an examination of the role of antenatal care attendance in ...
an examination of the role of antenatal care attendance in ... an examination of the role of antenatal care attendance in ...
1.4 Aims and objectives The aim of this study is to examine the relationship between antenatal care attendance and birth outcomes in South Africa. The specific objectives of the study are: • To describe antenatal care attendance behaviour among pregnant women in South Africa. • To investigate the influence of antenatal care attendance on birth outcomes. • To provide recommendations for intervention strategies to reduce adverse birth outcomes in South Africa. The study aims to answer the following questions: • What are the characteristics of pregnant women attending antenatal care? o What is the level of antenatal care attendance? o What are the socio-demographic factors of women attending antenatal care? • Are women with fewer antenatal care visits more likely to have adverse birth outcomes (low birth weights, still births and neo-natal deaths; delivered through Caesarian section) compared to those with more frequent visits? • Are women with no antenatal care visits more likely to have adverse birth outcomes (low birth weights, still births and neo-natal deaths; delivered through Caesarian section) compared to those who visited antenatal care facilities? This study has two hypotheses: • Women from lower socio-demographic backgrounds have lower antenatal care utilization • High levels of antenatal care attendance will result in lower adverse birth outcomes such as low birth weights and deaths. 1.5 Conceptual framework Figure 1 shows the structure of the conceptual framework model that is adopted in this study, which is propounded by Magadi (2003) and referred to as 'pathways of unfavourable birth outcomes' model. The model identifies a number of factors which do not have direct effect on adverse birth outcomes but contribute to these outcomes indirectly through intermediate factors. The desirability of the pregnancy, access to health facilities and marital status has no direct effect on adverse birth outcomes, such as low 4
irth weight, caesarean section and still births, but are linked to these outcomes through antenatal care. The model identifies antenatal care as the central link between socio- demographic, reproductive factors and birth outcomes. Socio-economic and demographic factors are likely to affect reproductive behaviour and accessibility of a maternal health facility. Literature has shown that women who are educated are more likely to have improved status and access to information and services. Educated women are likely to convert health information they receive through the media and other means of information into meaningful and effective practices. As a result, educated women are more likely to use modern family planning practices compared to less educated women (Case et al. 2005; Nielses 2000; MacKian 2003). Higher economic status is often associated with higher educational level. The model states that women with higher levels of education and higher economic status are more likely to use modern contraceptive methods than women with lower levels of education and lower economic status. They are also more likely to be living in urban areas than rural areas. Moreover, if they are situated far from health facilities they might be able to afford transport costs. In addition, they can afford consultation and medicine fees when using private health facilities. 5
- Page 1 and 2: AN EXAMINATION OF THE ROLE OF ANTEN
- Page 3 and 4: ACKNOWLEDGEMENTS My sincere appreci
- Page 5 and 6: THIS WORK IS DEDICATED TO: DEDICATI
- Page 7 and 8: CHAPTER ONE TABLE OF CONTENTS INTRO
- Page 9 and 10: LIST OF TABLES Socio-demographic ch
- Page 11 and 12: 1.1 Background of the study CHAPTER
- Page 13: 1.3 Justification of the study Whil
- Page 17 and 18: Birth outcomes such as size of the
- Page 19 and 20: 1.6 Organization of the dissertatio
- Page 21 and 22: the South African Demographic Healt
- Page 23 and 24: sufficient access to life-saving he
- Page 25 and 26: 2.2 Use of antenatal care Studies h
- Page 27 and 28: Early care also allows for the deve
- Page 29 and 30: Umkhanyakude district in KwaZulu-Na
- Page 31 and 32: likely to make decisions about thei
- Page 33 and 34: In contrast, another study showed a
- Page 35 and 36: clinics situated on or at the inter
- Page 37 and 38: inter-pregnancy intervals of 18-59
- Page 39 and 40: A questionnaire was used to collect
- Page 41 and 42: (v) Highest educational level Educa
- Page 43 and 44: mother. Lastly, the large number of
- Page 45 and 46: Table 4.1; Socio-Demographic Charac
- Page 47 and 48: 4.3 Number of antenatal care visits
- Page 49 and 50: Another interesting finding was tha
- Page 51 and 52: There was a statistically significa
- Page 53 and 54: 35-49 (17 percent). Similarly, mari
- Page 55 and 56: The results show a significant rela
- Page 57 and 58: The logistic regression results sho
- Page 59 and 60: that most people start families at
- Page 61 and 62: It has been argued that South Afric
- Page 63 and 64: pattern, with Asians being the high
irth weight, caesare<strong>an</strong> section <strong>an</strong>d still births, but are l<strong>in</strong>ked to <strong>the</strong>se outcomes through <strong>an</strong>tenatal <strong>care</strong>.<br />
The model identifies <strong>an</strong>tenatal <strong>care</strong> as <strong>the</strong> central l<strong>in</strong>k between socio- demographic, reproductive<br />
factors <strong>an</strong>d birth outcomes.<br />
Socio-economic <strong>an</strong>d demographic factors are likely to affect reproductive behaviour <strong>an</strong>d accessibility<br />
<strong>of</strong> a maternal health facility. Literature has shown that women who are educated are more likely to<br />
have improved status <strong>an</strong>d access to <strong>in</strong>formation <strong>an</strong>d services. Educated women are likely to convert<br />
health <strong>in</strong>formation <strong>the</strong>y receive through <strong>the</strong> media <strong>an</strong>d o<strong>the</strong>r me<strong>an</strong>s <strong>of</strong> <strong>in</strong>formation <strong>in</strong>to me<strong>an</strong><strong>in</strong>gful <strong>an</strong>d<br />
effective practices. As a result, educated women are more likely to use modern family pl<strong>an</strong>n<strong>in</strong>g<br />
practices compared to less educated women (Case et al. 2005; Nielses 2000; MacKi<strong>an</strong> 2003).<br />
Higher economic status is <strong>of</strong>ten associated with higher educational level. The model states that women<br />
with higher levels <strong>of</strong> education <strong>an</strong>d higher economic status are more likely to use modern contraceptive<br />
methods th<strong>an</strong> women with lower levels <strong>of</strong> education <strong>an</strong>d lower economic status. They are also more<br />
likely to be liv<strong>in</strong>g <strong>in</strong> urb<strong>an</strong> areas th<strong>an</strong> rural areas. Moreover, if <strong>the</strong>y are situated far from health<br />
facilities <strong>the</strong>y might be able to afford tr<strong>an</strong>sport costs. In addition, <strong>the</strong>y c<strong>an</strong> afford consultation <strong>an</strong>d<br />
medic<strong>in</strong>e fees when us<strong>in</strong>g private health facilities.<br />
5
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