Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa
Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and < 5 months, and a quarter (26.3%) attended ≥ 5 months. For those attending ≥ 5 months, 51.8% cited late recognition of pregnancy as the major reason for delayed attendance. Supply-side barriers were not identified as large contributing factors to delayed attendance. Late antenatal care access was predominantly associated with demand-side factors. Women who accessed antenatal care ≥ 5 months were more likely to be in the poorest 40% of the wealth-index distribution (p = 0.034) and to not have completed high school (p = 0.006). They were also more likely to report alcohol consumption during pregnancy (p = 0.020) and be multiparous (p = 0.035). Having completed high school was protective of late antenatal care access in stepwise logistic regression analysis (OR 0.403, CI 0.210–0.773, p < 0.01). For women who attended ≥ 3 months, late access was associated with unwanted pregnancy (p = 0.030). Conclusions for Practice Improved access to pregnancy tests could assist in earlier pregnancy identification. Interventions to increase awareness of the importance of early antenatal care attendance among vulnerable women may help.
KeywordsAntenatal care HIV Unintended pregnancy Health seeking
We would like to acknowledge the fieldwork team who helped with the data collection—Didi Gobile, Lucy Luphondo, Nomfuzeka Sikota, Christine Abrahams, Mpumi Ketelo and Marché-Lerice Potgieter. We also thank the women who were willing to share their experiences on accessing ANC care. The contribution of Ijeoma Solarin in developing the survey instrument used in an earlier study (Solarin and Black 2013) and replicated in this study is acknowledged. We thank the Western Cape Provincial Department of Health for permission to conduct the study in the government MOUs and district hospitals. AS thanks the National Research Foundation (NRF) for funding for her PhD and post-doctoral fellowship.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Day, C., & Gray, A. (2016). Health and related indicators. In A. Padarath, J. King, E. L. Mackie, J. Casciola, (Eds.), South African Health Review 2016 (pp. 243–348). Durban: Health Systems Trust. Retrieved March 20, 2017, from http://www.hst.org.za/sites/default/files/Health_Indicators_0.pdf.
- Massyn, N., Peer, N., Padarath, A., Barron, P., & Day, C. (2015). District Health Barometer 2014/2015. Durban: Health Systems Trust. Retrieved March 20, 2017, from http://www.hst.org.za/publications/district-health-barometer-201415-1.
- Moodley, J. (Ed.), (2014). Saving Mothers 2011–2013: Sixth report on confidential enquiries into maternal deaths in South Africa, Short report. Pretoria: Department of Health. Retrieved March 20, 2017, from http://www.kznhealth.gov.za/mcwh/Maternal/Saving-Mothers-2011-2013-short-report.pdf.
- National Department of Health. (2014). National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. Pretoria: National Department of Health. Retrieved March 20, 2017, from http://www.inpracticeafrica.com/~/media/Guidelines/SA_NDOH_HIV_Tx.pdf.
- National Department of Health. (2015). The 2013 National Antenatal Sentinel HIV Prevalence Survey in South Africa. Pretoria: National Department of Health. Retrieved March 20, 2017, from http://www.hst.org.za/sites/default/files/DoH%20Sentinel%20HIV%20Survey%20High%20Res%207102015.pdf.
- Pattinson, R. (Ed.), (2012). Saving Mothers 2008–2010: Fifth report on the confidential enquiries into maternal deaths in South Africa. Pretoria: Department of Health. Retrieved March 20, 2017, from http://www.health.gov.za/index.php/2014-08-15-12-55-04/category/100-2012rp?download=185:saving-mothers-2008-2010-fifth-report-on-the-confidential-enquiries-into-maternal-deaths-in-south-africa-comprehensive-report.
- Western Cape Government: Health. (2015a). Annual performance plan 2015/2016. 2015; Cape Town: Western Cape Health Department. Retrieved March 20, 2017, from https://www.westerncape.gov.za/sites/www.westerncape.gov.za/files/department-of-health-annual-performance-plan-2015-2016.pdf.
- Western Cape Government: Health. (2015b). Antenatal (pre-birth) health services. Cape Town: Western Cape Government: Health. Retrieved March 20, 2017, from https://www.westerncape.gov.za/service/antenatal-pre-birth-health-services.
- World Health Organization. (2015). World Health Statistics. Geneva: World Health Organization. Retrieved March 20, 2017, from http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?ua=1&ua=1.