A Description of Intimate Hygiene Practices During Pregnancy in a Cohort of Women in Johannesburg

Abstract

Background: Intimate hygiene practices during pregnancy can influence maternal and neonatal health outcomes. Limited data exist on these practices among South African women. This study aimed to characterise intimate hygiene practices among pregnant women in Johannesburg and examine associations with demographic factors and preterm birth. Methods: A secondary analysis was conducted on data from 18,076 pregnant women enrolled in the Group B Streptococcus Correlates of Protection Cohort Study in Johannesburg, South Africa. Participants completed questionnaires detailing their intimate hygiene practices, including frequency, methods, and products used. Statistical analyses assessed the prevalence of these practices, their association with demographic characteristics (age, race, education, occupation, dwelling type, parity, and HIV status), and preterm birth outcomes. Results: The mean age was 28.4 years (range 18–49). Most participants were Black (16,811; 93.0%), single (14,541; 80.4%), unemployed (11,691; 64.7%), and resided in urban areas (12,782; 70.7%). They reported a median intimate cleaning frequency of 14 times per week (IQR 8–14). Vaginal washing was reported by 6,312 women (34.9%). Among those who undertook vaginal washing, 62.5% used fingers, 35.7% used a cloth, and 0.4% used other objects. Over half (9,653; 53.3%) practiced douching, and 8,743 (48.4%) added products to their bathwater. Race was significantly associated with adding bathwater products (p < 0.00001). White women (39; 44.3%) had the highest proportion adding products. Tertiary-educated mothers were more likely to add products (396; 27.0%, p = 0.0041). Students had the highest rate of product use (154; 28.7%, p = 0.0018). Urban participants were more likely to add products (1,994; 25.2%) than semi-urban women (768; 23.2%, p = 0.025). Douching was also significantly associated with race (p < 0.00001), with the “Other” category (67; 65.1%) reporting the highest rate. Women with no schooling had the highest douching rate (53.2%, p = 0.0006). Semi-urban mothers douched the most frequently (4,757; 53.4%, p < 0.00001). Marital status was significantly associated with douching (p < 0.00001), with the highest prevalence among single women (6,658; 45.8%). Occupation was also significantly associated with douching (p = 0.016), with students having the highest douching prevalence (154; 28.7%). A significant association was observed between gestational age and the addition of products to bathwater for deliveries between 34 and <37 weeks compared to term deliveries (p = 0.045). Women who did not add products were more likely to deliver at term, while those who added products had a higher likelihood of delivering preterm. For deliveries <34 weeks compared to 34–<37 weeks, women who did not add products were more likely to deliver at 34–<37 weeks (p = 0.02). For deliveries at <34 weeks compared to 34–<37 weeks, women who douched were more likely to deliver at <34 weeks, while those who did not douche had higher proportions of deliveries at 34–<37 weeks (p = 0.035). In the combined preterm category (<37 weeks) compared to term deliveries, a statistically significant association was observed (p = 0.035), with women who douched being more likely to iv deliver preterm. Although some early preterm categories were more frequent among those who douched, overall no consistent statistically significant associations were found between hygiene practices and preterm birth outcomes. Conclusion: Intimate hygiene practices are prevalent among pregnant women in Johannesburg and are significantly associated with various demographic factors. While some associations with preterm birth were identified, no consistent significant association was established, warranting further studies.