title: Antenatal and delivery services in Kinshasa, Democratic Republic of Congo: care-seeking and experiences reported by women in a household-based survey.
abstract: OBJECTIVE
  Increasing coverage of quality reproductive health services, including prevention of mother-to-child transmission services, requires understanding where and how these services are provided. To inform scale-up, we conducted a population-based survey in Kinshasa, Democratic Republic of Congo.
  
  
  METHODS
  Stratified two-stage cluster sampling was used to select women ≥18 years old who had been pregnant within the prior three years. Participants were interviewed about their reproductive healthcare utilization and impressions of services received.
  
  
  RESULTS
  We interviewed 1221 women, 98% of whom sought antenatal care (ANC). 78% of women began ANC after the first trimester and 22% reported <4 visits. Reasons for choosing an ANC facility included reputation (51%), friendly/accessible staff (39%), availability of comprehensive services (29%), medication access (26%), location (26%), and cost (21%). Most women reported satisfactory treatment by staff, but 47% reported that the ANC provider ignored their complaints, 23% had difficulty understanding responses to their questions, 22% wanted more time with the provider, 21% wanted more privacy, and 12% felt uncomfortable asking questions. Only 56% reported someone talked to them about HIV/AIDS. Strongest predictors of seeking inadequate ANC included low participant and partner education and lack of certain assets. Only 32% of women sought postnatal care. Some results varied by health zone.
  
  
  CONCLUSIONS
  Scaling-up interventions to improve reproductive health services should include broad-based health systems strengthening and promote equitable access to quality ANC, delivery, and postnatal services. Personal and structural-level barriers to seeking ANC need to be addressed, with consideration given to local contexts.
authors: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: Lydia
authors: L
authors: Feinstein
authors: Bruno Lapika
authors: BL
authors: Dimomfu
authors: Bavon
authors: B
authors: Mupenda
authors: Sandra
authors: S
authors: Duvall
authors: Jean Lambert
authors: JL
authors: Chalachala
authors: Andrew
authors: A
authors: Edmonds
authors: Frieda
authors: F
authors: Behets
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000328:Adult; D036861:Delivery, Obstetric / Q000592:standards* / Q000706:statistics & numerical data; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Democratic Republic of Congo; antenatal care; household survey; implementation research; maternal and child health; prevention of mother-to-child transmission of HIV
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