Maternal health literacy and adherence to recommended ANC contact among pregnant women in Indonesian

Anggie Pradana Putri(1), Ady Irawan AM.(2), Lilik Hanifah(3), Susi Erna Wati(4), Yu Ying Lu(5*)

(1) National Taipei University of Nursing and Health Sciences; Stikes Mamba'ul 'Ulum Surakarta
(2) Universitas Duta Bangsa; Global Lubna Jaya Co.
(3) Stikes Mamba'ul 'Ulum Surakarta
(4) Universitas PGRI Kediri
(5) National Taipei University of Nursing and Health Sciences
(*) Corresponding Author


Maternal health literacy (MHL) equips pregnant women to seek timely Antenatal care (ANC). Through ANC, health workers can provide education that contributes to reducing the maternal mortality rate. This research aims to investigate the relationship between MHL and adherence to recommended ANC contacts and explore how mothers experience accessing ANC. The study design was a mixed-method study. A total of 305 pregnant women with various characteristics participated in this study. Quantitative data analysis used simple linear regression, while qualitative used Collaizi's strategy. The research found a positive relationship between MHL and adherence to recommended ANC contact with R2 = 0.18; F(1, 303) = 6.533, p < 0.05. Three themes represented the phenomenon of pregnant women in carrying out ANC: 1) perceptions about ANC, 2) challenges faced by pregnant women in accessing recommended ANC contact, and 3) supporting factors in doing routine ANC contact. Pregnant women with higher MHL have higher adherence to ANC contact. Health workers and policymakers can involve the results of this research in efforts to revise or make policies related to increasing pregnant women's ANC contacts.


adherence to recommended ANC contacts; pregnant women

Full Text:



World Health Organization. Sustainable Development Goals.html. Health topics: Sustainable Development Goals. Published 2021. Accessed July 5, 2021.

Alvaro R, Christianingrum R, Riyono T. Analisis RKP dan embicaraan endahuluan APBN (No. 04/an.PKA/PP/VI/2021): DAK fisik bidang kesehatan dalam mendukung target penurunan angka kematian ibu dan anak. Published online 2021. Accessed September 24, 2021.

Laksono AD, Rukmini R, Wulandari RD. Regional disparities in antenatal care utilization in Indonesia. Assefa Woreta S, ed. PLoS ONE. 2020;15(2):e0224006. doi:10.1371/journal.pone.0224006

Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2):e9. doi:10.2196/jmir.8.2.e9

Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International. 2000;15(3):259-267. doi:10.1093/heapro/15.3.259

Taheri S, Tavousi M, Momenimovahed Z, et al. Development and psychometric properties of maternal health literacy inventory in pregnancy. Tu WJ, ed. PLoS ONE. 2020;15(6):e0234305. doi:10.1371/journal.pone.0234305

Mojoyinola J. Influence of Maternal Health Literacy on Healthy Pregnancy and Pregnancy Outcomes of Women Attending Public Hospitals in Ibadan, Oyo State, Nigeria. Afr Res Rev. 2011;5(3). doi:10.4314/afrrev.v5i3.67336

Adanri O. Maternal Health Literacy, Antenatal Care, and Pregnancy Outcomes in Lagos, Nigeria. Published online 2017:149.

Asadi L, Amiri F, Safinejad H. Investigating the effect of health literacy level on improving the quality of care during pregnancy in pregnant women covered by health centers. J Edu Health Promot. 2020;9(1):286. doi:10.4103/jehp.jehp_204_20

Handebo S, Demie TG, Gessese GT, Woldeamanuel BT, Biratu TD. Does Women’s Literacy Affect Maternal Health Services Utilization in Ethiopia? A Stratified Analysis of 2019 Mini Ethiopian Demographic and Health Survey. In Review; 2022. doi:10.21203/

Warri D, George A. Perceptions of pregnant women of reasons for late initiation of antenatal care: a qualitative interview study. BMC Pregnancy Childbirth. 2020;20(1):70. doi:10.1186/s12884-020-2746-0

McNellan CR, Dansereau E, Wallace MCG, et al. Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries. BMC Pregnancy Childbirth. 2019;19(1):66. doi:10.1186/s12884-019-2207-9

Acharya D, Singh J, Kadel R, Yoo SJ, Park JH, Lee K. Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial. IJERPH. 2018;15(11):2450. doi:10.3390/ijerph15112450

