Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018

A longitudinal surveillance study of rural mothers

Bibliographic Data

ID21879264
AuthorsDaniel Sack (0000-0003-0864-8875, Vanderbilt University Medical Center, corresponding author), Ryan G Wagner (0000-0003-2741-3676, University of the Witwatersrand), Daniel Ohene-Kwofie (Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa), Daniel Ohene‐Kwofie (0000-0001-7107-9498, University of the Witwatersrand), Chodziwadziwa Kabudula (0000-0002-5867-0336, University of the Witwatersrand), Chodziwadziwa W Kabudula (Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa), Jessica Price (0000-0002-4020-6850, University of the Witwatersrand), Carren Ginsburg (0000-0002-8391-8268, University of the Witwatersrand), Carolyn M Audet (0000-0002-4715-1346, University of the Witwatersrand)
Year2021
Volume6
Issue10
Pagese006915
Publication date2021-10-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-006915
PMID34620615
OpenAlexW3201942314
LanguageEN
References cited32

INTRODUCTION: Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition. METHODS: We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic). RESULTS: Between 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents. CONCLUSION: Pregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions

Birth attendant · Environmental health · Health care · Health facility · Health services · Logistic regression · Maternal health · Population · Pregnancy · Public health · Rural area · Demography · Global Health and Surgery · Global Health Workforce Issues · Global Maternal and Child Health · Medicine · Nursing