Alongside HIV/AIDS, the study says, barriers to Comprehensive Emergency Obstetric Care currently impede the country's Millennium Development Goals (MDGs) of reducing child mortality and improving maternal health. BMC's study involved 1,231 interviews with women (over 18) in two urban and two rural health sub-districts in South Africa.
The research explored inequalities in access to -- and use of - maternal health services in South Africa. It considered affordability, availability and acceptability barriers to obstetric care from the perspectives of women who had recently used - or attempted to use - these services. The study found that rural women faced the greatest barriers, "including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability, relative to urban residents." Other negative experiences included staff inattentiveness, turning away women in early-labour, shouting at patients, and insensitivity towards those who had experienced stillbirths.
To move towards achieving its Millennium Development Goals, the BMC Health Services Research concluded, South Africa cannot just focus on increasing levels of obstetric coverage, but must address constraints facing women during pregnancy and delivery. More needs to be done to respond to these "patient-oriented" barriers by improving how and where services are provided, particularly in rural areas and for poor women, as well as altering the attitudes and actions of health care providers.
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