Demand for antenatal care in South Africa

Abstract

On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P </= 0.05. There are three main implications for policy. (1) Those women who are either risk-lovers or risk-neutral are unlikely to consume preventive and promotive health care, including antenatal care. Thus, there is need to put in place incentives that would convert seemingly risk-lovers to risk-averters. (2) Programmes aimed at reducing women unemployment and general working conditions would improve use of pre-natal care. (3) Improvements in perceived quality of care at the health facilities that offer antenatal care is needed to boost the consumption of antenatal care and probably other forms of health care.