Improper maternity wear, mean providers, and vomiting: Barriers to timely IPTp uptake for malaria prevention during pregnancy in rural Zambia

Pregnant women are particularly susceptible to malaria – a pregnant woman with malaria is more likely to suffer from anemia and deliver a low birth weight infant. Intermittent Preventive Treatment for pregnant women (IPTp) has been shown to reduce malaria incidence and maternal anemia in pregnant women. The objective of this qualitative study was to elucidate barriers to pregnant rural Zambian women's timely IPTp access. In December 2011 a total of 24 focus group discussions (FGDs) were conducted in six rural areas in Zambia – in each area a FGD was held with the following groups, disaggregated by sex: men/women with one child 12 months old or less and men/women with at least 3 children – 1 of whom is 12 months old or less. The study participants identified numerous barriers to obtaining IPTp through antenatal care (ANC) – uncaring providers, distance to health facilities, and insufficient finances to purchase proper maternity wear. They also identified barriers to IPTp uptake – women vomit or feel drowsy after taking fansidar, particularly if they take it on an empty stomach. While participants were aware that the correct time to begin ANC was at three months– most noted that women prefer to wait until the pregnancy is further along – when they are showing and they can feel the fetal movements. In summary, study participants identified barriers to timely IPTp uptake at the individual, couple, facility and structural level; hence, efforts to increase IPTp uptakes must be nuanced and multileveled.