Exploring inequalities in access to and use of maternal health services in South AfricaReportar como inadecuado

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BMC Health Services Research

, 12:120

First Online: 21 May 2012Received: 06 October 2011Accepted: 21 May 2012DOI: 10.1186-1472-6963-12-120

Cite this article as: Silal, S.P., Penn-Kekana, L., Harris, B. et al. BMC Health Serv Res 2012 12: 120. doi:10.1186-1472-6963-12-120


BackgroundSouth Africa’s maternal mortality rate 625 deaths-100,000 live births is high for a middle-income country, although over 90% of pregnant women utilize maternal health services. Alongside HIV-AIDS, barriers to Comprehensive Emergency Obstetric Care currently impede the country’s Millenium Development Goals MDGs of reducing child mortality and improving maternal health. While health system barriers to obstetric care have been well documented -patient-oriented- barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in South Africa from the perspectives of women who had recently used, or attempted to use, these services.

MethodsA mixed-method study design combined 1,231 quantitative exit interviews with sixteen qualitative in-depth interviews with women over 18 in two urban and two rural health sub-districts in South Africa. Between June 2008 and September 2009, information was collected on use of, and access to, obstetric services, and socioeconomic and demographic details. Regression analysis was used to test associations between descriptors of the affordability, availability and acceptability of services, and demographic and socioeconomic predictor variables. Qualitative interviews were coded deductively and inductively using ATLAS ti.6. Quantitative and qualitative data were integrated into an analysis of access to obstetric services and related barriers.

ResultsAccess to obstetric services was impeded by affordability, availability and acceptability barriers. These were unequally distributed, with differences between socioeconomic groups and geographic areas being most important. Rural women faced the greatest barriers, including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability, relative to urban residents. Negative provider-patient interactions, including staff inattentiveness, turning away women in early-labour, shouting at patients, and insensitivity towards those who had experienced stillbirths, also inhibited access and compromised quality of care.

ConclusionsTo move towards achieving its MDGs, South Africa cannot just focus on increasing levels of obstetric coverage, but must systematically address the access constraints facing women during pregnancy and delivery. More needs to be done to respond to these -patient-oriented- barriers by improving how and where services are provided, particularly in rural areas and for poor women, as well as altering the attitudes and actions of health care providers.

AbbreviationsANCAnte-natal care

BBABorn Before Arrival

CEOCComprehensive Emergency Obstetric Care

HWHealth Worker

MDGsMillennium Development Goals

MMRMaternal Mortality Rate

NCCEMDNational Committee on the Confidential Enquiry into Maternal Deaths

SESSocioeconomic status.

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Autor: Sheetal P Silal - Loveday Penn-Kekana - Bronwyn Harris - Stephen Birch - Diane McIntyre

Fuente: https://link.springer.com/

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