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To assess women’s experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing antenatal care policies are implemented and reinforced and that women are empowered to demand better services. © 2012 The Author(s).
A descriptive cross-sectional study was conducted involving women 18 years and over who had a live birth at one of three public healthcare facilities serving inner-city Johannesburg: one tertiary hospital, one secondary hospital and one primary care centre. These are the only three government facilities in the area with labour wards and are serviced by approximately 20 primary health care clinics in the surrounding metropolitan area with an estimated population of 800,000. Women delivering at these facilities tend to come from lower socio-economic backgrounds. Antenatal care is free in South Africa and current guidelines state that all primary healthcare facilities should screen pregnant women at their first presentation to the clinic, ideally before 20 weeks gestation. On diagnosing/suspecting pregnancy, women are meant to seek care at their designated local antenatal clinic as soon as possible for same day service. This service should be available Monday to Friday from 0700 h to 1600 h. Nevertheless, anecdotal evidence suggests women may not receive screening and care at their first contact with the clinic. With this in mind, we defined first clinic visit as the first time a woman attended an antenatal clinic seeking ANC and booking visit as the visit in which any antenatal screening was conducted. Interviews were conducted on 208 women in October 2009. The number of participants recruited from the three centres was proportionally representative to the size of the site based on the annual number of births at each site. Recruitment was conducted from the labour wards in order to identify women who had not attended antenatal care. Furthermore, having completed their pregnancy, it was considered that women would be able to give a more complete account of the care they received with less concern about their care being affected. Women were interviewed in the ward post-delivery and individually while waiting to be discharged. Two interviewers with knowledge of several South African languages conducted the interviews. A pre-tested questionnaire was verbally administered to each individual in English or was translated by the interviewers into the participant’s preferred language. Most interviewees who were uncomfortable being interviewed in English spoke Zulu or Xhosa. The questionnaire included sections on demographics, attendance at an ANC clinic, reasons for attendance or non-attendance and experience of care received. Gestational age at first clinic attendance was self-reported and distinctions were made between first clinic visit and booking visit. Data analysis was conducted using STATA 10.0 for windows (Stat Corp, tx USA). As this was a descriptive study, Chi-square tests were conducted on categorical variables with Fisher’s exact test employed where appropriate. For the purpose of this study and in accordance with DOH recommendations, women who reported attending an antenatal clinic for their first clinic visit at or before they were 5 months (20 weeks) pregnant were categorised as attending early while those who attended after they were 5 months were categorised as late. The study was approved by the Human Research Ethics Committee of the University of the Witwatersrand (M090817), study site facility managers and by the Gauteng Province. All participants were consented prior to being interviewed.
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