Optimizing Maternal Health in Refugee Settings: Perspectives on the WHO's Enhanced Antenatal Care Schedule: A Mixed- Methods Study in Zarqa, Jordan

Zaid  Almubaid; Zachrieh  Alhaj; Debora  Kim; Salem  Khalil; Esther  Jeong; Daniel F  Young; Andrew  Thornton; Hani  Serag

doi:10.18502/jbe.v11i2.20900

Zaid Almubaid John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Zachrieh Alhaj John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Debora Kim John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Salem Khalil John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Esther Jeong John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Daniel F Young John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Andrew Thornton John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States.
Hani Serag Department of Public Health, University of Texas Medical Branch, Galveston, Texas, United States.

DOI: https://doi.org/10.18502/jbe.v11i2.20900

Keywords: Maternal health; Global health; Refugee health; Jordan; Epidemiology

Abstract

Introduction: Antenatal care (ANC) is essential for improving maternal and newborn health by enabling early detectionand treatment of potential complications. In 2016, the World Health Organization (WHO) increased the recommendednumber of ANC visits from four to eight, aiming to enhance maternal health outcomes. This study explores the experiencesof pregnant women in Jordanian refugee camps and examines the perceived impact of the revised WHO ANC schedule.

Methods: A mixed-methods study was conducted at Zarqa health centers in Jordan from May 28, 2023, to July 26, 2023.Data were collected through structured interviews with 46 female patients (pregnant, postpartum, or trying to conceive),focus group discussions (FGDs) with six participants, and semi-structured interviews with six healthcare providers.Quantitative data were gathered using structured questionnaires, while qualitative data were obtained through FGDs andprovider interviews.

Results: Participants unanimously agreed that eight ANC visits are essential for optimal maternal and fetal health.Approximately 90% expressed a need for clearer communication from healthcare providers during appointments. Despitedemonstrating strong self-awareness about when to seek medical attention, participants highlighted key barriers toANC access, including transportation challenges, childcare responsibilities, and long waiting times. Healthcare providersacknowledged these barriers and emphasized the need for improved patient communication and resource allocation.Overall, participants reported general satisfaction with the services provided at refugee health clinics.

Conclusion: Optimizing ANC access in refugee settings requires a multifaceted approach that addresses communicationgaps, logistical challenges, and systemic healthcare barriers to ensure equitable maternal health outcomes