Antenatal care (ANC) is a critical component of maternal healthcare that plays a significant role in reducing maternal and neonatal morbidity and mortality. Regular ANC visits allow for the early detection and management of pregnancy-related complications, ensuring better health outcomes for both the mother and fetus (1). The World Health Organization (WHO) recommends at least eight ANC visits during pregnancy to monitor fetal development, provide essential health education, and prevent complications such as pre-eclampsia, anemia, and infections (2).

Despite the well-established benefits of ANC, its utilization varies across different populations due to factors such as socio-economic status, education level, cultural beliefs, and accessibility to healthcare facilities (3). Studies have shown that pregnant women with higher educational levels are more likely to seek timely and regular ANC services compared to those with lower education levels (4). Additionally, financial constraints, lack of awareness, and inadequate healthcare infrastructure have been identified as barriers to optimal ANC utilization in low- and middle-income countries (5,6).

Awareness and knowledge about ANC influence maternal health-seeking behavior and adherence to recommended ANC visits. A lack of knowledge can lead to delays in seeking care, increasing the risk of adverse pregnancy outcomes, including preterm birth and low birth weight (7). Therefore, assessing the level of knowledge, awareness, and practice of ANC among pregnant women is essential for identifying gaps and implementing targeted interventions to improve maternal and neonatal health outcomes.

This study aims to evaluate the level of knowledge, awareness, and practice of ANC among pregnant women attending healthcare facilities. The findings will help policymakers and healthcare providers develop strategies to enhance ANC utilization, thereby contributing to improved maternal and child health.

Study Design and Setting

This cross-sectional study was conducted among pregnant women attending antenatal care (ANC) clinics at selected healthcare centers. The study aimed to assess their level of knowledge, awareness, and practice regarding ANC.

Study Population and Sampling

A total of 300 pregnant women were selected using a simple random sampling method. The inclusion criteria included pregnant women in any trimester who provided informed consent. Women with high-risk pregnancies requiring specialized care and those unwilling to participate were excluded from the study.

Data Collection Tool

A structured questionnaire was used to gather information on sociodemographic characteristics, knowledge about ANC, awareness of its benefits, and ANC practice. The questionnaire was developed based on existing literature and validated through a pilot study involving 30 participants, which were excluded from the final analysis.

Data Collection Procedure

Data were collected through face-to-face interviews conducted by trained healthcare professionals. The questionnaire included sections on participants' education, income, previous ANC visits, and sources of information regarding ANC services. Knowledge was assessed using multiple-choice questions, while awareness and practice were measured using Likert-scale responses.

Data Analysis

Collected data were entered into Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics, such as frequencies and percentages, were used to summarize demographic details and knowledge levels. A chi-square test was applied to examine associations between ANC knowledge and variables such as education and socioeconomic status. A p-value of less than 0.05 was considered statistically significant.

Sociodemographic Characteristics

A total of 300 pregnant women participated in the study. The majority (50%) were aged between 26-35 years, while 26.7% were aged 18-25 years, and 23.3% were in the 36-45 age group. Regarding education, 40% had completed secondary education, while 26.7% had higher education, 20% had primary education, and 13.3% were illiterate. Most participants were employed (40%), followed by unemployed (33.3%) and self-employed (26.7%). In terms of monthly income, 40% earned between INR 10,000-20,000, while 30% earned less than INR 10,000, and 30% had an income above INR 20,000 (Table 1).

Knowledge About ANC

The study revealed that 65% of the participants had good knowledge of ANC, 25% had moderate knowledge, and 10% demonstrated poor knowledge. The majority were aware of the importance of regular ANC check-ups and their role in preventing pregnancy-related complications (Table 2).

Awareness and Practice of ANC

Awareness about the significance of ANC was high, with 80% of women acknowledging its importance. However, only 55% adhered to at least four recommended ANC visits. Awareness of danger signs during pregnancy was observed in 60% of the participants. The most common barriers to ANC utilization were financial constraints (40%) and distance to healthcare facilities (20%) (Table 3).

These findings highlight the need for enhanced awareness campaigns and strategies to improve ANC adherence among pregnant women. ​​

Table 1: Sociodemographic Characteristics of Participants

Table 2: Knowledge Level of Participants on ANC

Table 3: Awareness and Practice of ANC

Antenatal care (ANC) is an essential component of maternal healthcare that helps in the early detection and management of pregnancy-related complications. The present study assessed the level of knowledge, awareness, and practice of ANC among pregnant women, revealing significant gaps between awareness and actual utilization.

The findings indicate that while 80% of participants were aware of the importance of ANC, only 55% adhered to the recommended visits. This discrepancy aligns with previous studies that have highlighted that knowledge does not always translate into practice due to socioeconomic and accessibility barriers (1,2). Educational status was found to be a key determinant of ANC utilization, with higher education levels being significantly associated with better knowledge and adherence to ANC guidelines (3,4). These findings are consistent with research demonstrating that women with secondary or higher education are more likely to seek ANC services than those with little or no formal education (5).

Financial constraints emerged as a major barrier to ANC attendance, reported by 40% of participants. Studies have shown that out-of-pocket expenses, including transportation and consultation fees, significantly hinder access to maternal healthcare, particularly in low- and middle-income countries (6,7). Additionally, geographical accessibility remains a challenge, with women in rural areas being less likely to attend ANC visits due to the long distance to healthcare facilities (8,9). These barriers emphasize the need for government interventions such as subsidized ANC services and improved healthcare infrastructure to enhance access.

