scholarly journals Support, Access and Antenatal Care to Women with a history of Preeclampsia in Pregnancy

2020 ◽  
Vol 11 (2) ◽  
pp. 86
Author(s):  
Evi Diliana Rospia ◽  
Andari Wuri Astuti ◽  
Retno Mawarti
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Maternal Death ◽  
Information Search ◽  
Health Workers ◽  
Qualitative And Quantitative ◽  
Lack Of Information ◽  
Need Support ◽  
History Of ◽  
In Pregnancy

Preeclampsia and eclampsia are the second direct cause of maternal death worldwide, estimated to complicate 2-8% of all pregnancies, the global prevalence of preeclampsia is around 4.6%. The purpose of this scoping review is to provide an overview of studies related to antenatal support, access and services to mothers with a history of preeclampsia in pregnancy. The authors identify studies that explain preeclampsia in pregnancy from several databases namely PubMed, ProQuest, EBSCO and Springer Link. Searches are limited to studies published in English and present data for the 2009-2019 period. The identified study was reviewed using PRISMA Flowchart. Studies with qualitative and quantitative designs that explore the experiences of pregnant women regarding antenatal support, access and services were selected for review, while studies that were not experience related to antenatal support, access and services to mothers with a history of preeclampsia in pregnancy were excluded. A total of twelve articles were reviewed which obtained three sub-themes of support, namely the support of husband, family and health workers, from the theme of access obtained three sub-themes namely information search, modification programs and the availability of health workers. From the theme of antenatal care, four sub-themes are found, namely unsustainable care, lack of information, screening and feeling empowered. Pregnant women with preeclampsia need support from a partner or family and health workers. Information and screening need to be improved in antenatal care.

The Effect of Counselling Intervention during Antenatal Care on the Knowledge and Attitude about Danger Signs in Pregnancy: A Cross-Sectional Study in Takalar Regency -

2020 ◽  
Vol 10 (2) ◽  
pp. 51-55
Author(s):  
Nurhikmah ◽  
Tahir Abdullah ◽  
Stang ◽  
Suriah ◽  
Andi Imam Arundhana ◽  
...  
Keyword(s):  
Health Service ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Community Health ◽  
Health Workers ◽  
Community Health Service ◽  
Cross Sectional ◽  
Danger Signs ◽  
Knowledge And Attitude ◽  
In Pregnancy

Objective: This study was to examine the effects of counselling delivered during antenatal care on the knowledge and attitudes of pregnant women about danger signs in pregnancy.Methods: This was a pre-experimental design using one group pre- and post-test only. This study was conducted in Takalar, specifically within Sanrobone Community Health Service working area. Takalar is located in South Sulawesi Province Indonesia and this area is coastal with the majority of people working as a fisherman. Participants of this study were pregnant women living in the villages which are included in the working area of Sanrobone Community Health Service.Results: The study shows that counselling improved knowledge and attitude of pregnant women about danger signs in pregnancy (p=0.011 and p=0.025, respectively). The number of pregnant women with good knowledge and positive attitude increased after the intervention (43.8% vs 93.8%, 62.5% vs 93.8%, respectively).Conclusions: In can be concluded that intervention by means of counselling can improve the knowledge and attitude of pregnant women about danger signs in pregnancy. Therefore, it is important to implement the counselling program delivered by health workers in Community Health Service in order to mitigate the risk of maternal mortality.

scholarly journals Malaria in Pregnancy in Endemic Regions of Colombia: High Frequency of Asymptomatic and Peri-Urban Infections in Pregnant Women with Malaria

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ana-María Vásquez ◽  
Lina Zuluaga-Idárraga ◽  
Margarita Arboleda ◽  
Luz-Yáned Usuga ◽  
Carolina Gallego-Marin ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Cross Sectional Study ◽  
Malaria In Pregnancy ◽  
Limited Information ◽  
Cross Sectional ◽  
History Of ◽  
Placental Blood ◽  
Adverse Pregnancy ◽  
In Pregnancy

