Assessment of Pregnant Women’s Knowledge Regarding the Importance of the Fourth Antenatal Care Visit in Al-Najaf Governorate, Iraq

Pregnant Women’s Knowledge

Abstract

Background: Antenatal care (ANC) is a core maternal-health service that enables early detection of pregnancy-related complications, counselling, preventive supplementation, fetal monitoring, and preparation for safe delivery. Although the World Health Organization currently recommends eight ANC contacts, the fourth ANC visit remains an important benchmark in many health systems and a practical opportunity to reinforce key messages before delivery. Although maternal knowledge about ANC has been widely studied, the level of pregnant women’s knowledge of the fourth ANC visit is still limited in Iraq. Aim: The current study aimed to assess pregnant women’s knowledge of the importance and components of the fourth ANC visit in the context of current maternal health recommendations. Methods: A descriptive cross-sectional study using convenience sampling was conducted among 381 pregnant women attending antenatal care services at 32 randomly selected primary health care centers in Al-Najaf Governorate, Iraq. The sample size was determined using Cochran’s formula. Data were collected using a structured interviewer-administered questionnaire covering socio-demographic characteristics, knowledge regarding the components and importance of the fourth ANC visit, and sources of information. Data were analyzed using SPSS version 26, and descriptive statistics, Chi-square tests and Bivariate analysis were used to summarize the data and assess associations between ANC attendance and knowledge variables. Results: Overall, 307 women (80.5%) had adequate knowledge regarding the fourth ANC visit. Adequate knowledge was significantly more frequent among women who had attended four or more ANC visits than among those with fewer visits (χ² = 12.99, P < 0.001). Women with ≥4 ANC visits also showed higher awareness of laboratory investigations, nutritional counselling, supplementation, maternal and fetal monitoring, danger signs, and birth preparedness. Healthcare providers were the most commonly reported source of information (40%), followed by family and friends (35%). Conclusion: The findings suggest that most pregnant women attending primary health care centers in Al-Najaf Governorate had adequate knowledge regarding the importance and main components of the fourth ANC visit. However, important gaps remain regarding pregnancy danger signs and birth preparedness. Strengthening structured counselling during routine ANC visits may support maternal preparedness for pregnancy-related complications and improve the quality of ANC health education in PHCCs.