Why do women leave pregnancy tests so late?
Some women only receive antenatal care well into their pregnancy, and that’s not a good thing
When Stellenbosch health economist Anja Smith decided to find out why pregnant women accessed antenatal care too late, she didn’t expect so many would say it was because they didn’t know they were pregnant.
The World Health Organisation (WHO) recommends that women access health care between 12 and 14 weeks to reduce the risk of pregnancy complications and low infant birth weight.
But 26% of women interviewed in maternal mortality wards in Cape Town only visited a hospital for the first time after 20 weeks of pregnancy. Smith, together with Prof Ronelle Burger and Dr Vivian Black, just published a study exploring who, why and how many pregnant women in Cape Town accessed health care too late in their pregnancy.
Their study report explained antenatal care before five months was exceptionally important in SA.
The country has a very high maternal and infant mortality rate, far higher than a country of its economic status should.
To both prevent mother-to-child transmission and improve an HIV-positive mother’s immune system, women with HIV should ideally access care as soon as possible, the report said.
Just more than half of those women who accessed care late said they didn’t realise they were pregnant, the study found. Many already had children. They were also more likely to drink alcohol, more likely to not have finished high school and were among the poorest of women.
A third of those who accessed care late told interviewers they drank alcohol during pregnancy, a number Smith thinks could be higher as not everyone admitted drinking habits to a stranger.
The research showed completing high school was associated with women being more likely to access antenatal care on time. The research was published last week in the journal Maternal and Child Health Journal.
Other interesting facts researchers found: Four out five babies were unplanned.
But half of the surprised moms were happy to be pregnant.
A quarter of the pregnancies were unwanted.
23% of women who went for care late had been putting off going, meaning they may have not wanted to face the fact they were pregnant, Smith thinks.
Women who went for care before 12 weeks, which is ideal, were more likely to have planned the pregnancy.
The study concludes there should be greater access to free pregnancy tests. They could be accessible in the way condoms are accessible. The high number of women saying they didn’t know they were pregnant surprised Smith, who said it was one of the most “interesting” findings of the research. Smith said the high number of women claiming not to have known they were pregnant could be because they were in denial.
The study report quoted research in the UK that found women who didn’t know they were pregnant “hadn’t been able to identify the symptoms of pregnancy or link physical signs or experiences to … pregnancy”.
Women could also be lying about missing the pregnancy to try to explain why they accessed care later than normal.
One theory she had been told about by doctors was that more than 70% of women in the state sector used types of injectable contraception given either every two or three months. That can influence the body so that a missed period is not seen as a sign of possible pregnancy.
She thought there could be lapses in injection use due to clinics being closed, long waiting times or stockouts.
Smith is now studying access and knowledge of contraception.
“The contraception issue is a bigger story.”
Her most current research sent mystery patients to 40 clinics in two provinces to access contraception. These are fake patients testing the quality of information, if birth control options were matched with a woman’s needs and in line with government guidelines. An injection was not suitable for a woman with a full-time job, who was unable to spend half a day at a clinic, she explained, but that tended to be what was offered.
Of 152 visits to clinics in two provinces: In only just more than a third of visits, three or more contraception options were explained to women.
In only 37% of visits were women advised to use dual contraception (both condoms for HIV protection and another contraceptive for pregnancy protection).
In only 29% of visits were patients asked any questions about their own medical history. Smith thinks irregular access to contraception may be one of the reasons women fall pregnant unexpectedly and then miss the signs of pregnancy. She suggested that the government provide better access to pregnancy tests to aid them.