Background: Focused Antenatal Care (FANC) has been advocated by the World Health Organization as a key service approach to improving health of pregnant women and their babies. Four targeted visits to antenatal clinics were recommended; with the first visit done in the first trimester. Malawi national uptake of FANC in first trimester is 12%, while it is even lower in Mangochi district at 8%.

Objectives: To identify facility-imposed barriers to early utilisation of FANC services.

Methods: This was a repeated cross-sectional assessment that was conducted during implementing CDTFA meetings in communities. The study participants were of reproductive age group in the villages who attended FANC promotion meetings. Both the study and assessment were done from January to August, 2016. Data were collected through flexible interactive processes from participants who attended village level meetings

Results: Meetings were held in each of 403 villages of Mangochi district. During these interactions with community members we noted that promotion of male partner involvement was resulting in some women not accessing FANC services as those who did not bring their partner were not accepted at the clinics. Pregnant women are required to bring a cloth wrapper for the newborn in advance when they come for deliveries. This requirement prevents those women who cannot afford cloth wrappers from accessing FANC services. Other costs such as payment for authorisation letters from Village Heads for women who have no partner at the time of initiating FANC clinic and user fees in faith-based health facilities are also barriers in as far as early utilisation of FANC services is concerned.

Conclusions: Despite the benefits of integrating health services through the FANC service model, there is need to ensure that the approach to its promotion does not bar pregnant women from accessing services. Exploration of these barriers is necessary to enable health authorities to redesign FANC health promotion strategies that will promote uptake of integrated services in FANC clinics without infringing on the rights of the very same pregnant women to access healthcare.