Delayed pregnancy disclosure, attributed social factors and implications for antenatal care initiation: a qualitative study among Ugandan women and their partners.

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.