an examination of the role of antenatal care attendance in ...

maternal mortality by three quarters between 1990 and 2015 and reducing mortality rate of children
under the age of five years by two-thirds between 1990 and 2015 (WHO 2004).
In sub-Saharan Africa, antenatal care is widely used as part of primary health care strategies (Nielses
2000). The Safe Motherhood Initiative (SMI) was launched in 1987 and has been very influential in the
field of maternal and child health. According to Chapman (2003) SMI is the international program to
reduce the number of women affected by preventable and treatable complications during pregnancy
and. child birth through provision of improved high quality maternal health services. One of the key
messages from SMI is that each and every pregnancy should be treated as a risk, considering the fact
that all pregnant women are at risk of complications and in need of the same basic services and
monitoring during pregnancy (Maternal and Neonatal Health Program 2005; Penn-Kekana and Blaauw
2002; Nielses 2000).
Recently, there has been a shift from the traditional routine antenatal care visits with more than twelve
visits per pregnancy to more focused antenatal care visits with at least four visits per pregnancy. The
more focused antenatal care concentrates on interventions that aim at detection and prevention of the
problem that might affect the pregnant woman, counseling and health promotion to encourage good
health throughout the pregnancy and to prepare for birth and possible complications (Maternal and
Neonatal Health Program 2005).
1.2 Statement of the problem
The main purpose of antenatal care is to improve pregnancy outcomes for both the mother and the child
(Gharoro and Igbafe 2000). Antenatal care is thus important in identifying women at increased risk of
adverse pregnancy outcomes and for establishing a relationship between the health providers and the
women (Magadi et al. 2003; Pallikadavath et al. 2004).
However, in terms of birth outcomes South Africa fares relatively poorly compared to upper-middle
income countries. The maternal mortality ratio of 150/100 000, and an estimated perinatal mortality
rate of 40/1000 are poor considering the fact that 95.1 percent of women attend antenatal care, and 83.7
percent of women deliver in a medical facility. At the same time, the medical infrastructure in place
rendering comprehensive essential obstetric care is satisfactory (Penn-Kekana and Blaauw 2002).
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