Ahmed S, Fullerton J. Challenges of reducing maternal and neonatal mortality in Indonesia: Ways forward. Int J Gynecol Obstet. 2019;144:1-3. doi:10.1002/ijgo.12728

Cameron L, Contreras Suarez D, Cornwell K. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. Hotchkiss D, ed. PLoS ONE. 2019;14(6):e0217386. doi:10.1371/journal.pone.0217386

Nawabi F, Alayli A, Krebs F, et al. Health literacy among pregnant women in a lifestyle intervention trial: protocol for an explorative study on the role of health literacy in the perinatal health service setting. BMJ Open. 2021;11(7):e047377. doi:10.1136/bmjopen-2020-047377

Nawabi F, Krebs F, Vennedey V, Shukri A, Lorenz L, Stock S. Health Literacy in Pregnant Women: A Systematic Review. IJERPH. 2021;18(7):3847. doi:10.3390/ijerph18073847

Renkert S, Nutbeam. Opportunities to improve maternal health literacy through antenatal education: an exploratory study. Health Promotion International. 2001;16(4):381-388. doi:10.1093/heapro/16.4.381

Bello CB, Esan DT, Akerele SA, Fadare RI. Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria. Public Health in Practice. 2022;3:100266. doi:10.1016/j.puhip.2022.100266

Lang T. Documenting Research in Scientific Articles: Guidelines for Authors. Chest. 2007;131(2):628-632. doi:10.1378/chest.06-2088

Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice, 11th Ed. Df. Wolters Kluwer; 2017.

Taheri S, Tavousi M, Momenimovahed Z, et al. Development and psychometric properties of maternal health literacy inventory in pregnancy. Tu WJ, ed. PLoS ONE. 2020;15(6):e0234305. doi:10.1371/journal.pone.0234305

Chi PC, Bulage P, Urdal H, Sundby J. A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC Pregnancy Childbirth. 2015;15(1):18. doi:10.1186/s12884-015-0449-8

Guttersrud Ø, Naigaga MDAS, Pettersen KS. Measuring Maternal Health Literacy in Adolescents Attending Antenatal Care in Uganda: Exploring the Dimensionality of the Health Literacy Concept Studying a Composite Scale. j nurs meas. 2015;23(2):50-66. doi:10.1891/1061-3749.23.2.E50

Kharazi SS, Peyman N, Esmaily H. The Relationship between Maternal Health Literacy and Dietary Self-Efficacy with Pregnancy Outcomes. JMRH. 2020;8(1):2058-2068. doi:10.22038/jmrh.2019.32291.1350

Kohan S, Ghasemi S, Dodangeh M. Associations between maternal health literacy and prenatal care and pregnancy outcome. 2007;12(4):8.

Nodoshan T, Pirzadeh A, Nasirian M. The Relationship between Maternal Health Literacy and Pregnancy Status in New Mothers who Referred to Health Centers of Yazd. TBJ. Published online April 4, 2020. doi:10.18502/tbj.v18i6.2596

Naigaga MD, Guttersrud Ø, Pettersen KS. Measuring maternal health literacy in adolescents attending antenatal care in a developing country - the impact of selected demographic characteristics. J Clin Nurs. 2015;24(17-18):2402-2409. doi:10.1111/jocn.12796

Senol DK, Gol I, Ozkan SA. The Effect of Health Literacy Levels of Pregnant Women on Receiving Prenatal Care: A Cross-Sectional Descriptive Study. Published online 2019:8.

Forghani T, Ahmadian M, Rezaeisharif F, Ahadi M. Survey of Health Literacy during pregnancy and Its Relationship with Prenatal Care. J Health Lit. 2021;6(1). doi:10.22038/jhl.2021.55315.1148

Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122. doi:10.1136/bmjopen-2017-017122

Article Metrics

Abstract view : 80 times
PDF - 15 times



  • There are currently no refbacks.

Copyright (c) 2023 Anggie Pradana Putri, Ady Irawan AM., Lilik Hanifah, Susi Erna Wati, Yu Ying Lu

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

View My Stats

Universitas Muhammadiyah Semarang

Kedungmundu Raya Street No. 18 Semarang, NRC Building Universitas Muhammadiyah Semarang

Phone: 02476740287
Fax: 02476740287