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

Authors

  • Pulani Tlebere MBChB, MMed,

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    • Pulani Tlebere, MBChB, MMed, is an obstetrician/gynecologist and is Senior Program Officer for the United Nations Population Fund (UNFPA) Regional Directors Team, South Africa. She was Senior Specialist in the Women's Health and Genetics Directorate of the Maternal Child and Women's Health and Nutrition Cluster at the National Department of Health, South Africa, during completion of this study.

  • Debra Jackson RNC, MPH, DSc,

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    • Debra Jackson, RNC, MPH, DSc, is a NCC-certified neonatal intensive care nurse and Associate Professor in the School of Public Health, University of the Western Cape, South Africa.

  • Marian Loveday BSc, MPhil,

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    • Marian Loveday, BSc, MPhil, is a Researcher at the Health Systems Trust, South Africa.

  • Lyness Matizirofa BSc, MSc,

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    • Lyness Matizirofa, BSc, MSc, is a doctoral student in the Statistics Department, University of the Western Cape, South Africa.

  • Nomafrench Mbombo MCur, PhD,

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    • Nomafrench Mbombo, MCur, PhD, is a nurse midwife and Associate Professor in the School of Nursing, University of the Western Cape, South Africa.

  • Tanya Doherty BCur, MPH, PhD,

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    • Tanya Doherty, BCur, MPH, PhD, is nurse and a Senior Researcher at the Health Systems Trust and Medical Research Council, South Africa.

  • Alyssa Wigton MHS, MSc,

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    • Alyssa Wigton, MHS, MSc, is doctoral student at the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

  • Latasha Treger MPH,

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    • Latasha Treger, MPH, is a Project Officer at the U.S. Centers for Disease Control and Prevention, South Africa.

  • Mickey Chopra MSc, BMed

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    • Mickey Chopra, MSc, BMed, is the Director of the Health Systems Research Unit, South African Medical Research Council and Associate Professor in the School of Public Health, University of the Western Cape, South Africa.


Address correspondence to Debra J. Jackson, RNC, MPH, DSc, Associate Professor, School of Public Health, University of the Western Cape, PB X17, Bellville, South Africa, 7535. E-mail: bessrfam@iafrica.com

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.

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