Background. Malaria in pregnancy (MiP) has been associated with adverse pregnancy outcomes. There is limited information on MiP in low transmission regions as Colombia. This study aimed to describe the epidemiology of MiP through active surveillance of infections by microscopy and polymerase chain reaction (PCR). Methods. A cross-sectional study was conducted between May 2016 and January 2017 in five municipalities (Apartadó, Turbo, El Bagre, Quibdó, and Tumaco) in Colombia. Pregnant women self-presenting at health centers for antenatal care visits, seeking medical care for suspected malaria, or delivery, were enrolled. Diagnosis of Plasmodium spp was made in peripheral and placental blood samples by microscopy and PCR. Results. A total of 787 pregnant women were enrolled; plasmodial infection was diagnosed by microscopy in 4.2% (95% CI 2.8-5.6; 33/787) or by nPCR in 5.3% (95% CI 3.8-6.9; 42/787) in peripheral blood. Most of the infections were caused by P. falciparum (78.5%), and 46% were afebrile (asymptomatic). Women in the first and second trimester of pregnancy were more likely to be infected (aOR=3.06, 95%CI=1.6−5.8). To live in the urban/peri-urban area (aOR=3.04, 95%CI=1.4−6.56), to have a history of malaria during last year (aOR=5.45, 95%IC=2.16−13.75), and the infrequent bed net usage (aOR=2.8, 95%CI=1.31−5.97) were associated with the infection. Pregnant infected women had a higher risk of anaemia (aOR=2.18, 95%CI=1.15−4.12) and fever (aOR=14.2, 95%CI=6.89−29.8). Conclusion. The screening for malaria during antenatal care in endemic areas of Colombia is highly recommended due to the potential adverse effects of Plasmodium spp. infection in pregnancy and as an important activity for the surveillance of asymptomatic infections in the control of malaria.

scholarly journals Late registration for antenatal care by pregnant women with previous history of caesarean section

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mareko Ramotsababa ◽  
Vincent Setlhare
Keyword(s):  
Caesarean Section ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Late Registration ◽  
Lack Of Information ◽  
Data Saturation ◽  
History Of ◽  
Delayed Referral

Background: Despite good access to antenatal care (ANC) services for most women, and regular training of healthcare workers in obstetrics and gynaecology, many pregnant women with a previous history of caesarean section (C/S) still presented late for ANC services at Letsholathebe II Memorial Hospital (LIIMH) in Maun, Botswana. This may increase morbidity and mortality in women with previous C/S delivery and neonates. Knowing why women with previous C/S present late for ANC may help in the formulation of interventions that decrease morbidity and mortality amongst these women and neonates.Aim: The aim of this study was to explore the reasons why pregnant women with a previous history of C/S registered late for ANC, at LIIMH.Setting: This study was performed at LIIMH, a district hospital situated in Maun, Botswana.Methods: This was a descriptive qualitative study. Consenting pregnant women with previous C/S who presented at LIIMH after the 20 weeks of pregnancy were interviewed until data saturation. The data was analysed for themes.Results: The reasons for late registration at LIIMH include lack of information, misconception on the appropriate booking time and venue, dissatisfaction with the quality of ANC clinic services, use of alternative ANC providers, delayed referral, and pregnancy experience.Conclusion: Lack of knowledge of ANC delivery venue, using alternative ANC providers, and dissatisfaction with ANC clinic services, contributed to late registration. Pregnant women with previous history of C/S should be informed about ANC, delivery plans, and the assistance of alternative ANC providers should be explored.

scholarly journals Faktor-faktor yang Mempengaruhi Self Care Agency pada Ibu Hamil dengan Preeklampsia

2019 ◽  
Vol 11 (4) ◽  
pp. 289-294
Author(s):  
Apolonia Antonilda Ina ◽  
Veronika Ririn Marwaningsih
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Self Care ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Total Correlation ◽  
History Of ◽  
Care Agency ◽  
In Pregnancy

