Multiple perspectives on factors affecting early antenatal care attendance in the context of PMTCT in a rural district of South Africa

Despite the extensive coverage of prevention of mother-to-child transmission of HIV (PMTCT) and a decline in new HIV infections among children nationally, challenges still exist with regard to timeous initiation of antenatal care services in rural settings. This study aimed to explore multiple perspectives on factors affecting early antenatal care attendance in a rural district of Mpumalanga Province. A narrative qualitative exploratory design was used to conduct individual semi-structured, in-depth interviews with 29 purposively selected HIV positive pregnant and postnatal women, 5 healthcare providers as well as 4 focus group discussions with 32 grandmothers. Thematic inductive analysis involving exploration of inter and intra-thematic themes revealed 5 overarching themes on perceived factors affecting early antenatal attendance, namely: 1) over familiarity with antenatal care services; 2) personal factors; 3) fear; 4) poor knowledge; 5) societal practices. A number of individual, community and health system barriers to early antenatal care attendance were identified, which can help guide interventions to improve early antenatal care.