Under-utilization of antenatal care services in Timor-Leste: results from Demographic and Health Survey 2009–2010
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BACKGROUND: Timor-Leste is a young country in the Asia-Pacific region with a high maternal mortality rate of 557 per 100,000 live births. As most maternal deaths can be prevented by providing quality antenatal care (ANC) and skilled assistance during childbirth, understanding the barriers to the utilization of ANC services can enhance program implementation. This study aimed to investigate the prevalence and factors associated with the under-utilization of ANC services in Timor-Leste. METHODS: Timor-Leste Demographic and Health Survey (TDHS) 2009-2010 was a nationally representative multi-stage cross-sectional study involving 11,463 households and 9,828 childbirths. Information on last born child was recorded for 5,895 mother-child pairs. Factors influencing under-utilization of ANC were assessed using hierarchical logistic regression analysis. RESULTS: Only 3311 (55.2, 95% confidence interval (CI) 53.1 to 57.3%) made the recommended four ANC visits, while 2584 (44.8; 95% CI 42.7 to 46.9%) of them reported attending three or less ANC services. Significant factors positively associated with the under-utilization of ANC were low wealth status (odds ratio (OR) 2.09; 95% CI 1.68 to 2.60), no maternal education (OR 1.54; 95% CI 1.30 to 1.82) or primary maternal education (OR 1.21; 95% CI 1.04 to 1.41), no paternal education (OR 1.34; 95% CI 1.13 to 1.60), and having a big problem in permission to visit health facility (OR 1.65; 95% CI 1.39 to 1.96). CONCLUSIONS: Despite the apparently good progress made in re-establishing the healthcare infrastructure, 45 % of mothers remained in need of a focused intervention to increase their use of ANC services. Further prenatal care program should pay attention to women with low wealth status and those and their partners who are uneducated. Moreover, women should be encouraged to make decision on their own health.
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The current study observed high ANC attendance rates among Rohingya when compared to Bangladesh more generally and other South Asian countries where most women receive no more than three ANC visits.
“This is similar to the current study, which observed high ANC attendance rates among Rohingya when compared to Bangladesh more generally and other South Asian countries where most women receive no more than three ANC visits [14, 22, 46, 54].”
From Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh (2025) · cites this paper as [46]
The Abstract Results report that 44.8% of mothers in Timor-Leste attended three or fewer ANC visits, so the paper supports the general point that a substantial share fell below four visits. It does not support the claim that most women in other South Asian countries did so: its population is Timorese, and 44.8% is not a majority. The Rohingya finding is presented as the citing authors’ own result. (LLM, conf=0.84)
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Simon, D., Michael, D., Rahman, M. S., Hiott, M. C., Rahim, A., Sanin, K. I., Tofail, F., & Wuermli, A. J. (2025) · Conflict and Health · doi:10.1186/s13031-025-00733-6 · Cited by 2 · see citing works
“We expected to find relations between the woman’s years of formal education with ANC behaviors given the robust association in literature [6, 11, 13, 14, 46].”
Influential
- Authors
- Khanal, V., Brites da Cruz, J. L. N., Mishra, S. R., Karkee, R., & Lee, A. H.
- Affiliations
- B.P. Koirala Institute of Health Sciences (NP)
- Curtin University (AU)
- Corresponding author
- Khanal, Vishnu
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2015-09-08
- Volume
- 15
- Issue
- 1
- Pages
- 211-211
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC4563848
- OpenAlex
- W2170504631
- Cited by
- 37
- References
- 3
- Citations by year
- 2025: 2 · 2024: 2 · 2022: 9 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 5 · 2017: 3
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- antenatal care utilization, maternal health, Timor-Leste, maternal mortality, barriers to care, maternal education, paternal education, household wealth, prenatal care program
- MeSH terms
- Adolescent, Adult, Cross-Sectional Studies, Educational Status, Female, Health Services Misuse, Health Surveys, Humans, Middle Aged, Poverty, Pregnancy, Prenatal Care, Social Class, Timor-Leste, Young Adult
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