Barriers hindering attendance and adherence to antenatal care visits among women in rural areas in Rwanda: An exploratory qualitative study

PLoS One. 2025 May 21;20(5):e0323762. doi: 10.1371/journal.pone.0323762. eCollection 2025.

ABSTRACT

BACKGROUND: Antenatal care (ANC) improves maternal and neonatal health. However, less than half of pregnant women in sub-Saharan African (SSA) countries, including Rwanda, attend adequate ANC designed to provide routine care and detect and treat early pregnancy complications. This article explores the women’s views on factors that hinder adherence to ANC visits in Rwanda.

METHODS: This exploratory qualitative research used in-depth interviews to collect data from 22 pregnant women. Data were recorded, transcribed verbatim, and analyzed using a thematic approach.

RESULTS: A Thematic analysis revealed four themes: a) stigma dynamics, b) sociocultural beliefs and practices, c) lack of partner’s support, and d) Challenges to and at the healthcare setting. Unintended pregnancies, multiparity, and early weaning were identified as reasons why participants delayed attending the ANC. Sociocultural practices and beliefs that place women at the center of domestic chores, cultural misbeliefs, the influence of intergenerational behaviours, and social context were also reported as barriers to attending or adhering to ANC visits. The lack of partner support has been reported as a barrier due to existing family conflicts, domestic violence, competing personal priorities of partners over ANC, and fear of partners of HIV tests. They reported several structural barriers, including attendance and adherence to ANC visits, mandatory requirements before receiving ANC, long distance to the health facility, scattered health services within a health facility, long wait times, and negative attitudes and actions of healthcare providers.

CONCLUSIONS: The identified factors hindering pregnant women’s participation in ANC visits are modifiable in progressive countries such as Rwanda. Continued National support could reduce these barriers, increase ANC attendance, and meet the 2030 Sustainable Development Goal 3.

PMID:40397920 | DOI:10.1371/journal.pone.0323762