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

2.2 Use of antenatal care
Studies have shown that the utilization of antenatal care during pregnancy have a significant effect on
reducing adverse birth outcomes, hence maintaining the importance of adequate use of antenatal care
services by pregnant women (Magadi et al. 2000).
It has been shown that use of antenatal care in sub-Saharan Africa is high. According to AbouZahr et
al. (2003) the level of antenatal care attendance in sub-Saharan African countries increased between
1990 and 2000, with some countries documenting an increase of 45 percent in attendance. However, a
decrease in attendance has been reported in some parts of South Africa. In rural KwaZulu-Natal a
study was conducted to measure the use of primary health care services (Dedicoat 2003). The study
reported a decrease in the use of antenatal care services as compared to other primary health services in
rural KwaZulu-Natal. The authors argue this decrease may be due to the corresponding increase in
attendance at family planning services. It is likely that, due to family planning services, the pregnancy
rate is decreasing, hence the decrease in the antenatal care attendances (Dedicoat 2003). Camlin and
Moultrie (2004) also observed that in rural KwaZulu-Natal, fertility has declined rapidly for about two
decades and would have reached below replacement level in 2003. Family planning services have
therefore played an important role in bringing the fertility rates down in the area, and this has resulted
in a decline in attendance at health facilities for pregnancy related purposes.
Wilkinson et al. (2001) investigating the impact of removing user fees on clinic attendance in one of
the mobile clinics found that there was a gradual and sustained fall in the number of women presenting
for antenatal care despite the removal of the user fees. The study suggests that the fall was due to the
congestion at health facilities and reduced consultation times, caused by the increased access to
curative services, which in turn discouraged pregnant women from attending the antenatal care services
(Wilkinson et al. 2001).
The number of antenatal visits is important in influencing the quality of care received by pregnant
women. Internationally, four antenatal visits per pregnancy of low risk group women have been
recommended based on the evidence that fewer visits with specific services are more effective than
generalised visits (Villar et al. 2001).
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