Objective: To examine reasons for women not accessing antenatal care, and subsequent pregnancy outcomes for this group of women.
Design: Retrospective observational study between 1992 and 2001.
Setting: Large public provincial referral obstetric unit.
Sample: A total of 226 of 16 176 women (1.4%) who gave birth had not accessed antenatal care in the index pregnancy.
Results: The women who did not access antenatal care were more likely to be highly parous or young, indigenous, and users of alcohol than the women who did access antenatal care; women who lived in remote communities and women who significant medical conditions complicating their pregnancy were less likely to default on antenatal care. The women who did not access antenatal care had a higher incidence of preterm birth and post-partum haemorrhage; their babies were more likely to be of low birthweight, to be born with 5-min Apgar scores less than 5, and had a higher incidence of perinatal death.
Conclusions: Lack of antenatal care is associated with a significant number of poor pregnancy outcomes, which are not explained by the basic epidemiological characteristics of women. As the women not accessing antenatal care tend to be from the most disadvantaged or marginalised groups in our society, a better understanding of their reasons for not accessing antenatal care is necessary so that care options can be provided which this high-risk group of women may find acceptable and use.