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.

Lorrein Shamiso Muhwava,Leslie London,Neo Morojele

doi:10.1186/s12884-016-0807-1

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.

Highlights

Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa
Our study identified psychosocial factors associated with early ANC initiation and frequency of ANC attendance in two contrasting sites, a rural farming area with a predominantly coloured population and an urban township area with a predominantly black population
When all factors are considered together, the results suggest that a rural coloured woman who initiated ANC early and attended ANC adequately tended to be a married woman with no previous miscarriage, who was not highly religious and had desired to fall pregnant when she conceived with a partner with higher education and who was the father of the child she was carrying during that pregnancy

Summary

Introduction

Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The South African Confidential Enquiries into Maternal Deaths for 2008–2010 found an institutional maternal mortality ratio (MMR) of 176.22/100000 live births in 2008–2010 compared to 151.77/100000 live births in 2005–2007 and that the institutional MMR is still increasing [2]. Infrequent, poor and no antenatal care, as well as delay in accessing medical help were listed in The South African Confidential Enquiries into Maternal Deaths for 2008–2010 [2] as amongst the most frequent patient-related avoidable factors resulting in maternal deaths, representing important missed opportunities for prevention. In low and middle income countries (LMIC), attendance of less than four ANC visits has been associated with an increased risk of perinatal mortality, stillbirth [7]

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