Abstract:
Background and objective: Maternity care is provided free-of-charge through Sri Lanka’s
public healthcare system. However, pregnant women who rely on the public system also access
private antenatal care (ANC) on a fee-levying basis. This study describes ANC service
utilization in public and private sectors among pregnant women awaiting delivery at a public
tertiary hospital in Jaffna.
Methods: This descriptive cross-sectional study was conducted at Teaching Hospital Jaffna
(THJ). Pregnant women ≥18 years awaiting delivery after 33 weeks of gestation were recruited
over a 12-week period (20/06/2022 to 09/09/2022). An interviewer-administered questionnaire
was administered at the bedside and medical records reviewed to elicit sociodemographic data
and details of ANC use. Data were analysed with SPSS (v21). Standard descriptive statistics
and chi-square test were used in the analysis (significance level 0.05).
Results: In total, 251 pregnant women participated (response rate 97.6%). The majority
(80.5%, n=202) combined public ANC with private services. All participants accessed public
ANC at medical officer of health clinics and 96.8% were visited at home by a public health
midwife. The majority had visited public hospital clinics (76.9%) and used public laboratory
services (64.9%); 35.5% had used inpatient ANC. The use of private sector services was
comparatively lower; most accessed private pharmacies (60.6%), followed by channeling
centres (48.2%) and laboratories (45%); only two participants reporting using private inpatient
care. Median number of contacts with skilled ANC providers was 20 [IQR 17-23; public 17
(IQR 14-21); private 1 (IQR 0-5)]. Women with O/L qualifications (or higher) and those
employed were 1.4 and 1.2 times more likely, respectively, to use private ANC. Both these
associations were significant at the 0.05 level. Conclusions: A large proportion of pregnant women delivering at THJ use private ANC.
Contacts with ANC providers in the public sector exceeded Ministry of Health and WHO
guidance even in the post-COVID setting. Socioeconomic status appears to be associated with
private ANC use.
