Abstract
Background: Late 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.
Methods: Data 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.
Results: Overall 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.
Conclusion: The 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.
Keywords: Maternal Mortality, Antenatal care, Psychosocial factors, Rural, Urban, South Africa