Reasons for late initiation of antenatal care among pregnant women in Tshwane : a Narrative inquiry

Abstract

Background The incidence of late initiation of antenatal care in South Africa remains high, despite the reported benefits of early initiation of antenatal care and free antenatal care services since 1994. Antenatal care is a crucial strategy to reduce maternal and perinatal morbidity and mortality. Whenever antenatal care is initiated late, the opportunity to prevent, detect and treat pre-existing medical conditions and pregnancy-related complications becomes limited hence contributing to maternal and perinatal mortality. Aim of the study The study aimed to explore and describe the reasons for late initiation of antenatal care among pregnant women at a selected community health centre in Tshwane. Research design and method A narrative inquiry was conducted. Participants belonged to the same community. Data was collected using semi-structured interviews among ten pregnant women who initiated antenatal care after 20 weeks of gestational age at the selected community health centre. Interviews were recorded, transcribed, and analysed according to thematic analysis. Results Individual stories were analysed to get the content of their accounts, then the meaning of all the stories was collated to bring about the broad story of the reasons contributing to the late initiation of ANC. Four central themes and ten sub-themes were identified. These are namely unplanned pregnancy (unaware of pregnancy, contraceptive failure), work circumstances (lack of opportunity to attend ANC and stress from work), dilemma of reporting (fear of reporting and embarrassment) and service delivery issues (pregnancy confirmed somewhere else, service delivery flow, shortage of staff and misdiagnosis of pregnancy). Conclusion Regarding the ANC received, participants were satisfied. None complained about nurses’ attitudes. The need for women empowerment concerning their reproductive health and rights is very fundamental. There is a great need for motivating the use of Long Acting Reversible Contraceptives among women in their reproductive ages, to prevent unplanned pregnancies. ANC services should be extended to after hours and weekends to reach women struggling with socioeconomic circumstances or disadvantages. Lastly, there should be regular reinforcement and monitoring the implementation of existing policies to improve quality care.