Investigating the problem of underutilization of clinic-based prenatal services in rural communities in the Eastern Cape Province, South Africa.

Abstract

In its response to the high maternal reproductive morbidity and frequent pregnancy wastage, as well as the general problem of reproductive vulnerability among child-bearing women in South Africa, the government of the Eastern Cape Province has been able to increase the number of clinic-based prenatal services in various hospitals and health centres in urban and rural areas of the province. However, despite the noted increases in the provision of these services, most pregnant women in the rural areas of the province appear reluctant to utilize or still delay prenatal clinic consultations, thereby limiting their opportunity for prevention and treatment of preventable pregnancy complications. The purpose of this study was to explore the factors responsible for this anomaly. The study was carried out in two selected rural communities in the Amathole district, Eastern Cape Province, South Africa. The target communities were Gcuwa and Komanishini. Purposive (inclusion criterion-related) sampling was used to recruit participants for the study. The participants were selected based on the criteria of being pregnant, having given birth or being of child-bearing age. Two instruments were used to collect data: the interview guide and a self-developed questionnaire. The interview guide comprised eleven questions for the focus group discussions. The guide was used to ensure that important themes relevant to answering the research questions were tabled for discussion. The questionnaire data from 84 participants were analysed by means of descriptive statistics. A thematic analysis was performed on the responses from the focus group discussions to identify themes that emerge on the factors responsible for the reported reluctance of pregnant women to make use of prenatal services. The findings showed that the major factors responsible for the problem of underutilization of prenatal clinic-based services in the two villages include: “Lack of money to pay for services”; “Poor road network leading to where clinic is located”; “A lack of transport and the money to pay for it”; “Long distance to be covered”; and “Fear of being bullied or insulted by the nurses”. Implications of these findings were drawn and some recommendations for improved policy and practice and for further research were offered.