“We Are Having a Huge Problem with Compliance”: Exploring Preconception Care Utilization in South Africa

Abstract

Background: Preconception care (PCC), a policy directive from the World Health Organisation (WHO), comprises all the health interventions offered to women and couples before conception and is intended to improve their overall health status and the pregnancy outcomes. Although PCC should be an essential part of maternal and child health services in most African countries, its provision and utilization are not widely documented. Hence, this study aimed to explore the factors influencing preconception care utilization among high-risk women in South Africa. Methods: A descriptive qualitative study of 29 purposively selected women and healthcare workers was conducted through individual in-depth interviews using a semi-structured interview guide. The interviews were transcribed verbatim, and the analyses were performed using Nvivo version 12. The Social-Ecological Model (SEM) guided the data analysis. Four levels of factors (the individual, the interpersonal, the community and social, and the policy and institutional) were used to assess what can influence PCC utilization. Findings: The availability of PCC services, the intrahospital referral of women, the referral practices of other healthcare workers, the underutilization of the PCC facility, and resources emerged at the institutional levels, while compliance with PCC appointments, socioeconomic factors, pregnancy planning, assumptions, and knowledge was at the individual levels. Conclusion: The utilization of the preconception care services was inadequate. The primary influencer of preconception care utilization was at the individual, policy, and institutional levels. The availability of preconception care services and the intrahospital referral of women at high risk of adverse pregnancy outcomes positively influenced the women’s PCC utilization, while poor pregnancy planning, and unavailability of PCC policies and guidelines negatively influenced preconception care utilization. Therefore, interventions to improve PCC utilization should focus on the four SEM levels for effectiveness. There is a need to raise PCC awareness and develop policy and guidelines to ensure consistent, standardized practice among healthcare workers.

A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of theBukhalirandomised controlled trial

“…Aside from possibly impacting trial outcomes, this finding is concerning for participants' health, as preconception hypertension presents a risk for future cardiovascular disease in mothers (22)(23)(24), and for adverse outcomes in a potential pregnancy (25-27). The reported undermanagement may reflect a lack of current preconception care within the South African public healthcare system (28)(29)(30). In response to this finding, the Bukhali intervention team plans to implement more extensive follow-up of these high-risk, unmanaged cases.…”

Pregnancy after kidney and liver transplantation

“…While prenatal care is offered for free at all primary healthcare clinics, these services are underutilised in both sub-Saharan Africa and SA. [32,33] Transplant recipients should be counselled on factors associated with good pregnancy outcomes. These include delaying pregnancy for at least 1 year following the transplant, no evidence of graft rejection for at least 1 year prior to conception, stable graft function, absence of acute infections, stable maintenance doses of immunosuppressant drugs, and normal blood pressure.…”

A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial

“…Aside from possibly impacting trial outcomes, this finding is concerning for participants' health, as preconception hypertension presents a risk for future cardiovascular disease in mothers [32][33][34], and for adverse outcomes in a potential pregnancy [35][36][37]. The reported undermanagement may reflect a lack of current preconception care within the South African public healthcare system [38][39][40]. In response to this finding, the Bukhali intervention team plans to implement more extensive follow-up of these high-risk, unmanaged cases.…”