Background: Pregnant women in Uganda access antenatal care later in pregnancy than recommended. One potential factor influencing timing of antenatal care initiation is delayed pregnancy disclosure affecting the social support needed to facilitate care-seeking. However, data exploring women's decisions to disclose their pregnancy and the consequences for antenatal care-seeking are limited. We sought to understand social norms around pregnancy disclosure among pregnant Ugandan women and their male partners to inform interventions promoting appropriate antenatal care initiation.
Methods: In August-October 2020, we conducted in-depth interviews with 30 pregnant women and 15 male partners attending their first antenatal care visit at Kawempe National Referral Hospital, Kampala, Uganda. The female participants were purposively selected for their varying partnership status. We asked study participants about social norms around pregnancy disclosure, to whom they disclosed their pregnancy and when, whether pregnancy disclosure influenced social support they received and its implications for antenatal care initiation. We analyzed transcripts using deductive and inductive thematic analysis.
Results: Most participants selectively disclosed their pregnancy once confirmed, preferring to first disclose to close, trusted social relations (e.g. partner and/or mother), followed by a delayed selective, phased disclosure to other social relations (e.g., friends, certain family members and neighbors). Most women preferred waiting to disclose until at least their second trimester. Common reasons for delayed pregnancy disclosure included mitigating social judgement of pregnancy, fear of witchcraft and curses adversely impacting maternal and neonatal health, and concern about mockery or anger. These concerns arose from perceived social norms around the appropriate age for pregnancy and competing school priorities; lack of social recognition of the partnership and/or an unstable partner/relationship; and jealousy from others' desired fertility. Several reported that delaying pregnancy disclosure reduced their access to the financial and informational support they needed for earlier antenatal care initiation.
Conclusions: Many pregnant Ugandan women preferred only disclosing their pregnancy to close, trusted social ties while delaying disclosure to others. Delays in disclosure affected the social support they received thereby contributing to late antenatal care initiation. Targeted interventions to address factors contributing to delayed pregnancy disclosure may improve the timeliness of antenatal care and consequent maternal and neonatal outcomes.
Keywords: Antenatal care; Pregnancy; Social networks; Social support; Uganda.
Pregnant women in Uganda are not seeking health care as early as they should during pregnancy. This may be because they wait to tell family and friends who could help them get care for their pregnancy. Few studies have looked into when women share that they are pregnant with family and friends and how sharing this information could impact their access to care. We interviewed 30 pregnant women in Uganda and 15 male partners to explore their beliefs about when they should tell others about their pregnancy to help identify ways for women to access care earlier. We asked women who they told about their pregnancy and when, why they shared this information when they did, and if their decision to share this information was because they needed social support. Most women first only told close, trusted social family members like their partner and/or mother. Most preferred waiting until at least their second trimester to tell others about their pregnancy with many waiting to share this information for a long time. Reasons for waiting included fear of social judgement, witchcraft and curses, mockery and even anger which could cause adverse pregnancy outcomes. They were concerned about judgement of their age, lack of partner, or jealousy. A few respondents said they did not initiate antenatal care until they told their friends and family about their pregnancy. Delaying telling others reduced the help and information some respondents received to start antenatal care. Targeting reasons for delayed pregnancy disclosure could increase starting antenatal care early and impact maternal and infant health.
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