References

A national Health Plan for South Africa.Pretoria: African National Congress; 1994

Ali AA, Osman MM, Abbaker AO, Adam I. Use of antenatal care services in Kassala, eastern Sudan. BMC Pregnancy Childbirth. 2010; (10) https://doi.org/10.1186/1471-2393-10-67

Ali SA, Dero AA, Ali SA. Factors affecting the utilization of antenatal care among pregnant women: a literature review. Journal of Pregnancy Neonatal Medicine. 2018; 2:(2)41-45 https://doi.org/10.35841/neonatal-medicine.2.2.41-45

Akella D, Jordan M. Impact of social and cultural factors on teenage pregnancy. Journal of Health Disparities Research and Practice. 2015; 8:(1)41-62

Blecher M, Davén J, Kollipara A, Maharaj Y, Mansvelder A, Gaarekwe O. Health spending at a time of low economic growth and fiscal constraint. South African Health Review. 2017; (1)25-39

Blencowe H, Cousens S, Jassir FB National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health. 2016; 4:(2)e98-e108 https://doi.org/10.1016/S2214-109X(15)00275-2

Burns N, Grove SK. Understanding Nursing Research - eBook: Building an Evidence-Based Practice.London: Elsevier Health Sciences; 2014

Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches.California: SAGE publications; 2017

Dapaah JM, Nachinaab JO. Sociocultural Determinants of the Utilization of Maternal Health Care Services in the Tallensi District in the Upper East Region of Ghana. Advances in Public Health. 2019; (3)1-11 https://doi.org/10.1155/2019/5487293

Darega B, Dida N. Unplanned pregnancy: Prevalence and Associated factors among Antenatal Care Attending Women in Bale Zone, Oromiya Region, Southeast Ethiopia: A facility-based cross-sectional study. Global Journal of Medical Research. 2015; 15:(4)1-6

De Vos AS, Delport CS, Fouché CB, Strydom H. Research at grass roots: A primer for the social science and human professions.Pretoria: Van Schaik Publishers; 2017

Guidelines for Maternity Care in South Africa, 3rd ed. Pretoria: Government Printer, South Africa; 2015

Finlayson K, Downe S. Why do women not use antenatal services in low-and middle-income countries? A meta-synthesis of qualitative studies. PLoS medicine. 2013; 10:(1) https://doi.org/10.1371/journal.pmed.1001373

Gebremeskel F, Dibaba Y, Admassu B. Timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch Town and Arba Minch District, Gamo Gofa Zone, South Ethiopia. J Environ Public Health. 2015; 4:(1)277-89 https://doi.org/10.1155/2015/971506

Guevarra MV, Stubbs JM, Assareh H, Achat HM. Risk factors associated with late entry to antenatal care visits in NSW in 2014. Aust N Z J Public Health. 2017; 41:(5)543-4 https://doi.org/10.1111/1753-6405.12668

John TW, Mkoka DA, Frumence G, Goicolea I. An account for barriers and strategies in fulfilling women's right to quality maternal health care: a qualitative study from rural Tanzania. BMC pregnancy and childbirth. 2018; 18:(1)

Kost K, Lindberg L. Pregnancy intentions, maternal behaviors, and infant health: investigating relationships with new measures and propensity score analysis. Demography. 2015; 52:(1)83-111 https://doi.org/10.1007/s13524-014-0359–9

Lincoln YS, Lynham SA, Guba EG. Paradigmatic controversies, contradictions, and emerging confluences, revisited.California: SAGE Publications; 2011

Majrooh MA, Hasnain S, Akram J, Siddiqui A, Shah F, Memon Z. Accessibility of antenatal services at primary healthcare facilities in Punjab, Pakistan. J Pak Med Assoc. 2013; 63:(4)S60-6

Mogawane MA, Mothiba TM, Malema RN. Indigenous practices of pregnant women at Dilokong hospital in Limpopo province, South Africa. Curationis. 2015; 38:(2) https://doi.org/10.4102/curationis.v38i2.1553

Mulondo SA, Khoza LB. Behavioural factors associated with late presentation at antenatal care in Limpopo Province, South Africa. African Journal for Physical Health Education, Recreation and Dance. 2015; 20:206-223

Mulondo SA, Khoza LB, Maputle SM. Risk Factors and Complications Associated with Tuberculosis in Pregnancy and Neonates in Limpopo Province, South Africa. Journal of Human Ecology. 2015; 51:(1-2)128-137 https://doi.org/10.1080/09709274.2015.11906903

Mullachery P, Silver D, Macinko J. Changes in health care inequity in Brazil between 2008 and 2013. International Journal for Equity in Health. 2016; 15:(1) https://doi.org/10.1186/s12939-016-0431-8

