The reason that I did not go – determinants of the use of antenatal care services in South Africa, two decades after the end of apartheid

According to South Africa's new constitution, access to health care is a fundamental right. Equitable provision of maternal health care is important in redressing past legacies and achieving the Millennium Development Goals. We analyse the utilisation of antenatal care (ANC) services under South Africa's public health system to inform policy concerned with equity of access. We conceptualise access to care as covering three distinct but interacting dimensions: availability, affordability and acceptability. We explain variations in the number of ANC visits among women giving birth in four selected communities, two urban and two rural. Results indicate that more-marginalised women were significantly less likely to have the minimum recommended number of ANC visits whereas being older, in a stable or married relationship and more highly educated and having no previous deliveries were positive influences. Further analysis revealed variations between facilities in the determinants of sufficient ANC visits. These results are discussed using insights based on qualitative patient interviews. Our findings show inequalities in utilisation which may indicate remaining inequities in access.