Source: 7th Space
South Africa's maternal mortality rate (625 deaths/100,000 live births) is high for amiddle-income country, although over 90% of pregnant women utilize maternal healthservices. Alongside HIV/AIDS, barriers to Comprehensive Emergency Obstetric Carecurrently impede the country's Millenium Development Goals (MDGs) of reducing childmortality and improving maternal health.
While health system barriers to obstetric carehave been well documented, "patient-oriented"barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in SouthAfrica 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 sixteenqualitative in-depth interviews with women (over 18) in two urban and two rural healthsub-districts in South Africa.
Between June 2008 and September 2009, information wascollected on use of, and access to, obstetric services, and socioeconomic and demographicdetails. Regression analysis was used to test associations between descriptors of theaffordability, availability and acceptability of services, and demographic andsocioeconomic predictor variables.
Qualitative interviews were coded deductively andinductively using ATLAS ti.6. Quantitative and qualitative data were integrated into ananalysis 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 socioeconomicgroups and geographic areas being most important. Rural women faced the greatestbarriers, including longest travel times, highest costs associated with delivery, and lowestlevels of service acceptability, relative to urban residents.
Negative provider-patientinteractions, including staff inattentiveness, turning away women in early-labour, shoutingat patients, and insensitivity towards those who had experienced stillbirths, also inhibitedaccess and compromised quality of care.
Conclusions: To move towards achieving its MDGs, South Africa cannot just focus on increasing levelsof obstetric coverage, but must systematically address the access constraints facingwomen 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 actionsof health care providers.