Antenatal care for uncomplicated pregnancies.London: National Institute for Health and Clinical Excellence; 2008

Polit DF, Beck CT. Nursing research: Principles and Methods.Philadelphia: Lippincott Williams & Wilkins; 2018

Factors contributing to late antenatal care booking in Mopani District of Limpopo Province. 2017. http://uir.unisa.ac.za/handle/10500/25028 (accessed 7 October 2020)

Sanda HU. Media awareness and utilization of antenatal care services by pregnant women in Kano State-Nigeria. Journal of Social Science Studies. 2014; 1:(2) https://doi.org/10.5296/jsss.v1i2.5175

Sibiya MN, Ngxongo TS, Reddy P Timing of first antenatal care attendance and associated factors among pregnant women in an obstetric health facility in eThekwini district, KwaZulu-Natal Province, South Africa. African Journal for Physical Activity and Health Sciences. 2018; 24:(2)181-92

Sinyange N, Sitali L, Jacobs C, Musonda P, Michelo C. Factors associated with late antenatal care booking: population-based observations from the 2007 Zambia demographic and health survey. Pan Afr Med J. 2016; 25:(8)127-133 https://doi.org/10.11604/pamj.2016.25.109.6873

South African Institute of Race Relations. Race relations in South Africa Reasons for Hope. 2019. https://irr.org.za/reports/occasional-reports/files/reasons-for-hope-report-final.pdf (accessed 10 October 2020)

Titaley CR, Dibley MJ, Roberts CL. Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007. BMC Public Health. 2010; (10) https://doi.org/10.1186/1471-2458-10-485

Provision of effective antenatal care: Integrated Management of Pregnancy and Child Birth (IMPAC).Geneva: World Health Organization; 2016a

Global Health Observatory (GHO) data.Geneva: World Health Organization; 2016b

Zaki NM, Albarraq AA. Use, attitudes and knowledge of medications among pregnant women: A Saudi study. Saudi Pharm J. 2014; 22:(5)419-28 https://doi.org/10.1016/j.jsps.2013.09.001

Zhao QI, Huang ZJ, Yang S, Pan J, Smith B, Xu B. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health. 2012; 12 https://doi.org/10.1186/1471-2458-12–1012

Factors associated with underutilisation of antenatal care services in Limpopo, South Africa

02 November 2020
18 min read
Volume 28 · Issue 11

Abstract

Background

The aim of this study was to explore and describe factors associated with underutilisation of antenatal care services. In South Africa, maternal and child healthcare services are provided free of charge. Despite this, utilisation of antenatal care services remains a major public health challenge. Literature affirms that 96% of pregnant women present at antenatal care services only after 12 weeks of pregnancy, and this is influenced by several factors. Women's attitude plays an integral role.

Methods

This study used a qualitative, exploratory, descriptive design. Purposive and convenient sampling methods were used to select 10 hospitals and 83 pregnant women, respectively. Ten focus group discussions were conducted to collect data. Trustworthiness was ensured by means of Guba's model and data were analysed, qualitatively, using Tesch's eight steps.

Results

The majority of the pregnant women (83%) were from rural areas, had unplanned pregnancies, had five pregnancies/children or more, factors that are associated with underutilisation of antenatal care services. Cultural practices and beliefs regarding early presentation to antenatal care services and its effect on pregnancies were also found to be associated with underutilisation.

Conclusions

Some pregnant women do not consider antenatal care services as essential and choose to present late, despite the knowledge that monitoring of maternal health during pregnancy by midwives could prevent maternal and neonatal morbidity, while improving maternal and neonatal health and wellness. Recommendations include the provision of information and education materials to women, as well as health education, to sensitise and increase women's awareness of the urgency in utilising antenatal care services.

The availability, accessibility and utilisation of antenatal care services play a major role in the lives of pregnant women and neonates worldwide (World Health Organization [WHO], 2016a). Globally, underutilisation of antenatal care services is influenced by various factors, such as low maternal education, stigma, teenage pregnancies, multiple parity and cultural factors (WHO, 2016a). Knowledge has been shown to have a direct effect on pregnant women's attitude towards prenatal care and other health issues (Sanda, 2014). A study done by Guevarra et al (2017) found that poverty, unemployment and low levels of education are associated with poor utilisation of antenatal care services in New Zealand. The WHO (2016b) suggests that efforts to reduce maternal mortality must focus on adequate antenatal care services and medical management. Blencowe et al (2016) report that 33% of perinatal mortality (PNM) that occurs at birth is largely the result of avoidable causes, such as late presentation or no attendance at antenatal care services. Poor utilisation of antenatal care services plays a major role in poor maternal and neonatal outcomes.

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