BARRIERS TO ANTENATAL CARE REMAIN

IN 2014, Amnesty International released a report on the barriers that prevented pregnant women and girls accessing timely antenatal care in South Africa. Four years on, a new review of maternal mortality in the country has found that many of these barriers remain.

Antenatal care is crucial to any pregnant woman because it screens for complications that may develop during pregnancy which, left untreated, could put the mother and baby in danger.

Amnesty International’s 2014 report, Struggle for Maternal health, based on research in Mpumalanga and KwaZulu-Natal, highlighted that too many women and girls were dying needlessly in South Africa during pregnancy or shortly after giving birth.

Some things have improved since then. The South African government recommends that women and girls begin their antenatal care visits from 14 weeks into their pregnancies but most only seek antenatal care after 20 weeks. Appointments are free of charge and, since April 2017, the government increased the number of appointments from four to eight. Nearly all women receive at least one visit, and the number of maternal deaths has reduced significantly since 2014.

However, a 2018 review of maternal deaths between 2014 and 2016 has again found a lack of antenatal care to be a key contributory factor in maternal deaths in the country. A total of 3 697 women and girls are reported to have died of pregnancy-related causes during this period. A quarter of the deaths were linked to late or no antenatal care.

Struggle for Maternal Health found that barriers to accessing antenatal care include high transport costs, a lack of privacy and informed consent – particularly in HIV testing – and a lack of information. The high expense and a lack of transport options made antenatal care a luxury many pregnant women and girls could not afford.

Some had to use private transport to take them to their antenatal appointments, which means choosing between their families eating or them accessing antenatal care.

Four years on, in Mpumalanga, a health care worker who did not want to be named said that transport remains one of the biggest challenges the women face. Ambulances often arrive late, especially in rural areas, which can result in grave complications for the women giving birth.

In KwaZulu-Natal, the situation is slightly better as the community now has government transport to take them to the hospital from their local health care facility for appointments.

A local Non-Governmental Organisation volunteer says the service runs on specific days and those who required it had to book it. She said this was an improvement from four years ago, but ambulances were still unreliable, forcing women to pay for private transport in emergencies.

“If you call an ambulance now in the late afternoon, it will only come tomorrow morning,” she said.

Another finding of Amnesty’s 2014 report was a widespread fear that health care workers would disclose a pregnant patient’s HIV status, which resulted in many of the pregnant women and girls staying away from antenatal care.

Many women and girls incorrectly understood that HIV tests were a compulsory part of their antenatal care. This points to a lack of information, which the government must provide.

Struggle for Maternal Health was part of Amnesty International’s submission at South Africa’s review at the UN before the Committee on Economic, Social and Cultural Rights in October. Although the committee did not delve into the maternal health aspect of South Africa’s challenges, it highlighted the profound inequalities in South Africa’s health system and called for National Health Insurance to be expedited.

The NHI must deliver adequate health cover, especially on reproductive health, for vulnerable pregnant women and girls.

Mohamed is Executive Director of Amnesty International South Africa