Growing inequities in maternal health in South Africa: a comparison of serial national household surveys

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dc.contributor.authorWabiri, Njeri
dc.contributor.authorChersich, Matthew
dc.contributor.authorShisana, Olive
dc.contributor.authorBlaauw, Duane
dc.contributor.authorRees, Helen
dc.contributor.authorDwane, Ntabozuko
dc.date.accessioned2021-10-08T06:54:46Z
dc.date.available2021-10-08T06:54:46Z
dc.date.issued2016
dc.description.abstractAbstract Background Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. Methods Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. Results High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. Conclusions Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.
dc.identifier.apacitationWabiri, N., Chersich, M., Shisana, O., Blaauw, D., Rees, H., & Dwane, N. (2016). Growing inequities in maternal health in South Africa: a comparison of serial national household surveys. <i>BMC Pregnancy and Childbirth</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34332en_ZA
dc.identifier.chicagocitationWabiri, Njeri, Matthew Chersich, Olive Shisana, Duane Blaauw, Helen Rees, and Ntabozuko Dwane "Growing inequities in maternal health in South Africa: a comparison of serial national household surveys." <i>BMC Pregnancy and Childbirth</i> 16, 1. (2016): 174 - 177. http://hdl.handle.net/11427/34332en_ZA
dc.identifier.citationWabiri, N., Chersich, M., Shisana, O., Blaauw, D., Rees, H. & Dwane, N. 2016. Growing inequities in maternal health in South Africa: a comparison of serial national household surveys. <i>BMC Pregnancy and Childbirth.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34332en_ZA
dc.identifier.issn1471-2393
dc.identifier.ris TY - Journal Article AU - Wabiri, Njeri AU - Chersich, Matthew AU - Shisana, Olive AU - Blaauw, Duane AU - Rees, Helen AU - Dwane, Ntabozuko AB - Abstract Background Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. Methods Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. Results High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. Conclusions Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Pregnancy and Childbirth LK - https://open.uct.ac.za PY - 2016 SM - 1471-2393 T1 - Growing inequities in maternal health in South Africa: a comparison of serial national household surveys TI - Growing inequities in maternal health in South Africa: a comparison of serial national household surveys UR - http://hdl.handle.net/11427/34332 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34332
dc.identifier.vancouvercitationWabiri N, Chersich M, Shisana O, Blaauw D, Rees H, Dwane N. Growing inequities in maternal health in South Africa: a comparison of serial national household surveys. BMC Pregnancy and Childbirth. 2016;16(1):174 - 177. http://hdl.handle.net/11427/34332.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Pregnancy and Childbirth
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12884-016-1048-z
dc.subject.otherAccess
dc.subject.otherEquity gap
dc.subject.otherMaternal health
dc.subject.otherNational household survey
dc.subject.otherRelative inequalities
dc.subject.otherSouth Africa
dc.subject.otherAdolescent
dc.subject.otherAdult
dc.subject.otherFamily Characteristics
dc.subject.otherFemale
dc.subject.otherHealth Services Accessibility
dc.subject.otherHealth Status Disparities
dc.subject.otherHealthcare Disparities
dc.subject.otherHumans
dc.subject.otherMaternal Health
dc.subject.otherMaternal Health Services
dc.subject.otherMiddle Aged
dc.subject.otherPregnancy
dc.subject.otherSocioeconomic Factors
dc.subject.otherSouth Africa
dc.subject.otherSurveys and Questionnaires
dc.titleGrowing inequities in maternal health in South Africa: a comparison of serial national household surveys
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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