South Africa, like many other developed countries, is challenged by the under attendance and
delay in initiation of antenatal care (ANC) services among pregnant adolescents. Adolescents
are more vulnerable to pregnancy related complications, which may contribute to maternal
and child mortality and morbidity. This study aimed at evaluating the under attendance and/or
delay in initiation of ANC services among young pregnant adolescents (13-16 years old) as a
risk for adverse maternal and birth outcomes. The research was based at a district hospital on
the North Coast of Kwazulu-Natal. A retrospective review of all young adolescent (13-16
years old) maternity case records for the period from 2011-2013 was conducted. Data
collected included ANC trends in attendance, obstetric and perinatal outcomes.
A total of 314 pregnancies were recorded among young adolescents at this single hospital
over a period of 3 years. Adolescent pregnancy was associated with a risk of late ANC
booking and reduced ANC visits. The prevalence of anaemia (32%) was relatively high
among the girls. Fifty percent of all adolescents received episiotomies while, 45(14%)
experienced perineal tears. Logistic regression models found that the condition of perineum
was significantly associated with HIV status (OR= 0.36; 95% CI=0.16; 0.84; p<0.05). HIV
positive mothers were more likely to have an intact perineum post-delivery. However, HIV
positive adolescents were twice as likely to be diagnosed with anaemia compared HIV
negative mothers (results not significant). Underutilisation of ANC (i.e less than 4 visits) was
significantly associated with lower gestational age (< 37 weeks) (OR=2.64; 95% CI=1.04;
6.74; p<0.05). Fifteen percent of young mothers delivered early (< 37 weeks), 10% delivered
babies with a low birth weight (< 2500g) and 15% of the neonates suffered fetal distress. Low
birth weight, low Apgar scores as well as the incidence of maternal anaemia and Pregnancy
Induced Hypertension (PIH) were found to be related to late ANC booking. Qualitative
findings highlighted the perceived barriers of ANC by pregnant adolescents. Interviews
identified the following as factors that hindered access of care; financial barriers, attitudes of
Health Care Workers (HCW), system barriers and fear of HIV testing.
Urgent population based strategies are required to encourage timeous initiation of ANC
among adolescents. Strengthening of health education programs on the benefits of ANC
attendance among adolescents can be utilized as part of an approach to address the current
public health concern.