Kematian ibu akibat hipertensi dalam kehamilan dapat dicegah dengan deteksi dini terjadinya peningkatan tekanan darah melalui antenatal care yang berkualitas. Preeklampsia masih menjadi masalah yang belum terselesaikan karena angka kejadian yang masih tinggi dan komplikasi kematian ibu dan anak yang terjadi. Hal ini menjadikan studi tentang preklampsia masih sangat dibutuhkan dengan harapan bisa memberikan kontribusi data untuk penelitian lanjutan. studi tentang self  agency pada ibu hamil dengan preeklampsia belum pernah dilakukan di Indonesia. Self agency yang kuat akan memberikan kontribusi ibu hamil dalam mencegah terjadinya komplikasi akibat preeklampsia. Tujuan penelitian yaitu menganalisis faktor-faktor yang mempengaruhi self care agency pada  ibu hamil dengan preeklampsia. Desain penelitian yaitu  cross sectional. Penelitian dilaksanakan pada bulan Juli sampai September 2019. Sampel pada penelitian ini  yaitu ibu-ibu hamil yang berada di Rumah Sakit dan Praktik Bidan Mandiri sebanyak 90 responden. Proses pengumpulan data yaitu responden mengisi kuesioner yang diberikan peneliti. Kuesioner tersebut telah dilakukan uji validitas dan reliabilitas dibuktikan dengan nilai corrected item-total correlation > 0,3 serta  nilai Cronbach alpha > 0,6. Data yang telah diperoleh kemudian dianalisis menggunakan uji chi square serta  regresi logistik. Hasil penelitian didapatkan tidak ada hubungan antara usia, paritas, riwayat keluarga, pekerjaan, pendidikan, frekuensi ANC dengan kejadian preeklampsia dengan p value > 0,05. Riwayat hipertensi merupakan faktor risiko preeklampsia. Bagi peneliti selanjutnya disarankan untuk menambah jumlah sampel dan melakukan analisis lebih lanjut mengenai faktor-faktor yag belum diteliti, seperti riwayat preeklampsia, jarak kelahiran, usia gestasi.  Kata kunci: AKI, preeklampsia, self care agency MULTIPLE FACTORS OF SELF CARE AGENCY IN PREGNANCY WOMEN WITH PREECLAMPSIA   ABSTRACT Maternal mortality due to hypertension in pregnancy can be prevented by early detection of increased blood pressure through quality antenatal care. Preeclampsia is still an unsolved problem because of the high incidence and complications of maternal and child deaths that occur. This makes the study of preeclampsia still very much needed in the hope that it can contribute data for further research. a study of self agency in pregnant women with preeclampsia has never been done in Indonesia. A strong self agency will contribute to pregnant women in preventing complications due to preeclampsia. The research objective was to analyze the factors that influence the self care agency in pregnant women with preeclampsia. The study design was cross sectional. The study was conducted in July to September 2019. Samples in this study were pregnant women who were in the Hospital and the Practice of Independent Midwives as many as 90 respondents. The process of collecting data is that respondents fill out questionnaires given by researchers. The questionnaire was tested for validity and reliability as evidenced by the corrected item-total correlation> 0.3 and Cronbach alpha> 0.6. The data obtained were then analyzed using the chi square test and logistic regression. The results showed there was no relationship between age, parity, family history, work, education, frequency of ANC with the incidence of preeclampsia with p value> 0.05. A history of hypertension is a risk factor for preeclampsia. Further researchers are advised to increase the number of samples and conduct further analysis of factors that have not been studied, such as a history of preeclampsia, birth spacing, gestational age.  Keywords: Maternal Mortality Rate, preeclampsia, self care agency

Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Geographic Location ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

scholarly journals Acceptability of single screening and treatment policy for the control of malaria in pregnancy: perceptions of providers and pregnant women from selected health facilities in Lindi region, Tanzania

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chonge Kitojo ◽  
Frank Chacky ◽  
Emmanuel S. Kigadye ◽  
Joseph P. Mugasa ◽  
Abdallah Lusasi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Facilities ◽  
Malaria In Pregnancy ◽  
National Guidelines ◽  
Qualitative And Quantitative ◽  
Main Challenge ◽  
Malaria Rapid Diagnostic Tests ◽  
Experienced Pain ◽  
Care Workers ◽  
In Pregnancy

Abstract Background Tanzania started implementing single screening and treatment (SST) for all pregnant women attending their first antenatal care (ANC) visits in 2014, using malaria rapid diagnostic tests (RDTs) and treating those who test positive according to the national guidelines. However, there is a paucity of data to show the acceptability of SST to both pregnant women and health care workers (HCWs), taking into consideration the shortage of workers and the added burden of this policy to the health system. This study assessed the perceptions and opinions of health service users and providers to determine the acceptability of SST policy. Methods Pregnant women and HCWs in eight health facilities in two districts of Lindi region (Kilwa and Lindi) were interviewed using semi-structured questionnaires with open and close-ended questions. Both qualitative and quantitative data were collected, including demographic characteristics, women’s experience, their perception on SST and challenges they face when receiving services for malaria offered at ANC. Experience of HCWs regarding the implementation of SST as part of routine services and the challenges encountered when providing ANC services for malaria in pregnancy (MIP) were also assessed. Results Of the 143 pregnant women interviewed, 97% viewed testing favourably and would wish to be tested for malaria again, while 95% were satisfied with services and reasons for testing during the first ANC visit. Nearly all (99%) would recommend their fellow pregnant women to be tested for malaria and all women recommended that the Ministry of Health should continue the SST strategy. This was despite the fact that 76% of the women experienced pain and 16% had anxiety as a result of finger prick. Sixteen HCWs (mostly nurses) were interviewed; they also viewed SST implementation favourably and reported feeling empowered to use RDTs for malaria screening. The main challenge identified by HCWs was that nurses are not allowed to prescribe anti-malarials to women who test positive and need to refer them to the outpatient department for treatment. Conclusion SST was considered an acceptable approach to control MIP by HCWs and pregnant women, and they recommended the continuation of the policy. In addition, consideration should be given to implementing a task-shifting policy to allow nurses to dispense anti-malarials to pregnant women.

