All pregnant women should be screened for preeclampsia, anaemia, foetal growth and post-maturity at all ANC visits [ 28 ]. Standard preventative therapy, including tetanus toxoid injections, iron preparations and calcium supplements, should be issued to all pregnant women at each ANC [ 28 ]. A guide is included on how to advise women about nutrition and self-care [ 28 ].
The guidelines highlight the importance of preparing individualised ANC and delivery plans for each woman at the first ANC visit and that the plans should be reviewed during each subsequent visit and adjusted based on the identified needs. The plan should be prepared in consultation with the woman concerned. This ensures that the woman is involved in her own care.
The plans should also include transport arrangements, infant feeding options and future contraception. A description of how the first and the follow-up visits should be conducted is provided [ 28 ].
Only women with low-risk factors should follow the BANC approach. All women with risk factors should either be referred to an appropriate level of care or follow a specially prepared schedule based on the risk factors identified.
Specific times are scheduled for performing repeat routine tests such as Hb, HIV and RPR, and these times coincide with specific routine follow-up visits.
It is therefore important to schedule the follow-up visits as specified by the BANC guidelines in order to ensure the correct timing of repeat tests. Pattinson [ 2 ] suggests that each PHC clinic should have one or more people in the role of ANC supervisor to ensure clinical and administrative supervision. All information regarding pregnancy and consultation should be recorded in an ANC card which should not be filed at the clinic but which should be kept by the pregnant woman.
The woman is advised to always carry the ANC card with her, wherever she goes, and to produce the card each time she visits any health-care institution. This practice facilitates communication between the different health-care providers involved in the care of women during pregnancy and childbirth [ 2 ].
Several factors have been identified to be positively influencing the implementation of the BANC approach. These challenges include shortage of staff, lack of cooperation from referral hospitals, lack of in-service training, problems with transportation of specimens to laboratories, lack of material resources, unavailability of Basic Antenatal Care programme guidelines and lack of management support [ 35 ].
Although the BANC approach emphasises quality over quantity of visits [ 36 ], reducing the number of ANC visits has posed numerous challenges in the pregnancy outcomes. According to Hofmeyr and Mentrop [ 37 ], too few visits and the long interval between routine ANC visits in late pregnancy in the BANC approach have been responsible for a number of maternal and perinatal deaths.
Hofmeyr and Mentrop [ 37 ] argue that the more frequent and closely spaced ANC visits as pregnancy advances in the traditional approach assisted in early diagnosis and management of selected ANC problems such as preeclampsia, foetal growth impairment and others and that too few visits result in missed opportunities to detect and treat asymptomatic pregnancy complications.
The international evidence supports a more regular contact between healthcare workers and pregnant women. It is envisaged that this intervention will improve the pregnancy experience as well as the outcomes of pregnant women and their babies in South Africa. The adjustments include the 30 weeks and 34 weeks and then a 2-week visit until delivery. An audit of the current BANC system has shown that two important principles of good care were often missing: a plan for further antenatal care and the delivery plan including delivery at the appropriate level of care or hospital.
Therefore, appropriate planning for the pregnancy as well as for the delivery, based on information obtained and correctly interpreted at every visit, will ensure that women and their families are ready and prepared when the big day arrives.
Although South Africa is still experiencing numerous challenges with the BANC approach, there is hope that this country will also achieve positive results as the country continues to adjust and improve the BANC approach to suit its circumstances.
The author would like to acknowledge the following: Prof. NS Sibiya and Prof. The author declares that she has no financial or personal relationship which may have inappropriately influenced her in writing this chapter. Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Medical Care. Dental Care. View opening times. Close Contact Us. Make a booking. Best nutrition There are certain foods that should be avoided during pregnancy.
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Trends in Maternal Mortality: to Notes on the data. Definition of indicators Antenatal care coverage at least one visit is the percentage of women aged 15 to 49 with a live birth in a given time period that received antenatal care provided by skilled health personnel doctor, nurse or midwife at least once during pregnancy.
Given the limited resources of health care and the wide range of services provided as part of antenatal care, such questions must be dealt with.
Care should be appropriate, cost-effective and based on the needs of the specific pregnant woman. Observational studies have clearly demonstrated that antenatal care prevents health problems for both mother and child. Yet until fairly recently, little was known about which elements of antenatal care were particularly valuable. Research shows that many antenatal interventions are unnecessary or of unproven benefit.
Nevertheless, components of antenatal care and timing continue to be introduced without scientific evaluation.
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