CoChat
Sign Up
Cited by 44Global Maternal and Child HealthReproductive Health and ContraceptionPublic Health and Social Inequalities

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

Open access
Wabiri, Njeri, Chersich, Matthew, Shisana, Olive, Blaauw, Duane, Rees, Helen, Dwane, Ntabozuko·2016·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-016-1048-zPMC PMC5007803
Open this paper in CoChat — free accountOpen PDF

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12884-016-1048-z

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. [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 10.1111/1471-0528.12869 25236634 · DOI
  2. [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 10.1111/1471-0528.13064 25213804 · DOI
  3. [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 10.1097/AOG.0b013e3181af33e6 19622990 · DOI
  4. [8]Wabiri N, Chersich M, Zuma K, Blaauw D, Goudge J, Dwane N. Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey. PLoS One [Internet]. 2013 [cited 2013 Nov 7];8:e73864. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3765324&tool=pmcentrez&rendertype=abstract PMC3765324 24040097
  5. [9]Shisana O Rehle T Simbayi L Zuma K Jooste S Zungu N South African national HIV prevalence, incidence, behaviour and communication survey, 2012 2014 Cape Town HSRC Press 27002359
  6. [11]Shisana O Rehle T Simbayi L Zuma K Jooste S Pillay-van-Wyk V South African national HIV prevalence, HIV incidence, behaviour and communication survey 2005 Cape Town HSRC press
  7. [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. PMC2885415 20559425 · DOI
  8. [14]Howe LD, Hargreaves JR, Huttly SR. Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg. Themes Epidemiol. [Internet]. 2008 [cited 2012 Mar 28];5:3. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2248177&tool=pmcentrez&rendertype=abstract PMC2248177 18234082
  9. [15]Onwujekwe O, Uzochukwu B, Eze S, Obikeze E, Okoli C, Ochonma O. Improving equity in malaria treatment: relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria. Malar. J. [Internet]. 2008 [cited 2012 Jul 25];7:5. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2249588&tool=pmcentrez&rendertype=abstract PMC2249588 18182095
  10. [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. 20837575 · DOI
  11. [20]Wagstaff A Paci P Van Doorslaer E On the measurement of inequalities in health Soc Sci Med 1991 33 545 57 10.1016/0277-9536(91)90212-U 1962226 · DOI · Paper page
  12. [21]WHO Health inequality monitoring with a special focus on low- and middle-income countries 2013 Luxembourg WHO Press
  13. [22]Bambara C Health inequalities and welfare state regimes: theoretical insights on a public health “puzzle” J Epidemiol Community Health 2011 65 740 5 10.1136/jech.2011.136333 21690243 · DOI · Paper page
  14. [24]Ernstsen L, Strand BH, Nilsen SM, Espnes GA, Krokstad S. Trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors: repeated cross-sectional surveys from the Nord-Trøndelag Health Study (HUNT) 1984–2008. BMC Public Health [Internet]. BioMed Central Ltd; 2012;12:266. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3434116&tool=pmcentrez&rendertype=abstract PMC3434116 22471945
  15. [25]Asada Y On the choice of absolute or relative inequality measures Milbank Q 2010 88 616 22 10.1111/j.1468-0009.2010.00614.x 21166871 PMC3037178 · DOI
  16. [27]Wacholder S Binomial regression in GLIM: estimating risk ratios and risk differences Am J Epidemiol 1986 123 174 84 3509965
  17. [28]Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med. Res. Methodol. [Internet]. 2003;3:21. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=521200&tool=pmcentrez&rendertype=abstract. Accessed 5 July 2016 PMC521200 14567763
  18. [29]Khang Y, Yun S, Lynch J. Monitoring trends in socioeconomic health inequalities: it matters how you measure. BMC Publ Heal. 2008;8:66. doi:10.1186/1471-2458-8-66. PMC2266739 18284701 · DOI
  19. [30]Spiegelman D Hertzmark E Easy SAS calculations for risk or prevalence ratios and differences Am J Epidemiol 2005 162 199 200 10.1093/aje/kwi188 15987728 · DOI
  20. [31]Wagstaff A. Socioeconomic inequalities in child mortality: comparisons across nine developing countries. Bull. World Health Organ. [Internet]. 2000;78:19–29. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2560599&tool=pmcentrez&rendertype=abstract PMC2560599 10686730
  21. [32]Zou G A modified Poisson regression approach to prospective studies with binary data Am J Epidemiol 2004 159 702 6 10.1093/aje/kwh090 15033648 · DOI
  22. [33]Kakwani N Wagstaff A van Doorslaer E Socioeconomic inequalities in health: measurement, computation and statistical inference J Econ 1997 77 87 103 10.1016/S0304-4076(96)01807-6 · DOI
  23. [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 20216425 PMC2880466
  24. [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 10.1097/QAI.0b013e318262514f 22692094 · DOI
  25. [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. PMC4549107 26303952 · DOI
  26. [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 27820523
  27. [48]Bailis D Segall A Chipperfield J Two views of self-rated general health status Soc Sci Med 2003 56 203 17 10.1016/S0277-9536(02)00020-5 12473308 · DOI
  28. [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 10.1093/geronb/gbr050 21666144 · DOI
  29. [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 10.1186/1744-8603-10-36 PMC4026120 24886029 · DOI

Cited by

Sorted by citations

Authors
Wabiri, N., Chersich, M., Shisana, O., Blaauw, D., Rees, H., & Dwane, N.
Affiliations
  • Human Sciences Research Council (ZA)
  • University of the Witwatersrand (ZA)
  • University of Cape Town (ZA)
Corresponding author
Wabiri, Njeri
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2016-09-01
Volume
16
Issue
1
Pages
256-256
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-016-1048-z
PMC
PMC5007803
OpenAlex
W2514770372
Cited by
44
References
2
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 10 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 2
FWCI
4.27
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Open University of Cape Town (University of Cape Town) (submittedVersion)
Funders
Presidents Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) (3U2GGH000570)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
maternal health inequalities, access to maternal health services, South Africa, antenatal care attendance, skilled birth attendance, planned pregnancy, HIV testing, socioeconomic disparities, urban-rural differences, Eastern Cape, North West Province
MeSH terms
Maternal Health, Adolescent, Adult, Family Characteristics, Female, Health Services Accessibility, Humans, Maternal Health Services, Middle Aged, Pregnancy, Surveys and Questionnaires, Socioeconomic Factors, South Africa, Health Status Disparities, Healthcare Disparities, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review