The maternal age in this study was highest in the age range of 20–29 years old, with the mean age of 28.3 years, showing a younger age group. A similar result was found in a study in Kuala Lumpur with a median of 29 years (Pitaloka and Rizal 2006). Peculiar to this study was the ethnic makeup, with two-thirds were from the indigenous races of Sarawak known also as Dayak, compared to studies done in Peninsula Malaysia with the majority of Malays, Chinese and Indians (Pitaloka and Rizal 2006). Minimal tertiary level education and housewives show similar findings as found in other countries with a rural setting such as in Bangladesh (Hasan et al. 2007), Egypt (Montasser et al. 2012), Ethiopia (Zeine et al. 2010), India (Khanam et al. 2012) and Asian countries such as Vietnam (Tran et al. 2012). Even though the highest income group was below the recommended minimal monthly income of MYR 850, the mean was MYR 143.04 and the median was MYR 1000 showing the patterns of rural socioeconomic status. However, this was lower as compared to the national census of mean household income of RM 3080 in rural Malaysia (Department of Statistics, Malaysia 2012). The median family size was 5, with an average of four children. This was in accordance with the declining fertility rate, which was encountered by the researcher during community survey as well as findings from the literature regarding reducing the fertility rate in Malaysia (Yadav 2012).
The characteristics of antenatal care received during last pregnancy revealed that the majority of them visited, at least, the state-recommended total of eight visits per pregnancy, which was similar to a high number of antenatal visits in developed countries such as in the United Kingdom (Redshaw and Heikkila 2010) and Sweden (Hildingsson et al. 2002). Two-thirds of the women visited the MCH clinic before 3 months of gestational age, which was also similar to Vietnam (Tran et al. 2012) and United Kingdom (Redshaw and Heikkila 2010). The median distance to the nearest MCH clinic was 15 min, closer distance compared to Bangladesh (Hasan et al. 2007), but similar to Tanzania whereby the nearest clinic was located in the village itself (Rockers et al. 2009). Understandably, more than three-quarters of the respondents used their own transport for follow-up; with the median amount of MYR 37.00 per visit.
The level of satisfaction with antenatal care services in this study was high, similar to other studies done in Kuala Lumpur, Malaysia (Pitaloka and Rizal 2006) Oman (Ghobashi and Khandekar 2008), Bangladesh (Hasan et al. 2007), United Kingdom (Redshaw and Heikkila 2010), Ethiopia (Esimai and Omoniyi-Esan 2009) and Scotland (Teijlingen et al. 2003). Even though they were satisfied with the waiting hours, however, they were less satisfied with the duration spent during consultation and treatment with medical staff, similar to findings in an urban antenatal clinic setting in Kuala Lumpur (Pitaloka and Rizal 2006) and in developed countries such as Oman (Ghobashi and Khandekar 2008).
Ethnicity, level of education, and out of pocket expenses appeared to be important factors for satisfaction on antenatal care. The studies done in developing countries such as in Nigeria and Oman also showed similar findings of race affecting the level of satisfaction on antenatal care services (Ghobashi and Khandekar 2008; Oladapo et al. 2008). Travailing far to the nearest clinic has been shown to reduce the level of satisfaction found in previous studies in Ghana (Overbosch et al. 2004) and Vietnam (Tran et al. 2012). There have been mixed findings regarding the level of education affecting satisfaction among women in antenatal care services. The lower level of education was associated with dissatisfaction such as in Sweden (Hildingsson and Radestad 2004), whereas tertiary and higher education were associated with high satisfaction levels as found in Nigeria (Esimai and Omoniyi-Esan 2009) and Ethiopia (Yohannes et al. 2013).
This study identified several limitations such as the cross-sectional design of this study and the dependence on recall memory of the respondents. The strength is its state-wide implementation where the respondents were recruited mainly from villages in the suburban and rural communities. This allows the findings to represent the community in these areas of Sarawak.