Abstract
BackgroundAntenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers’ understanding of their patient’s behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women’s reasons for starting ANC later than the South African National Department of Health’s recommended 20 weeks gestation. We also looked at the impact of late ANC presentation on overall healthcare providers’ work experiences and their response in their interactions with patients.MethodsIn-depth interviews were conducted with 10 healthcare providers at Maternal Obstetrics Units (MOU) and Primary Healthcare Centres (PHC) in Gauteng, South Africa. Healthcare providers were selected with the assistance of the facility managers. Data analysis was conducted using the qualitative analysis software NVivo 11, using a thematic approach of pinpointing, examining, and recording patterns within the data.ResultsHealthcare providers were aware of patients need for secrecy in the early stages of pregnancy because of fears of miscarriage and women’s preference for traditional care. Women with prior pregnancies presumed to know about stages of pregnancy and neglected to initiate ANC early. Barriers to early ANC initiation also include, women’s need to balance income generating activities; travel cost to the clinic and refusal of care for coming after the daily patient limit has been reached. Healthcare providers encounter negative attitudes from un-booked patients. This has a reciprocal effect whereby this experience impacts on whether healthcare providers will react with empathy or frustration.ConclusionsTiming of ANC is influenced by the complex decisions women make during pregnancy, starting from accepting the pregnancy itself to acknowledging the need for ANC. To positively influence this decision making for the benefit of early ANC, barriers such as lack of knowledge should be addressed prior to pregnancy through awareness programmes. The relationship between healthcare providers and women should be emphasized when training healthcare providers and considered as an important factor that can affect the timing of ANC.
Highlights
Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies
More recently (2018), three quarters of women were observed to have made at least four ANC visits, 47% had an ANC visit in the first trimester, 32% first received ANC during the fourth or fifth month of pregnancy, 2% delayed care until the eighth month and about 6% were un-booked at Midwife Obstetric Units (MOUs) [14]
Participants were recruited from Community Health Centres (CHC) which often includes a Primary Health Care Centre (PHC) and Midwife Obstetric Unit (MOU)
Summary
Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Antenatal care (ANC) provides healthcare services to the pregnant women in an attempt to ensure, by antenatal preparation, the best possible pregnancy outcome for women and their babies. The South Africa Department of Health guidelines recommend that pregnant women seek ANC services as soon as they suspect a pregnancy or as early as the first missed menstrual period. All pregnant women are encouraged to attend eight ANC visits in order to reduce the risk of adverse obstetric outcomes [1]. In South Africa, between 2015 and 2016, 94% of pregnant women attending public health facilities had at least one ANC visit [13]. More recently (2018), three quarters of women were observed to have made at least four ANC visits, 47% had an ANC visit in the first trimester, 32% first received ANC during the fourth or fifth month of pregnancy, 2% delayed care until the eighth month and about 6% were un-booked at Midwife Obstetric Units (MOUs) [14]
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