Barriers to early prenatal care in South Africa

ObjectiveTo understand the barriers delaying early prenatal care for women in South Africa.MethodsA mixed-methods study was conducted at a center in Pretoria.ResultsFollowing 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 12 weeks; however, the average gestational age at initial presentation was 19.1 ± 7.7 weeks. 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.ConclusionSignificant 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.