Healthcare attendance patterns by pregnant women in Durban, South Africa

Background: High rates of perinatal mortality and morbidity and maternal mortality in South Africa remain a major problem. The Saving Mothers and Saving Babies Reports identified patient-related factors as possible causes. Among the patient-related factors was non-attendance, or attendance late in pregnancy, for antenatal care in public hospitals. It would appear that pregnant women confirm their pregnancies by visiting general practitioners, but do not attend antenatal care in the public sector. Aim: The aim of this study was to determine healthcare attendance patterns among pregnant women in Durban, South Africa. Method: This was a descriptive study. Participants were recruited and categorised into “early booker”, “late booker” and “unbooked in labour” groups. All the participants were interviewed individually using a structured questionnaire. Results: The majority of participants presented for formal “booking” late in pregnancy; 47.9% “booked” at a gestational age of six months after the last menstrual period. Among the “early bookers”, the majority (94.4%) had confirmed their pregnancy by four months of amenorrhoea, and 60.6% of these confirmed their pregnancies within the public health sector. All the “early bookers” began antenatal care prior to the 20th week of gestation. A total of 66.9% of the “late bookers” and 66.7% of the “unbooked” women also had their pregnancies confirmed at four months amenorrhoea, but 49.0% of the “late bookers” and 59.8% of the “unbooked” women confirmed their pregnancies in the private health sector. The “late bookers” also showed a delay of two to three months between confirming the pregnancy and booking visits. Of the women in this study, 49% visited a general practitioner (GP) to confirm the pregnancy after two to four months of amenorrhoea. This figure rose to 53.0% if only the “late bookers” and the “unbooked” were analysed. Further, 35.3% visited a GP more than once, either for antenatal care or because of ill health. Conclusion: It is imperative for GPs to understand the role of antenatal care and to refer pregnant women appropriately.South African Family Practice Vol. 48 (10) 2006: pp. 17-17