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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Njeri Wabiri, Matthew Chersich, Olive Shisana, Duane Blaauw, Helen Rees, Ntabozuko Dwane

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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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.
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Literature
1.
2.
Massyn N, Day C, Peer N, Padarath A, Barron P. District Health Barometer 2013/14. Durban; 2014.
3.
National Department of Health. The 2012 National Antenatal Sentinel HIV & Herpes Simplex Type-2 Prevalence Survey in South Africa. 2013.
4.
Moodley J, Pattinson R, Fawcus S, Schoon M, Moran N. The confidential enquiry into maternal deaths in South Africa: a case study. Bjog. 2014;121:53–60.CrossRefPubMed
5.
Department of Health. Saving Mothers: Tenth interim report on Confidential Enquiries into Maternal deaths 2011–2012. Pretoria; 2013.
6.
Buchmann E, Mnyani C, Frank K, Chersich M, McIntyre J. Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country. Bjog. 2015;12:220–7.CrossRef
7.
Black V, Brooke SCM. Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Obs Gynecol. 2009;114:292–9.CrossRef
8.
9.
Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Zungu N, et al. South African national HIV prevalence, incidence, behaviour and communication survey, 2012. Cape Town: HSRC Press; 2014.
10.
Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Pillay-van-Wyk V, et al. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008.A Turning Tide Among Teenagers ? [Internet]. Cape Town, South Africa: HSRC press; 2009. Available from: www.​hsrcpress.​ac.​za
11.
Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Pillay-van-Wyk V, et al. South African national HIV prevalence, HIV incidence, behaviour and communication survey. Cape Town: HSRC press; 2005.
12.
Rehle T, Hallet T, Shisana O, van Wyk V, Zuma K, Carrara H, et al. Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008. PLoS One [Internet]. 2010;5. Available from: e11094. doi:10.​1371/​journal.​pone.​0011094.
13.
Bartholomew D, Steele F, Moustaki I, Galbraith J. The analysis and interpretation of multivariate data for social scientists. London: Chapman & Hall/CRC; 2002.
14.
15.
16.
UNFPA. Preventing HIV and unintended pregnancies: strategic framework 2011–2015. 2012.
17.
Tugwell P, Petticrew M, Kristjansson E, Welch V, Ueffing E, Waters E, Brockhoff J, Bonnefoy J, Morgan A, Doohan E, Kelly M P. Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health. Bmj. 2010;341:c4739. http://​dx.​doi.​org/​10.​1136/​bmj.​c4739.
18.
StataCorp LP. STATA/SE [Internet]. College Station, Texas, United States: StataCorp LP; 2013. Available from: www.​stata.​com
19.
Carr-hill R, Chalmers-dixon P. The Public Health Observatory Handbook of Health Inequalities Measurement. Lin J, editor. 2005.
20.
Wagstaff A, Paci P, Van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33:545–57.CrossRefPubMed
21.
WHO. Health inequality monitoring with a special focus on low- and middle-income countries. Luxembourg: WHO Press; 2013.
22.
Bambara C. Health inequalities and welfare state regimes: theoretical insights on a public health “puzzle”. J Epidemiol Community Health. 2011;65:740–5.CrossRef
23.
Mackenbach J, Kunst A. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44:757–71.CrossRefPubMed
24.
25.
26.
Kunst A, Mackenbach J. Measuring socioeconomic inequalities in health. Copenhagen: World Health Organization Regional Office for Europe; 2000.
27.
Wacholder S. Binomial regression in GLIM: estimating risk ratios and risk differences. Am J Epidemiol. 1986;123:174–84.PubMed
28.
29.
30.
Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162:199–200.CrossRefPubMed
31.
32.
Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–6.CrossRefPubMed
33.
Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: measurement, computation and statistical inference. J Econ. 1997;77:87–103.CrossRef
34.
Business Day Live. North West departments put under administratio. 2015;
35.
Corruption Watch. The sickness in E Cape Health Department. 2016.
36.
37.
Centre for Health Policy. Mapping maternal health research in low-middle income (LMIC) countries. Johannesburg, South Africa; 2014.
38.
National Department of Health SA. South African National AIDS Council. Clinical guidelines: PMTCT (Prevention of Mother-to-Child Transmission). 2010. 2010.
39.
Goga A, Dinh T, Jackson D, SAPMTCTE study group. Evaluation of the effectiveness of the national prevention of mother-to-child transmission (PMTCT) programme measured at six weeks postpartum in South Africa. 2010.
40.
Hoffman R, Black V, Technau K. Effects of highly active antiretroviral therapy duration and regimen on risk for mother-to-child transmission of HIV in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2010;54:35–41.PubMedPubMedCentral
41.
Okonji J, Zeh C, Weidle P. CD4, viral load response, and adherence among antiretroviral-naive breast-feeding women receiving triple antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV in Kisumu. Kenya J Acquir Immune Defic Syndr. 2012;61:249–57.CrossRefPubMed
42.
Scorgie F, Blaauw D, Dooms T, Coovadia A, Black V. “I get hungry all the time”: experiences of poverty and pregnancy in an urban healthcare setting in South Africa. Glob Heal. 2015;11:37. doi:10.​1186/​s12992-015-0122-z.
43.
44.
Murray M, Hunter B, Bisht R, Ensor T, Bick D. Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries. JBI Libr Syst Rev. 2012;10:4165–567.
45.
UK Department for International Development and Bill and Melinda Gates Foundation. London Summit on Family Planning. 2012.
46.
47.
Jylha M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69:307–16.CrossRefPubMed
48.
Bailis D, Segall A, Chipperfield J. Two views of self-rated general health status. Soc Sci Med. 2003;56:203–17.CrossRefPubMed
49.
Dowd J, Todd M. Does self-reported health bias the measurement of health inequalities in U.S. Adults? evidence using anchoring vignettes from the health and retirement study. J Gerontol B Psychol Sci Soc Sci. 2011;66:478–89.CrossRefPubMed
50.
Mnyani C, Simango A, Murphy J, Chersich M, McIntyre J. Patient factors to target for elimination of mother-to-child transmission of HIV. Glob Heal. 2014;10:36.CrossRef
Metadata
Title
Growing inequities in maternal health in South Africa: a comparison of serial national household surveys
Authors
Njeri Wabiri
Matthew Chersich
Olive Shisana
Duane Blaauw
Helen Rees
Ntabozuko Dwane
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1048-z

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