Exploring inequalities in access to and use of maternal health services in South Africa

Simple item page
dc.contributor.authorSilal, Sheetalen_ZA
dc.contributor.authorPenn-Kekana, Lovedayen_ZA
dc.contributor.authorHarris, Bronwynen_ZA
dc.contributor.authorBirch, Stephenen_ZA
dc.contributor.authorMcIntyre, Dianeen_ZA
dc.date.accessioned2015-11-23T11:44:38Z
dc.date.available2015-11-23T11:44:38Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: South 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. METHODS: A 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. RESULTS: Access 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. CONCLUSIONS: To 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.en_ZA
dc.identifier.apacitationSilal, S., Penn-Kekana, L., Harris, B., Birch, S., & McIntyre, D. (2012). Exploring inequalities in access to and use of maternal health services in South Africa. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/15245en_ZA
dc.identifier.chicagocitationSilal, Sheetal, Loveday Penn-Kekana, Bronwyn Harris, Stephen Birch, and Diane McIntyre "Exploring inequalities in access to and use of maternal health services in South Africa." <i>BMC Health Services Research</i> (2012) http://hdl.handle.net/11427/15245en_ZA
dc.identifier.citationSilal, S. P., Penn-Kekana, L., Harris, B., Birch, S., & McIntyre, D. (2012). Exploring inequalities in access to and use of maternal health services in South Africa. BMC health services research, 12(1), 120.en_ZA
dc.identifier.ris TY - Journal Article AU - Silal, Sheetal AU - Penn-Kekana, Loveday AU - Harris, Bronwyn AU - Birch, Stephen AU - McIntyre, Diane AB - BACKGROUND: South 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. METHODS: A 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. RESULTS: Access 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. CONCLUSIONS: To 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. DA - 2012 DB - OpenUCT DO - 10.1186/1472-6963-12-120 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Exploring inequalities in access to and use of maternal health services in South Africa TI - Exploring inequalities in access to and use of maternal health services in South Africa UR - http://hdl.handle.net/11427/15245 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15245
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-12-120
dc.identifier.vancouvercitationSilal S, Penn-Kekana L, Harris B, Birch S, McIntyre D. Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Services Research. 2012; http://hdl.handle.net/11427/15245.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Statistical Sciencesen_ZA
dc.publisher.facultyFaculty of Scienceen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2012 Silal et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/en_ZA
dc.subject.otherobstetric servicesen_ZA
dc.subject.otherRural womenen_ZA
dc.subject.otherwomen in early-labouren_ZA
dc.subject.otherhealth careen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.othermaternal mortality rateen_ZA
dc.titleExploring inequalities in access to and use of maternal health services in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Silal_Exploring_inequalities_in_access_2012.pdf
Size:
224.76 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles