title: Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. lorrainemuhwava@yahoo.com.
authors.forename: Lorrein Shamiso
authors.initials: LS
authors.lastname: Muhwava
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.|Medical Research Council, Pretoria, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Neo
authors.initials: N
authors.lastname: Morojele
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Leslie
authors.initials: L
authors.lastname: London
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004651:Employment; D005220:Fathers / Q000523:psychology; D005260:Female; D006801:Humans; D017533:Marital Status; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011247:Pregnancy; D011275:Pregnancy, Unwanted / Q000523:psychology; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000523:psychology*; D015995:Prevalence; D012067:Religion; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
references.citation: Fam Plann Perspect. 2000 Mar-Apr;32(2):56-64
references.pmid: 10779236
references.citation: J Midwifery Womens Health. 2001 Jul-Aug;46(4):240-7
references.pmid: 11603639
references.citation: J Midwifery Womens Health. 2003 Jul-Aug;48(4):268-72
references.pmid: 12867911
references.citation: Soc Sci Med. 2004 Apr;58(8):1463-73
references.pmid: 14759690
references.citation: Soc Sci Med. 2004 Jun;58(12):2645-54
references.pmid: 15081212
references.citation: Midwifery. 2004 Jun;20(2):122-32
references.pmid: 15177855
references.citation: Med Care. 1988 Jul;26(7):724-35
references.pmid: 3393032
references.citation: Soc Sci Med. 1991;32(6):705-14
references.pmid: 2035047
references.citation: Soc Sci Med. 1992 Nov;35(10):1311-5
references.pmid: 1439914
references.citation: Addiction. 1993 Jun;88(6):791-804
references.pmid: 8329970
references.citation: Soc Sci Med. 1995 Apr;40(7):1003-12
references.pmid: 7792624
references.citation: Qual Life Res. 1996 Apr;5(2):275-80
references.pmid: 8998496
references.citation: Soc Sci Med. 1999 May;48(10):1407-14
references.pmid: 10369440
references.citation: J Soc Psychol. 1999 Aug;139(4):411-25
references.pmid: 10457758
references.citation: N Z Med J. 2005 Jun 3;118(1216):U1489
references.pmid: 15937524
references.citation: AIDS Patient Care STDS. 2008 Feb;22(2):147-58
references.pmid: 18260806
references.citation: Int J Nurs Stud. 2008 Dec;45(12):1757-63
references.pmid: 18653188
references.citation: Soc Sci Med. 2010 Feb;70(4):534-42
references.pmid: 19932549
references.citation: AIDS Care. 2010 Sep;22(9):1093-100
references.pmid: 20824562
references.citation: Cad Saude Publica. 2011;27 Suppl 2:S237-53
references.pmid: 21789416
references.citation: Midwifery. 2012 Feb;28(1):30-8
references.pmid: 21146264
references.citation: BMC Health Serv Res. 2012;12:40
references.pmid: 22335834
references.citation: BMC Pregnancy Childbirth. 2012;12:16
references.pmid: 22436344
references.citation: S Afr Med J. 2012 Nov;102(11 Pt 1):851-4
references.pmid: 23116742
references.citation: PLoS One. 2013;8(1):e53747
references.pmid: 23335973
references.citation: PLoS Med. 2013;10(1):e1001373
references.pmid: 23349622
references.citation: BMC Pregnancy Childbirth. 2013;13:14
references.pmid: 23324410
references.citation: Soc Sci Med. 2013 Mar;80:37-46
references.pmid: 23415590
references.citation: BMC Pregnancy Childbirth. 2013;13 Suppl 1:S5
references.pmid: 23445830
references.citation: S Afr Med J. 2013 Jun;103(6):406-12
references.pmid: 23725962