Prevalence and factors associated with anemia in pregnancy among women receiving antenatal care at the West Gonja District Hospital of Northern Ghana.

2020 ◽  
Vol 4 (3) ◽  
pp. 01-12
Author(s):  
Martin Malick
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Hemoglobin Concentration ◽  
World Health ◽  
Multiple Gestation ◽  
The West ◽  
Factors Associated ◽  
Folate Supplement ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Background: Anemia in pregnancy is a major public health problem especially in Low and Middle-income countries (LMIC) including Ghana and is defined by the World Health Organization (WHO) as being present when the hemoglobin concentration in the peripheral blood is 11g/dl or less. In most African countries anemia in pregnancy occurs if the hemoglobin concentration falls below 10g/dl. Pregnant women are at a higher risk of developing anemia due to several factors such as hemodilution, nutritional factors, multiple gestation, socio-economic status and malaria infestation. Anemia in pregnancy is an important cause of maternal mortality and affects half of pregnant women worldwide; with 56% of West African pregnant women being anemic. The objective of this study is to assess the prevalence and identify the risk factors associated with anemia among pregnant women receiving antenatal care at the West Gonja Hospital (WGH) Methods: A cross-sectional was conducted with 136 pregnant women receiving antenatal care at the WGH between January 2017 to February 2018. Random sampling was used to select participants and data was collected using a structured questionnaire. Data was analyzed using the SPSS Version 24.0. Results: A total 71(52.2%) of the study population were anemic, while 65 (47.8%) were not anemic. 20(74.1%) of the 27 pregnant housewives were anemic, while 11(64.7%) of the pregnant farmers were anemic. 27 (96.4%) of the 28 pregnant women who took their iron/folate supplement only some few days were anemic. 12 (100%) of the 12 participants who took their iron/folate supplement a few times a week were anemic. 4 (80%) of the 5 participants who never took their iron/folate supplement were anemic. 21 (70%) of those who did not sleep under ITN were anemic. 33 (84.6%) of the 39 patients who were diagnosed with malaria were also anemic. 28 (87.5%) of the 32 participants who took only 2 meals a day were anemic. 27 (79.4%) of the 34 patients who took liver, beef, chicken and fish only twice weekly were anemic. 15 (88.2%) of the 17 patients who drank tea some days in a week were anemic. Conclusion: Although most of the pregnant women were adequately educated on the most relevant aspects of anemia in pregnancy, more than half of them were still anemic. Anemia was more prevalent among pregnant uneducated housewives with poor nutritional habits. All the pregnant sickle cell disease patients as well as those diagnosed with malaria were also anemic.

GAMBARAN PENGETAHUAN, UMUR,DUKUNGAN SUAMI, DAN EKONOMI, PADA IBU HAMIL TENTANG KEPATUHAN PEMERIKSAAN KLINIK PRATAMA SANTA ELISABETH MEDAN

2020 ◽  
Vol 5 (02) ◽  
pp. 80-88
Author(s):  
Lilis Sumardiani
Keyword(s):  
Data Analysis ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Frequency Distribution ◽  
Post Partum ◽  
Number Of Children ◽  
Mothers And Children ◽  
Knowledge Age ◽  
Husband Support ◽  
In Pregnancy

Introduction :antenatal care is an examination of pregnant women both physically and mentally as well as saving mothers and children in pregnancy, childbirth and the puerperium, so that they post partum healthy and normal not only physically but also mentallyMethod : The study was conducted by distributing questionnaires to pregnant women with emesis gravidarum. Data analysis using univariants for frequency distribution. Result : The results showed an overview of knowledge of pregnant women with good knowledge of 13 people (65%), sufficient knowledge of 5 people (25%) and lack of knowledge of 1 person (5%) while lacking knowledge of pregnant women who did not comply did 1 pregnancy check up (5) %). overall obedient pregnant women undergo pregnancy examinations aged <20 years 7 people (35%), 20-30 years there are 7 people (35%) and there are 4 people> 35 years (20%). while those aged <20 years who are not compliant pregnant women do pregnancy examinations 2 people (10%). pregnant women about compliance with antenatal care namely, support from the husband is very good there are 12 people (60%), good 4 people (20%) and enough 4 people (40%). 20%), the middle economy there are 13 people (65%), and the low economy 4 people (20%), while the economy is lacking in pregnant women who do not comply with one pregnancy checkup (5%). parity, shows that the total number of pregnant women regarding compliance with antenatal care is, that has children who live 1 times 4 people (20%), the number of children who live 2-5 times 11 people (55%), and the number of children who live> 5 times 5 people (25%) while parity, in pregnant women who do not comply with pregnancy examination 1 person (5%) Duscussion:From this study it can be concluded that knowledge, age, husband support, economy and parity in pregnant women regarding compliance with antenatal care in the Klinik Pratama Santa Elisabeth Medan is said to be a minority who are disobedient and more who are obedient do ANC visits

