title: Barriers to early prenatal care in South Africa.
abstract: OBJECTIVE
  To understand the barriers delaying early prenatal care for women in South Africa.
  
  
  METHODS
  A mixed-methods study was conducted at a center in Pretoria.
  
  
  RESULTS
  Following interviews with 21 women at a prenatal clinic in Pretoria, a quantitative survey was completed by 204 postpartum women. During interviews, women described presenting late owing to contemplating induced abortion, fear of HIV testing, and fear of jealousy and bewitching. The survey results demonstrated that a majority of women (133 [65.2%]) reported knowledge of recommendations to present before 12weeks; however, the average gestational age at initial presentation was 19.1±7.7weeks. Women were more likely to present earlier if the pregnancy was planned (P=0.013) and were less likely to if they had at any point contemplated induced abortion (P=0.021). Fears of bewitching and harmful psychological stress owing to a positive HIV test result prevailed in both the interviews and the surveys.
  
  
  CONCLUSIONS
  Significant efforts should be devoted to improving access to contraception and prepregnancy counseling in order to improve early prenatal care attendance. Similarly, addressing cultural concerns and fears regarding pregnancy is imperative in promoting early attendance.
authors.affiliation: Doris Duke International Clinical Research Fellowship, Yale University School of Medicine, New Haven, CT, USA; University of Pretoria MRC Maternal and Infant Healthcare Strategies, Pretoria, South Africa. Electronic address: diane.n.haddad@vanderbilt.edu.
authors.forename: Diane N
authors.initials: DN
authors.lastname: Haddad
authors.affiliation: University of Pretoria MRC Maternal and Infant Healthcare Strategies, Pretoria, South Africa.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Makin
authors.affiliation: University of Pretoria MRC Maternal and Infant Healthcare Strategies, Pretoria, South Africa.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pattinson
authors.affiliation: University of Pretoria MRC Maternal and Infant Healthcare Strategies, Pretoria, South Africa; Yale University Department of Pediatrics, New Haven, CT, USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Forsyth
mesh_terms: D000028:Abortion, Induced / Q000523:psychology; D000328:Adult; D005239:Fear; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D011295:Prenatal Care / Q000523:psychology*; D036301:Qualitative Research; D012107:Research Design; D013019:South Africa; D055815:Young Adult
keywords: Access to care; HIV; Maternal mortality; Mixed-methods study; Obstetrics; Prenatal care; South Africa; Sub-Saharan Africa