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Table 1 Barriers to birth preparedness and antenatal-care attendance according to the three delays model [22, 23], in Busoga, Eastern Uganda

From: Acceptability of evidence-based neonatal care practices in rural Uganda – implications for programming

DELAY

BARRIER

DELAY 1: DELAY TO SEEK CARE

Knowledge Barriers

- ANC misconstrued as provision of medicine for sick pregnant women

- Limited community knowledge on: importance of attending ANC four times; importance of ANC to mother and unborn baby; cause and care for danger signs

Culture and traditional beliefs and practices

- Deep rooted beliefs in herbs as part of pregnancy care

- Decision making as a male prerogative (seeking and choice of care)

- Conflicts related to polygamy: men making preferential treatment among wives

- Mother-in-laws making decisions for daughter-in-laws

- Influence from older mothers

- Too much burden of work on women

- The fear of preparing for the unborn whose viability is considered uncertain

DELAY 2: DELAY TO ARRIVE AT A HEALTH UNIT

Financial Constraints

- Lack of money for transport and hospital related costs (including under the table payments)

- Women's reliance on male partners for funds and men unable to raise and sometimes unwilling to give the funds

- Health facility requirements for BP being too costly for families

Peer influence on choice of care

- Women relying on fellow women for advise on ANC attendance

DELAY 3: DELAY TO GET CARE ONCE AT A HEALTH UNIT

Service delivery gaps

- Emphasis on ANC card by health workers as a pre-condition to skilled care

- Lack of skilled staff

- Poor attitude and communication skills of health workers e.g. rudeness and ignoring clients

- Health workers do not actively encourage couples to choose skilled providers for delivery