SA is experiencing a downward trend in maternal mortality

A number of groundbreaking and progressive laws and policies are in place in South Africa to advance gender equality and the empowerment of women. Reviewing several indicators reveals that women’s quality of life has gotten better over time. However, women continue to have poor health outcomes from things like STIs, gender-based violence, and other things, which can result in issues with their health and other undesirable socio-demographic results. Recent media attention has focused on the demand for medical institutions to provide pregnant patients with the right levels of care.

The video portrays how South African healthcare is now organized, with a focus on how women are treated. The Status of Women’s Health in South Africa. Evidence from Selected Indicators, a new publication from Statistics South Africa that draws on a variety of internal and external data sources, notes progress in the ratio of maternal death in facilities (MMFR). The ratio showed a national decline from 105,9 deaths per 100 000 live births in 2019 to 88,0 in 2020, showing a decline in MMFR in South Africa. No matter the length or location of the pregnancy, or the cause of death (obstetric or non-obstetric), the MMFR refers to deaths that occur during pregnancy, childbirth, and the puerperium of a woman while pregnant or within 42 days following termination of pregnancy.

It provides information about women’s overall status, access to healthcare, and how well the healthcare system caters to their needs. It is a crucial indicator of human and societal development. Western Cape had the lowest MMFR in 2020 (43,6 fatalities per 100 000 live births), followed by Mpumalanga (67,1 deaths per 100 000 live births). Between 2019 and 2020, the MMFR increased in the provinces of the Eastern Cape and Northern Cape. The national pattern, which is also evident in all other provinces, exhibited diminishing patterns throughout.

The right to choose whether to have children is guaranteed to all women in South Africa under the constitution. All women, regardless of color, age, location, or socioeconomic situation, now have access to a safe and legal abortion thanks to the passage of the Choice on Termination of Pregnancy (TOP) Act 92 of 1996. Pregnancy termination rates between 13 and 20 weeks were nearly steady at 10, 7, 11, 1, and 9, 6 in the years 2018, 2019, and 2020, respectively. Pregnancies that are terminated at medical facilities between 13 and 20 weeks of pregnancy or gestation are included in this rate as a percentage of all pregnancies that are terminated.

Pregnancies may be ended between 13 and 20 weeks if there is a significant danger that the mother’s bodily or mental health will be harmed; if the fetus will experience physical or mental abnormalities; or if the pregnancy was the product of rape or incest. The Northern Cape, Limpopo, and Mpumalanga had the lowest termination rates between 2018 and 2020, while Western Cape and Gauteng had the highest rates.

In South Africa, the prevalence of HIV (human immunodeficiency virus) and related gender discrepancies are of great concern. According to empirical data, mother-to-child transmissions of HIV in the nation are largely attributed to new HIV infections contracted before conception and during pregnancy (MTCT). In light of the fact that public health facilities continued to offer reproductive services to expectant women throughout the COVID-19 pandemic lockdown in 2020, the research found that access to reproductive health services was encouraging.

The rate rose from 61,7% in 2018 to 71,5% in 2020 on a nationwide level. Western Cape (77,6%), Free State (77,4%), and KwaZulu-Natal (76,6%) reported the highest rates of clients already on ART at the first prenatal visit in 2020.

The HIV epidemic in South Africa continues to disproportionately affect women. The findings indicate that in 2017, sexually active women aged 25 to 49 had the greatest HIV prevalence. However, the prevalence has been rising among people over the age of 35 and declining among those between the ages of 20 and 29.

How South Africa compares to other countries

Maternal mortality rates worldwide have significantly decreased during the previous 20 years, dropping from 342 deaths to 211 per 100,000. However, every day more than 800 women worldwide pass away from complications related to pregnancy and childbirth, some up to 42 days after giving birth. The majority of these deaths can be avoided. Another 20 women experience major injuries, illnesses, and disabilities due to pregnancy for every maternal fatality. The situation of maternal health in South Africa and how it might be improved are analyzed by professors Salome Maswime and Lawrence Chauke.

About 20 more women experience major injuries, illnesses, or disabilities as a result of pregnancy for every maternal fatality. Maternal mortality was 462/100,000 in low-income countries in 2017 compared to 11/100,000 in high-income nations. Five deaths per 100,000 live births are the lowest rate in Western Europe. 533 deaths per 100,000 births occur in Sub-Saharan Africa.

