# Causes of delayed antenatal care at an urban community health centre in Gauteng, South Africa

## TL;DR

This study explores why pregnant women in South Africa delay starting antenatal care and suggests ways to encourage earlier care initiation.

## Contribution

The study identifies specific factors and proposes targeted strategies to improve early antenatal care initiation in urban South African settings.

## Key findings

- Healthcare workers' behavior and negative attitudes were significant barriers to early ANC initiation.
- Operational management issues and socio-economic factors also contributed to delays.
- Staff training and improved clinic management could help mitigate these delays.

## Abstract

Maternal and perinatal deaths remain significant despite various strategies that have been implemented. Antenatal care (ANC) for pregnant women is crucial in reducing maternal and child mortality. Delayed ANC is associated with several maternal and foetal complications, which can be prevented through timely intervention. Previous studies have identified various factors contributing to the late initiation of ANC, and although recommendations have been made and implemented, there has been no impact. Objectives were to determine and rank the factors contributing to the delayed initiation of ANC among pregnant women attending a community health centre in the Tembisa township and to explore potential strategies for the early initiation of ANC.

A cross-sectional survey was conducted using a validated questionnaire on pregnant women attending their first ANC after 20 weeks of gestation.

Multiple variables affecting the early initiation of ANC were identified, namely healthcare workers’ behaviour, negative attitude, operational management factors and participants’ socio-economic standing. Staff counselling, support and training in holistic maternal healthcare, as well as accurate, uniform and consistent health educational information that recognises and addresses cultural beliefs, could encourage early initiation of ANC.

Staff empowerment and support for maternal health care through wellness services are crucial. Clinic operational management should adopt best practices to address prolonged time spent accessing services. Relevant health educational information for change should be provided.

The study‘s findings offer insights into the factors that delay the timely initiation of ANC and strategies to mitigate these delays.