seeking.

  • Strengthen the continuum of care
    Address fertility beliefs and reasoning around pregnancy, and promote family planning to reduce unintended pregnancies.

  • Support relationships, not only individuals
    Engage families, partners, and communities as part of maternal health strategies.

  • Reduce indirect costs and uncertainty
    Transport support, predictable services, and clear communication can strengthen women’s perceived ability to act.

  • Improve the quality of care
    Quality care does more than improve satisfaction—it reshapes women’s sustained engagement with health services.

References

1. Assefa E, Tadesse M. Factors related to the use of antenatal care services in Ethiopia: Application of the zero-inflated negative binomial model. Women’s Health. 2017 Aug;57(7):804–21.

2. Tekelab T, Chojenta C, Smith R, Loxton D. Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis. PLoS One. 2019 Apr 11;14(4):e0214848. doi:


OpenEdition vous propose de citer ce billet de la manière suivante :
Secrétaire Scientifique (2 février 2026). Beyond Autonomy: How Women Navigate Antenatal Care in Jimma Zone, Ethiopia. UN ŒIL SUR LA CORNE / AN EYE ON THE HORN. Consulté le 16 février 2026 à l’adresse https://doi.org/10.58079/15lo7


Vous aimerez aussi...

Laisser un commentaire

Votre adresse e-mail ne sera pas publiée. Les champs obligatoires sont indiqués avec *

This site uses Akismet to reduce spam. Learn how your comment data is processed.