In high-income nations, there was a one in 5,400 chance that a woman would pass away from pregnancy-related problems, as opposed to one in 45 in low-income nations. Maternal mortality is 674 per 100,000 in West and Central Africa. 1,150 in South Sudan and 1,140 in Chad, respectively.

Although it is greater than the UK’s rate of 7/100,000, South Africa has one of the lowest rates in all of Africa (113/100,000). According to the South African Demographic and Health Survey and the National Confidential Enquiries for Maternal Deaths, the rate in South Africa has decreased from 150 deaths for every 100,000 births in 1998 to 113 for every 100,000 in 2019.

Drivers of maternal mortality in South Africa

Obstetric hemorrhage, hypertensive disorders of pregnancy, and HIV-related infections are the three main causes of maternal fatalities in South Africa. In South Africa, a significant number of pregnancy-related difficulties are also caused by pre-existing medical conditions. Most fatalities are still considered to be avoidable.

A sizable percentage of South African women (76%) go to at least four prenatal visits, and (96%) give birth in a hospital while being attended by a qualified birth attendant (97%). In an ideal world, these numbers would result in a significantly reduced maternal mortality rate. This indicates that there are still gaps and that further work is required.

Late booking continues to be the major problem. In 2016, only 47% of women made reservations during the first trimester. 72% of the women who died between 2017 and 2019 had received prenatal care. But just half had made reservations prior to 20 weeks. Negative pregnancy outcomes are more likely when antenatal treatment is delayed, according to research.

90% of South Africans live less than 7 km (or 2 km) from a healthcare institution, and 67% live less than 2 km (or 7 km). Despite this accessibility, it might be difficult for women to find timely transportation to medical facilities. Due to inadequate road systems and emergency referral systems, the situation is significantly worse for rural women.

Different levels of care are offered by healthcare facilities. In South Africa, district hospitals account for the majority of fatalities because they may lack specialized, critical care, or effective emergency medical services. Complications prevent patients from receiving higher levels of care in a timely manner. Women may have a staffing shortfall for specialized, medical, and nursing positions in addition to overcrowding even when they have access to higher levels of care.

According to a survey covering the years 2017 to 2019, district hospitals provided subpar care to 80% of the women who died. For community health centers and regional hospitals, the figure was 60%. As a result, the country’s healthcare system has a serious problem with low quality of care. The same research named crowding, a lack of resources, a lack of nursing and medical staff, and other factors as the main causes of the low quality of care.

Another problem is disrespectful mother care. One of the world’s worst disgraceful incidents was the abuse of South African maternity services in 2015. It comprised neglect, abandonment, non-consensual care, and non-confidential care in addition to verbal and physical abuse. Women stated they anticipate being yelled at, physically assaulted, and neglected in some institutions.

Maternal mortality is a sign of the availability and standard of care. Additionally, socioeconomic characteristics are indirectly related to it. Compared to those who do not, women who have access to education, decent housing, and employment opportunities are more likely to have positive health outcomes.

The treatment of women has also been linked to sociodemographic factors including “race.”Women’s health-seeking behavior and the way healthcare providers provide care are impacted by the views of the staff members (to the extent of delaying and withholding care).

What can be done to improve outcomes?

  • The first step in preventing unintended and unexpected pregnancies is to address the need for contraception. In 2012, it was projected that 215 million women worldwide lacked access to contraception.
  • Women would be encouraged to attend prenatal clinics and give birth in a medical facility under the supervision of a trained attendant if health education and promotion were provided at the community level.
  • Respect and dignity should be shown throughout maternal care.
  • To ensure that women receive prompt and effective care, effective transportation and emergency medical services are required.
  • Access to high-quality obstetric care would be improved by stronger health systems. In functional health systems with effective referral mechanisms, women survive pregnancy and delivery difficulties. A responsive healthcare system that takes demographic and disease changes into account is urgently needed.
  • In order to win the war against maternal deaths, it is urgently necessary to address the disparity between the demand and supply of healthcare services, as well as to raise the social and economic status of women in society and improve the standard of maternal and reproductive healthcare services.

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