Abstract
Maternal mortality in South Africa is unacceptably high, and interventions to address this are urgently needed. Whilst urban centres, such as Johannesburg, are home to significant numbers of non-national migrant women, little is known about their maternal healthcare experiences. In order to inform future research, an exploratory study investigating the maternal healthcare and help-seeking experiences of migrant women living in inner-city Johannesburg was undertaken. Intersections between migration, maternal health and life in the city were explored through semi-structured interviews with 15 Zimbabwean women who had engaged with the public healthcare system in Johannesburg during pregnancy and childbirth. Interviews were dominated by reports of verbal abuse from healthcare providers and delays in receiving care—particularly at the time of delivery. Participants attributed these experiences to their use of English—rather than other South African languages; further work comparing this with the experiences of nationals is required. Beyond the healthcare system, the study suggests that the well-being of these migrant women is compromised by their living and working conditions in the city: maintaining access to income-generating activities is prioritised over accessing antenatal care services. Migrant Zimbabwean women make use of their religious and social networks in the city to inform help-seeking decisions during pregnancy and delivery. Improving the maternal healthcare experiences of urban migrant women should contribute to reducing maternal mortality in South Africa. Further research is required to inform interventions to improve the maternal health of migrant women in the city, including the multiple determinants of urban health that operate outside the biomedical healthcare system.
Highlights
South Africa has alarming numbers of women dying due to complications during pregnancy and childbirth
Our study provides insights into the maternal healthcare experiences of migrant Zimbabwean women in Johannesburg who are reliant on an over-stretched and overburdened public healthcare system
Contributing to a small, but growing, literature exploring the maternal healthcare experiences of migrant women in the city, it is hoped that the findings presented here support improved understanding into the public healthcare challenges faced by urban migrants in south and southern Africa
Summary
South Africa has alarming numbers of women dying due to complications during pregnancy and childbirth. MMR dropped significantly to 197 per 100,000 births in 2011, primarily as a result of extensive provision of antiretroviral drugs (ARVs) to pregnant women (Dorrington et al 2014), this remains unacceptably high for a middle-income country such as South Africa. In the Gauteng Province, where Johannesburg is located, about 7.4% of the population are non-nationals (StatsSA 2012) including some who are undocumented (Crush and Williams 2005). This lack of documentation means they encounter many obstacles when trying to access social services and resources, including public healthcare (Vearey 2011)
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