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

conferred an increased risk of adverse birth outcomes that was independent of important confounding
socio-economic factors (ibid).
A study conducted in Scotland with the aim of determining whether the first and second births among
teenagers were associated with increased risk of adverse birth outcomes found that women with a first
birth during their teenage years were not at increased risk of any adverse outcomes and were
significantly at decreased risk of requiring emergency caesarean section. However, second births
among teenagers were found to be associated with an almost threefold risk of a premature birth and
stillbirth compared with women aged 20 and 24. (Smith and Pell 2001).
Marital status can influence the level of antenatal care utilisation. In Kenya, it was found that
unmarried women and those who started childbearing at ages younger than 20 years were less likely to
use antenatal care services compared to those who are married and were aged more than 20 years old
(Magadi et al. 2000).
Some studies have found little effect of marital status on the use of antenatal care. Mekonnen and
Mekonnen (2002) found married women residing in rural areas were 20 percent more likely to use
antenatal care than unmarried women residing in the same areas. Unmarried women were found to be
more than twice as likely as married women to receive delivery assistance from health care services.
2.4.4 Environmental factors
One of the important determinants of antenatal care utilization is the physical accessibility of the health
care services. Access in this study refers to the availability of the health care service in closer proximity
to the users (Chakraborty et al. 2003). Women living in rural areas are likely to be living some
distance from health facilities. In order to access health facility, they are expected to walk long
distances or spend money on transport in order to receive antenatal care. This may cause women not to
receive antenatal care frequently due to lack of time, energy to walk and money for transport.
In a study in the Hlabisa district using maps developed through the GIS technology, Tanser et al.
(2001) found that geographical distance is one of the important determinants of primary health care
utilisation in rural areas. The results from this study indicate that people living closer to the clinics were
more likely to attend the clinics than those living far from clinics. In addition, the results also show that
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