Gambaran Pengetahuan Dan Sikap Ibu Hamil Tentang Tanda Bahaya Selama Kehamilan Di Klinik Romauli

2020 ◽  
Vol 5 (1) ◽  
pp. 90-103
Author(s):  
Lilis Sumardiani
Keyword(s):  
Pregnant Women ◽  
Maternal Death ◽  
Health Workers ◽  
Statistical Tests ◽  
Measuring Instruments ◽  
Chi Square ◽  
Cross Sectional ◽  
Danger Signs ◽  
Health Journal ◽  
Adequate Prenatal Care

The risk of maternal death is higher due to the delay factor, which is an indirect cause of maternal mortality. There are three risks of delay, namely being late in making decisions to be referred to (including being late in recognizing danger signs during pregnancy), being late to the health facilities during an emergency and being late in getting adequate services by health workers. The main causes of maternal deaths in Indonesia are bleeding (28%), eclampsia (24%), and infection (11%). The cause of maternal death can be prevented by adequate prenatal care. This study aims to describe the knowledge of attitudes of pregnant women about danger signs during pregnancy at Romauli ClinicMethod. This type of research is descriptive analytic with cross sectional approach. The total populations are all pregnant women who did the examination at Romauli Clinic from April to May are 120 pregnant women. The number of samples taken is a portion of the population, namely 25 pregnant women who are determined accidentally. The measuring instruments used are questionnaires and questionnaires. Data analysis uses 2x2 chi square test.Result. The results of this study indicate that there is an overview between knowledge and attitudes of pregnant women about danger signs duringElisabteh Health Journal : Jurnal Kesehatan, Vol. V No. 01 (Juni, 2020) : V-01 E-ISSN 2541-4992pregnancy by observing the results of statistical tests obtainead p = 0.003 <α 0.05. Because the significance value is smaller than the real level of 0.05,Duscussion. it can be concluded that there is an overview between the knowledge of the attitudes of pregnant women about danger signs during pregnancy at Romauli Clinic Marelan District Medan City.

scholarly journals Faktor- Faktor yang Berhubungan dengan Pemanfaatan Pelayanan Antenatal di Wilayah Kerja Puskesmas Air Tawar Kota Padang

2019 ◽  
Vol 19 (3) ◽  
pp. 661
Author(s):  
Desi Andriani ◽  
Husna Yetti ◽  
Roza Sriyanti
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Family Income ◽  
Health Workers ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
P Value ◽  
Independent Practice ◽  
Cross Sectional ◽  
Antenatal Services

Antenatal care or antenatal care is a planned program that is observation, education and medical treatment for pregnant women, to obtain a safe and satisfying pregnancy and childbirth process. The indicator used to assess the access of pregnant women to antenatal care is K1 direction (first visit) is the contact of pregnant women to health workers and K4 (perspective visit) is 4 or more times contact with health workers. From the data of the Padang City Health Office, it was found that the Air Tawar Puskesmas with this low level was caused by various factors. The purpose of this study was to determine factors related to the use of antenatal services. This type of research is a quantitative study with cross sectional study design with 110 respondents of third trimester pregnant women with purposive sampling technique. Data analysis was performed univariate, bivariate with Chi squre test. From the research results obtained from the five factors studied, it was found that the factors related to the use of antenatal services in freshwater health centers were access or distance with pvalue 0.009 = OR 21.676), service availability factors with a p value of 0.001 = OR 9.293, the role factor midwives with a p value of 0.001 = OR 12.302, while the family income factor, disease complaints obtained results have nothing to do with the use of antenatal services. The author's suggestion is that there is a need for good coordination with the Independent Practice Midwife (BPM), revitalize puskesmas to more strategic places and improve better facilities, improve accessibility that can be minimized, strive to reach pregnant women, especially for accessibility that is less affordable.

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