Abstract
BackgroundThere is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa.MethodsWe used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts.ResultsIn both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery.ConclusionsThe findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.
Highlights
There is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services
South Africa's Maternal Mortality Ratio (MMR) at 310 per 100 000 live births is high for a middle-income country
All three hospitals surveyed for this study were able to perform the signal functions of comprehensive emergency obstetric care [14]
Summary
We conducted an analysis of inequality in utilization of hospital-based maternal delivery services in the Bushbuckridge and Hlabisa health sub-districts of Mpumalanga and Kwa-Zulu Natal Provinces, respectively. These two sub-districts were chosen because they both have HDSS providing population-level data on SES, births, and location of delivery. The Africa Centre Demographic Information System (ACDIS) collects similar data on approximately 85,000 people in an area of Hlabisa [11] Data from this database were extracted for 2009 on 8,448 households with complete socio-economic data and the subset of 1,491 households with a woman over 18 years of age who had delivered in the preceding year. In order to test for trends and associations between those needing maternal delivery services and those who used these services, the Partitions of Pearson’s Chi-squared test for ordered columns, a contingency table analysis of ordered categorical variables (such as quintiles), was conducted [13]
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