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

It has been argued that South Africa respects patients choice in the context of medically unnecessary
cosmetic procedures such as wisdom teeth removals which are not medically necessary, assuming that
the risks are fully explained to the patient, hence the choice of caesarean delivery. However, Matshidze
et al. (1998) argue that in the case of caesarean section the risks are not fully explained and that woman
might unreasonably and unnecessary influenced by their doctors' bias on women's ability to give birth
on their own.
Following the caesarean section was the low birth weight of the child. Nationally, South Africa has a
low birth-weight rate of nine percent. However, large percentage of births had missing data on birth
weights, thus most birth weight are not documented. As a result, the findings here are likely to be
underestimated. Sometimes mothers are not told the weight of their babies at birth, or babies are not
weighed at birth. The rate of low birth weight might also be attributed to the high rates of preterm
births as a result of high rates of caesarean deliveries; hence almost all preterm births have birth weight
less than 2500 grams. Similar findings were observed in Latin America during their recent WHO global
survey on maternal and perinatal health; where preterm delivery rates were highly associated with 10 to
20 percent of caesarean section rates (Villar et al. 2006). This concurs well with the results from the
study where 15.5 percent of the adverse birth outcomes are associated with caesarean section
Findings from the logistic regression showed that women who initiated antenatal care early were less
likely to have adverse birth outcome compared to women who are non attenders, however the findings
were not significant, arguing that there is no significance difference on adverse birth outcomes between
women with no antenatal care and those who initiated antenatal care early. Research findings have
demonstrated that initiation of antenatal care reduces the levels of adverse birth outcomes (Fantahum et
al. 2000; Khan et al. 2005; Chapman 2003, Nielses 2000; and Myer and Harrison 2003). The reason
behind this may be attributed to the fact that women initiating antenatal care early are more likely to
educated, have high API, live in urban areas and are likely to be other races other than Africans, thus
also reporting high proportions of adverse birth outcome due to caesarean section incidences and low
birth weights. Also the research findings shows that women who initiated their antenatal care late were
significantly less likely to have adverse birth outcome compared with women with no antenatal care.
These findings illustrate the effectiveness of the maternal health system of South Africa, as more
adverse birth outcomes are prevented, even when the woman have presented late to the health facility.
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