Addressing Late Antenatal Care in Cape Town: A Study on Adolescent Pregnancies

Adolescent pregnancies present significant health risks for both young mothers and their babies. Despite global decreases in adolescent fertility rates, South Africa's rate has remained high, with 61 births per 1000 female adolescents in 2021. This rate is much higher than the average of 46 in other low- and middle-income countries. Late antenatal care (ANC) seeking is a critical issue, especially since the COVID-19 pandemic has increased adolescent pregnancies, making timely access to ANC more important than ever. A study by the Department of Economics, Faculty of Economic Management and Business Sciences, Stellenbosch University, Stellenbosch, South Africa, and the Department of Commerce, Business and Management, Faculty of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa examines why adolescents in Cape Town delay seeking ANC and identifies factors contributing to this delay.

Study Background and Methods

The study was conducted in three public healthcare facilities in the Cape Town Metropole. It focused on adolescents aged 16-18 who used public healthcare services. A total of 202 adolescents participated in the survey, which included questions about socio-demographics, pregnancy discovery, ANC attendance, and experiences at ANC facilities. Late ANC attendance was defined as attending ANC after the first trimester (three months). The study used univariate, bivariate, and multivariate methods to analyze the data.

Key Findings

The results revealed that 50.8 percent of the surveyed adolescents had their first ANC visit after three months of pregnancy, and 14.9 percent did not attend at all. Poor pregnancy identification and lack of information about ANC were major contributors to delayed care-seeking. Significant predictors of delayed care-seeking included age, education, and alcohol consumption.

• Pregnancy Identification: One of the main reasons for late ANC attendance was that many adolescents did not realize they were pregnant. Nearly half (45.5 percent) of those who attended late reported not knowing they were pregnant earlier.
• Lack of Information: A significant number of adolescents delayed seeking care because they were unaware of the necessity and benefits of early ANC. Some did not think early care was necessary or did not know where to seek it.
• Socio-Economic Factors: Adolescents from lower socio-economic backgrounds and those who consumed alcohol during pregnancy were more likely to delay ANC. Moreover, adolescents who were still in school were less likely to attend ANC early.

Impact of Late ANC Attendance

Delayed ANC attendance has severe consequences for both the mother and the newborn. Early ANC allows for the detection, monitoring, and treatment of potential complications, which is beneficial for both the mother and the baby. Late ANC is associated with lower birth weights, premature births, and a higher likelihood of newborns needing neonatal care. In South Africa, where about one in three women accessing ANC is HIV-positive, late ANC also increases the risk of mother-to-child HIV transmission.

The average gestational age at the first full ANC visit among the surveyed adolescents was 23.6 weeks, well past the recommended 12 weeks by the World Health Organization. This delay means that many adolescents miss out on important health interventions, including early HIV testing and treatment.

Recommendations for Improvement

To address the issue of late ANC attendance among adolescents, the study suggests several strategies. Improving pregnancy detection is crucial; providing better access to pregnancy tests in public health facilities can help adolescents identify pregnancies earlier. Increasing awareness through educational campaigns is also important, as these campaigns can inform adolescents about the importance of early ANC and where to access these services. Creating a supportive environment in both healthcare settings and at home can encourage adolescents to seek care earlier. This involves training healthcare workers to be more approachable and understanding towards young mothers. Additionally, targeted interventions should focus on adolescents from disadvantaged backgrounds and those who engage in risky behaviors, such as alcohol consumption, to ensure they receive the Maternal healthnecessary support and information.

The study highlights the critical need for timely ANC access for pregnant adolescents in Cape Town. Addressing the barriers to early ANC can significantly improve health outcomes for both young mothers and their babies. Public health interventions should focus on early pregnancy detection, education, and support to encourage adolescents to seek care promptly. By implementing these strategies, the health system can better support adolescent mothers and contribute to reducing the risks associated with late ANC attendance.