The role of healthcare providers in promoting ANC cannot be overlooked. Previous studies suggest that the quality of counseling and communication between healthcare workers and pregnant women significantly impacts ANC adherence (10,11). In this study, 60% of women were aware of danger signs during pregnancy, which is comparable to studies where comprehensive counseling by healthcare professionals led to increased awareness and better maternal health outcomes (12). However, gaps in awareness still exist, indicating the need for structured ANC education programs.

Cultural and social factors also influence ANC-seeking behavior. In many communities, decision-making regarding maternal healthcare is influenced by family members, particularly husbands and elders, which can either support or hinder ANC utilization (13,14). Interventions aimed at increasing male partner involvement in ANC decision-making have been shown to improve maternal healthcare outcomes by encouraging timely and regular ANC visits (15).

Given these findings, it is evident that while knowledge about ANC is relatively high, systemic barriers limit its practice. Strengthening healthcare policies, increasing financial support for maternal care, and enhancing health education programs can significantly improve ANC utilization rates. Future studies should explore the impact of targeted interventions, such as mobile health initiatives and community-based awareness programs, in bridging the gap between knowledge and practice.

1. Ibrahim HK, El Borgy MD, Mohammed HO. Knowledge, attitude, and practices of pregnant women towards antenatal care in primary healthcare centers in Benghazi, Libya. J Egypt Public Health Assoc. 2014 Dec;89(3):119-26. doi: 10.1097/01.EPX.0000455673.91730.50.
2. Yimer A, Alemnew N, Bayu H, Habitu YA, Mohammed A, Alemu A. Pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia. AJOG Glob Rep. 2024 Aug 13;4(4):100391. doi: 10.1016/j.xagr.2024.100391.
3. Janakiraman B, Gebreyesus T, Yihunie M, Genet MG. Knowledge, attitude, and practice of antenatal exercises among Ethiopian women: A cross-sectional study. PLoS One. 2021 Feb 19;16(2):e0247533. doi: 10.1371/journal.pone.0247533.
4. Sitot A, Gebremeskel BF, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG. Assessment of knowledge, attitude and practice towards antenatal exercise among pregnant women attending antenatal care at health centers of Mekelle, Tigray Region, Ethiopia, 2020. PLoS One. 2022 Aug 9;17(8):e0262805. doi: 10.1371/journal.pone.0262805.
5. Kasahun AW, Shitu S, Mekonnen BA, Hawlet M, Zewdie A. Knowledge, attitude and practice towards antenatal physical exercise among pregnant women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023 Dec 14;18(12):e0295275. doi: 10.1371/journal.pone.0295275.
6. Yimer A, Alemnew N, Bayu H, Habitu YA, Mohammed A, Alemu A. Pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia. AJOG Glob Rep. 2024 Aug 13;4(4):100391. doi: 10.1016/j.xagr.2024.100391.
7. Ibrahim HK, El Borgy MD, Mohammed HO. Knowledge, attitude, and practices of pregnant women towards antenatal care in primary healthcare centers in Benghazi, Libya. J Egypt Public Health Assoc. 2014 Dec;89(3):119-26. doi: 10.1097/01.EPX.0000455673.91730.50.
8. Janakiraman B, Gebreyesus T, Yihunie M, Genet MG. Knowledge, attitude, and practice of antenatal exercises among Ethiopian women: A cross-sectional study. PLoS One. 2021 Feb 19;16(2):e0247533. doi: 10.1371/journal.pone.0247533.
9. Sitot A, Gebremeskel BF, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG. Assessment of knowledge, attitude and practice towards antenatal exercise among pregnant women attending antenatal care at health centers of Mekelle, Tigray Region, Ethiopia, 2020. PLoS One. 2022 Aug 9;17(8):e0262805. doi: 10.1371/journal.pone.0262805.
10. Kasahun AW, Shitu S, Mekonnen BA, Hawlet M, Zewdie A. Knowledge, attitude and practice towards antenatal physical exercise among pregnant women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023 Dec 14;18(12):e0295275. doi: 10.1371/journal.pone.0295275.
11. Yimer A, Alemnew N, Bayu H, Habitu YA, Mohammed A, Alemu A. Pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia. AJOG Glob Rep. 2024 Aug 13;4(4):100391. doi: 10.1016/j.xagr.2024.100391.
12. Ibrahim HK, El Borgy MD, Mohammed HO. Knowledge, attitude, and practices of pregnant women towards antenatal care in primary healthcare centers in Benghazi, Libya. J Egypt Public Health Assoc. 2014 Dec;89(3):119-26. doi: 10.1097/01.EPX.0000455673.91730.50.
13. Janakiraman B, Gebreyesus T, Yihunie M, Genet MG. Knowledge, attitude, and practice of antenatal exercises among Ethiopian women: A cross-sectional study. PLoS One. 2021 Feb 19;16(2):e0247533. doi: 10.1371/journal.pone.0247533.
14. Sitot A, Gebremeskel BF, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG, Gebremeskel GG. Assessment of knowledge, attitude and practice towards antenatal exercise among pregnant women attending antenatal care at health centers of Mekelle, Tigray Region, Ethiopia, 2020. PLoS One. 2022 Aug 9;17(8):e0262805. doi: 10.1371/journal.pone.0262805.
15. Kasahun AW, Shitu S, Mekonnen BA, Hawlet M, Zewdie A. Knowledge, attitude and practice towards antenatal physical exercise among pregnant women in Ethiopia: A systematic review and meta-analysis. PLoS One. 2023 Dec 14;18(12):e0295275. doi: 10.1371/journal.pone.0295275.