A comparison of booked and unbooked mothers delivering at the Port Moresby General Hospital: a case-control study

A case-control study of unbooked mothers delivering at the maternity unit of the Port Moresby General Hospital was undertaken over a period of 7 months. 48 mothers who had no antenatal attendances during pregnancy were recruited with 96 booked controls. Reasons for non-attendance, understanding of the importance of antenatal clinics and socioeconomic and demographic factors were recorded to assess likely risk factors for non-attendance. Almost half the mothers cited financial difficulties as the reason for non-attendance at antenatal clinics despite most of them knowing that it was important to have antenatal care during pregnancy. The two most important risk factors for being unbooked were mothers having no education (p <0.001) and the type of employment of their spouse (p <0.01). Unbooked mothers were more likely to have preterm babies (OR 16.1; 95%CI 3.4-75.7) and all 6 perinatal deaths occurred in babies born to unbooked mothers. Remedial approaches would need to take into account maternal education, education of partners and the fact that despite free antenatal services in urban clinics financial difficulties in terms of other costs involved still remain an obstacle to overcome.