“They Told Me to Come Back”: Women’s Antenatal Care Booking Experience in Inner-City Johannesburg

To assess women’s experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city
Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews
were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery
about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service
provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women
who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the
clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought
care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for
late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access
antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise
ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing
antenatal care policies are implemented and reinforced and that women are empowered to demand better services.