Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey

Abstract

BackgroundLate booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa.MethodsData from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents’ last pregnancy.ResultsOverall prevalence among urban women of early ANC initiation was 46 % and 84 % for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45 % and 78 % for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95 % CI 1.0–2.5) and wanted pregnancy (OR 1.8; 95 % CI 1.1–3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95 % CI 1.0–3.6) but inversely associated with high religiosity (OR 0.5; 95 % CI 0.3–0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95 % CI 1.9–9.3) and the father of the child being present in the respondent’s life (OR 3.0; 95 % CI 1.0–9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95 % CI 0.2–0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site.ConclusionThe majority of women from both sites attended ANC frequently but less than 50 % initiated ANC before the recommended 16 weeks gestational age. Interventions to reduce prevalence of late ANC booking and inadequate ANC attendance should engage religious leaders, address unintended pregnancy through family planning education and involve male partners in women’s reproductive health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0807-1) contains supplementary material, which is available to authorized users.

“They must understand we are people”: Pregnancy and maternity service use among signing Deaf women in Cape Town

“…Nearly all women in the sample (96%) reported attending an antenatal clinic, and close to half (49%) did so within the first trimester. These findings are consistent with other studies of antenatal care initiation in South Africa which indicate that almost all women receive antenatal care during pregnancy (35), but a significant proportion delay seeking care beyond the first trimester (36–38) which increases the risk of adverse pregnancy outcomes (39). Most women in the sample attended more than four antenatal visits during their most recent pregnancy which is similar to the Western Cape average of 4.7 visits (35) and WHO guidelines (33).…”

Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China

“…A study conducted in Southern and Northern areas of China suggested the same finding with our study [15]. The proportions of having adequate prenatal visits, receiving the first prenatal visit within 12 weeks and delivering at secondary- or higher-level health facilities in our study were higher than those in other developing countries such as Ethiopia and Africa, and were also higher than those of previous studies reported in Shaanxi Province and Western China [8, 16–21]. This suggested that the coverage of maternal health services utilization has been improved after years of development, which is consistent with the result of a study comparing the inequality status of maternal health services utilization before and after health care reform in Shaanxi Province[11].…”

Personal support and expressions of care for pregnant women in Soweto, South Africa

“…While attention has focused on physical changes and discomfort during pregnancy, far less has been paid to women’s emotional, economic, and social well-being [40], especially in African settings [but see 13,14,30,41, 42]. In women’s narratives, a dominant theme was that pregnant women at times felt vulnerable and emotionally alone, and sometimes were unable to identify what was bothering them or had no one with whom to discuss what was going on in their lives [40,43].…”