Community‐Based Situation Analysis of Maternal and Neonatal Care in South Africa to Explore Factors that Impact Utilization of Maternal Health Services

Abstract

This community situational analysis determined factors impacting the utilization of maternal health services in South Africa. Quantitative and qualitative research methods were used, including semistructured household interviews, case studies of women with no antenatal care and/or home birth, and verbal/social autopsies of maternal and infant deaths, conducted in three diverse sites across the country. Data analysis used quantitative statistics for the semistructured interviews and a qualitative thematic content approach for the case studies and verbal/social autopsies. Each component was analyzed separately and then triangulated. The following themes emerged: 1) transport and distance to care were the biggest problems, particularly in rural areas; 2) providers' communication with families was very poor; 3) health-seeking behavior was better than anticipated; 4) treatment by health providers and quality of care showed mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and neonatal service quality cannot be overlooked; and 6) families and communities are an untapped resource for improving maternal and neonatal health. Implications for maternal and infant health care in developing countries are discussed, with a particular focus on barriers to utilization and involvement of communities and families in maternity care.

Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

“…[16]2015SenegalCross-sectional/Case-seriesDeaths identified by active household surveys, using mHealth platform Childcare+.Caregivers (N not reported) interviewed about 5 maternal deathsMaternal1–2 weeks

4 of the 5 case reports describe death due to post-partum hemorrhage

3 of the 5 had emergency cesarean section deliveries

2 of the 5 had seen traditional providers and/or used traditional medicines

MVP VASA Tool, which combines the WHO Verbal Autopsy tool with an expanded section of social contributorsPathway to Survival0.88Njuki R, Kimani J, Obare F, Warren C. [17]2014KenyaCross-sectionalDeath audits for HIV-related deaths among women living within 5 km of specific facilities in 3 districts (deaths 1996–2010).Caregivers (N not reported) about 218 HIV/AIDS-related deaths among women aged 15–49Women of Reproductive AgeData collection in 2010 for deaths as far back as 1996

Delays associated with: poor knowledge and understanding of AIDS-related illness, distance to facility, transportation costs, medical pluralism, stigma, low HIV perception, lack of family support and health care system barriers.

WHO Verbal Autopsy Questionnaire, Social Autopsy Tool unclearNot clear1.0Nonyane BAS, Kasmi N, Koffi AK, Begum N, Ahmed S, Baqui AH, Kalter HD. [18]2016Bangla-deshCross-sectionalNewborn deaths identified in four sub-districts between Oct. 2007 and May 2011.Caregivers (N = 319) interviewed about 331 deaths.Neonatal2.5 yearsOf 165 mothers reporting concerns/barriers, 60% reported the most common barrier as cost.18% said they thought the baby would die anyway.16% thought the baby needed traditional care.12% cited too late at night to travel and 11% cited distance to formal care facility.WHO Verbal Autopsy Questionnaire, CHERG Social Autopsy ToolNot clear1.0Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, Wigton A, Treger L, Chopra M. [19]2007South AfricaCross-sectionalMothers (HIV±) who participated in previous PMCTC study; mothers from same communities; community health...…”

“…Twelve of the 16 studies provided glimpses into some of the other reasons families may not be seeking prompt attention. These included perceived low quality of care at the facility [6,9,17,21], attributing illness to spiritual and other non-medical causes [6,8,18,19], thinking that the baby would die anyway or was too sick to travel [12,14], thinking that the baby was not sick enough to seek care [14], not having a family member to accompany the woman to the facility [12,20], and needing husband’s permission to seek care [8]. Specific examples of how such barriers influence care include that in Bangladesh, 18% of mothers said they did not bring the baby for care because they thought it would die anyway [18].…”

“…In India among families experience a post-neonatal death, 104 out of 177 cases with delays at home (58.7%) reported waiting to go to the health facility to see if home remedies would to take effect [7]. In South Africa, one constraint on care-seeking commonly reported through qualitative inquiries was that the cause of the illness was attributed to witchcraft, for which western health facilities are ineffective [19]. …”

“…Of the 16 articles examined in this review, four included a qualitative component in addition to the quantitative data [6,8,17,19], and only one focused solely on qualitative results [9]. Existing social autopsy tools include an open-ended qualitative portion, yet these data are rarely included in published manuscripts.…”

Giving Birth in a Foreign Land: Exploring the Maternal Healthcare Experiences of Zimbabwean Migrant Women Living in Johannesburg, South Africa

“…The languages spoken by healthcare providers and users mediate experiences of access to public healthcare for migrants in the city; this is further exacerbated by the unavailability of interpreters and the resentment of English displayed by some healthcare providers (Davies et al 2010;Vearey 2011;Crush and Tawodzera 2014;IOM 2013;Moyo 2010;Tlebere et al 2007).…”