Meta-Analysis the Effects of Education, Pregnancy Planning, Husband Support, and Distance to Health Facilities on the Utilization of Antenatal Care Service


  • Fransiska Sitepu Master's Program in Public Health, Universitas Sebelas Maret
  • Didik Tamtomo Faculty of Medicine, Universitas Sebelas Maret
  • Hanung Prasetya Study Program of Acupuncture, Health Polytechnics, Ministry of Health Surakarta



Background: Antenatal care (ANC) is comprehensive and quality antenatal care provided to pregnant women in the form of antenatal checks to prevent causes of morbidity and mortality in pregnant women and children. The decrease in the number of visits of pregnant women to health facilities has resulted in high maternal mortality due to complications of pregnancy and childbirth. This study aimed to analyze the effect of education, pregnancy planning, husband's support, and distance to health facilities on the utilization of ANC.

Subjects and Method: This was a meta-analysis. Population was pregnant women. Intervention: higher education, planned pregnancies, strong husband support, and distance to close facilities. Comparison: low education, unplanned pregnancies, weak spousal support, and long distances to facilities. Outcome: utilization of ANC. The articles used were obtained from Google Scholar, BMC Pregnancy and Childbirth, PubMed, and Science Direct. The keywords used “Antenatal Care” AND “Utilization of ANC” AND “Husband Support and ANC”. The articles used were full text in English from 2009 to 2022. Articles were selected using the PRISMA diagram and analyzed using the Review Manager 5.3 application.

Results: 14 cross-sectional studies showed that mothers with higher education (aOR=2.93; 95% CI=1.93 to 4.45; p=0.001); planned pregnancy (aOR= 1.99; 95% CI= 1.26 to 3.15; p=0.003); had husband support (aOR=2.89; 95% CI= 1.23 to 6.81; p=0.020); and closer distance to health facilities (aOR=3.07; 95% CI=1.43 to 6.55; p=0.003) had high and significant posibility to utilize ANC.

Conclusion: Higher education, pregnancy planning, husband's support, and proximity to health facilities influence the utilization of antenatal care.

Keywords: antenatal care, pregnant women, morbidity.

Correspondence: Fransiska Sitepu. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java 57126, Indonesia. Email: Mobile: +628136­7655293.


Bala ET, Ifa M (2017). Determinants of Antenatal Care Utilization in Ambo Town, Central Ethiopia: Community Based Cross Sectional Study. 36 (January 2017), 1-8.

De Guzman GS, Banal-Silao MJB (2022). Antenatal Care Utilization during The COVID-19 Pandemic: An Online Cross-Sectional Survey among Filipino Women. BMC Pregnancy Child-birth, 22(1): 1–12. DOI: 10.1186/s12884022052345.

Dewi MK, Widarini W, Karmaya INM (2014). Hubungan karakteristik sosial ekonomi dan dukungan suami dengan kelengkapan antenatal care (ANC) di Puskesmas Denpasar Selatan III (The relationship between socio-economic characteristics and husband's support with the completeness of antenatal care (ANC) at the South Denpasar Health Center III). PHPMA. 2(1): 45. DOI: 10.15562/phpma.v2i1.122

Gebrekirstos LG, Wube TB, Gebremedhin MH, Lake EA. (2021). Magnitude and determinants of adequate antenatal care service utilization among mothers in Southern Ethiopia. PLoS ONE, 116 (7), 1–19. DOI: 10.1371/journal.pone.0251477

BTT, Tac PV, Duc DM, Duong DTT, Thi LM. (2015). Factors associated with four or more antenatal care services among pregnant women: a cross-sectional survey in Eight South Central Coast Provinces of Vietnam. Int J Womens Health. 7, 699–706. DOI: 10.2147/IJWH.S87276

Kaphle HP, Gupta N, Shrestha N, Paul A, Dayal A, Singh A (2018). Determinants for the Utilization of Antenatal Care in Nepal. IJPSM 8(5): 7–18. DOI: 10.24247/ijmpsoct20182

Kementerian Kesehatan Republik Indonesia (2020a). Pedoman pelayanan antenatal, persalinan, nifas, dan bayi baru lahir di era adaptasi baru (Guidelines for antenatal care, delivery, postpartum, and newborns in the new adaption era).

Lestari RR (2021). Gambaran pengetahuan ibu hamil dan dukungan suami terhadap kunjungan antenatal care (ANC) Di Desa Salo Timur Wilayah Kerja Puskesmas Salo Tahun 2020 (Overview of knowledge of pregnant women and husband’s support for antenatal care (ANC) visits in East Salo Village Work Area of Salo Health Center in 2020). PREPOTIF, 5(1), 181–187. DOI: 10.31004/prepotif.v5i1.1372

Putri SW, Martya R (2021). Pelayanan antenatal care (ANC) pada ibu hamil di fasilitas pelayanan kesehatan selama pandemi COVID-19 (Antenatal Care Services (ANC) for pregnant women in health service facilities during the COVID-19 pandemic). NERSMID. 4(1): 1-11

Rahimi BA, Mohamadi E, Maku M, Hemat MD, Farooqi K, Mahboobi BA, Mudaser GM, Taylor WR (2022). Challenges in antenatal care utilization in Kandahar, Afghanistan: a cross-sectional analytical study. PloS One. 17(11): e0277075. DOI: 10.1371/journal.pone.0277075

Reis-Muleva B, Duarte LS, Silva CM, Gouveia LMR, Borges ALV (2021). Antenatal Care in Mozambique: Number of Visits and Gestational Age at the Beginning of Antenatal Care. Rev Lat Am Enfermagem, 29 (October). DOI: 10.1590/1518-8345.4964.3481

Tewodros B, Mariam GA, Dibaba Y (2012). Factors affecting antenatal care utilization in Yem Special Woreda, South-western Ethiopia. Ethiop J Health Sci. 9(1): 25-27

Tizazu MA, Asefa EY, Muluneh MA, Haile AB (2020). Utilizing a minimum of four antenatal care visits and associated factors in Debre Berhan Town, North Shewa, Amhara, Ethiopia, 2020. Risk Manag. Healthc. Policy. 13: 2783–2791. DOI: 10.2147/RM-HP.S285875

Tsegaye B, Amare B, Reda M (2021). Prevalence and factors associated with immediate postnatal care utilization in Ethiopia: Analysis of Ethiopian Demographic Health Survey 2016. IJWH, 13: 2783–2791. DOI: 10.2147/RMHP.S285875

Wai KM, Shibanuma A, Oo NN, Fillman TJ, Saw YM, Jimba M (2015). Are husbands involving in their spouses’ utilization of maternal care services?: a cross-sectional study in Yangon, Myanmar. PLoS ONE, 10(12). DOI: 10.1371/journal.pone.0144135.

Wolderufael TS (2018). Factors influencing antenatal care service utilization among pregnant women in pastoralist community in Menit-Shasha District, Ethiopia. International Journal of Medical Research & Health Sciences, 7(5): 143.




How to Cite

Sitepu, F., Tamtomo, D., & Prasetya, H. (2023). Meta-Analysis the Effects of Education, Pregnancy Planning, Husband Support, and Distance to Health Facilities on the Utilization of Antenatal Care Service. Journal of Maternal and Child Health, 8(4), 510–525.