title: The Role of Cultural Beliefs in Accessing Antenatal care in Malawi: A Qualitative Study.
abstract: The World Health Organization in 2002 recommended a focused antenatal care model of four visits for women in low-income countries. Despite the high percentage of mothers (95%) who see a skilled attendant and the adaptation of the recommended antenatal model, only 46% of Malawian mothers meet the recommendation. The purpose of this study was to identify the cultural beliefs that influence women's antenatal care or pregnancy-related health care decisions.
  
  
  
  Twenty pregnant mothers and eight health workers from two urban tertiary care hospitals in Malawi were recruited to participate in a qualitative study assessing barriers to antenatal care. Data were collected between September and December 2014 through face-face, audio-recorded interviews, and a demographic survey.
  
  
  
  Identified maternal cultural beliefs included: seeking advice from village elders, spousal fidelity, and disclosing pregnancy. Health workers mentioned that providers often held the same cultural beliefs and, therefore, turned women away if they tried to go against cultural norms.
  
  
  
  Cultural beliefs play an integral role in the decision-making process of antenatal care. Specifically, the belief and practice of when to disclose pregnancy prohibits women from seeking antenatal care in the first trimester.
authors.affiliation: School of Health Related Professions, University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Joni
authors.initials: J
authors.lastname: Roberts
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California.
authors.forename: Helen
authors.initials: H
authors.lastname: Hopp Marshak
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California.
authors.forename: Diadrey-Anne
authors.initials: DA
authors.lastname: Sealy
authors.affiliation: College of Medicine, University of Malawi, Chichiri Blantyre 3, Malawi.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Manda-Taylor
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California.|College of Medicine, University of Malawi, Chichiri Blantyre 3, Malawi.
authors.forename: Ron
authors.initials: R
authors.lastname: Mataya
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California.
authors.forename: Peter
authors.initials: P
authors.lastname: Gleason
mesh_terms: D000293:Adolescent; D000328:Adult; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008295:Malawi; D008875:Middle Aged; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D055815:Young Adult
keywords: Africa; Malawi; antenatal care; culture; maternal child health; pregnancy; prenatal care