Abstract
ObjectiveTo investigate and compare determinates for delayed first presentation to antenatal care (ANC) services.MethodsA cross-sectional study was conducted amongst pregnant women attending their first ANC visit in rural Capricorn District and peri-urban Tlokwe sub-district communities in South Africa. Data collection included questionnaires and medical record abstraction. Bivariate and multivariate analyses assessed factors associated with late ANC presentation.ResultsWe recruited 807 pregnant women. Of these, 51% of rural women and 28% of peri-urban women presented late for first ANC. Rural women were more likely to present late for first ANC (AOR = 2.65; 95% CI 1.98–3.55) and report barriers to accessing ANC services (P<0.0001). Late ANC presentation in rural communities was associated with being married (AOR = 2.36; 95% CI 1.33–4.19), employed (AOR = 1.90; 95% CI 1.03–3.50), <20 years of age (AOR = 2.19; 95% CI 1.10–4.37), and reporting an unplanned pregnancy (AOR = 2.21; 95% CI 1.40–3.50). Late presentation in peri-urban communities was associated with unplanned pregnancy (AOR = 1.67; 95% CI 1.01–2.74), being told to come back later to initiate ANC after presenting early (AOR 0.51; 95% CI 0.30–0.89) and being pregnant for the first time (AOR = 0.56; 95% CI 0.34–0.94)ConclusionBoth rural and peri-urban women had high rates of late presentation for first ANC. However, women in the rural communities were more likely to present late. Unplanned pregnancy was an independent risk factor in both rural and peri-urban communities. Interventions around family planning, especially for adolescent girls and young women, are needed to improve early presentation for ANC.
Highlights
Antenatal care (ANC) includes preventive and curative care services delivered during pregnancy
Late ANC presentation in rural communities was associated with being married (AOR = 2.36; 95% confidence intervals (CI) 1.33–4.19), employed (AOR = 1.90; 95% CI 1.03–3.50),
Late presentation in peri-urban communities was associated with unplanned pregnancy (AOR = 1.67; 95% CI 1.01–2.74), being told to come back later to initiate ANC after presenting early (AOR 0.51; 95% CI 0.30–0.89) and being pregnant for the first time (AOR = 0.56; 95% CI 0.34–0.94)
Summary
Antenatal care (ANC) includes preventive and curative care services delivered during pregnancy. ANC services, especially at first visit, includes essential screening for health conditions such as human immunodeficiency virus (HIV) and Syphilis; for HIV-infected pregnant women, the maximum benefit of antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT) of HIV requires early presentation to the health system [1]. Immunizations, such as Tetanus toxoid, given during pregnancy can be life-saving for both mother and infant. Documented risk factors for late first ANC presentation include lack of education, attitudes and knowledge regarding pregnancy, being unmarried, history of obstetric complications, and cultural beliefs. Even with adequate knowledge, socio-cultural determinants of health-seeking behaviors may negatively impact utilization of ANC services [7]
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