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Why Do Women Seek Antenatal Care Late? Perspectives From Rural South Africa


  • Landon Myer,

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    • Landon Myer is based in the School of Public Health and Primary Health Care at the University of Cape Town. His background is in anthropology, with additional training in epidemiology. His interests are in social epidemiology, with particular emphasis on the HIV/AIDS epidemic in South Africa. At the time this research was conducted, he was a Senior Scientist at the South African Medical Research Council.

  • Abigail Harrison

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    • Abigail Harrison is a Senior Scientist at the South African Medical Research Council. Her interests are in qualitative research into sexual and reproductive health, particularly among adolescents. She has also worked extensively in programs to promote safe motherhood, as well as in health seeking behaviors associated with sexually transmitted diseases.

3Address correspondence to Landon Myer, Department of Public Health and Primary Health Care, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa.


Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.