Background: South Africa has a high Maternal Mortality Ratio (MMR) and is not on track to
meet Millennium Development Goal (MDG) 5, target 5A (to reduce by three quarters between
1990 and 2015 the MMR). Along with gathering crucial information about maternal deaths, it is
also important to understand the experiences and opinions of those who have almost died during
their pregnancy or delivery - termed near-misses in maternal health services - to recommend
relevant interventions aimed at bringing down South Africa's MMR. Aim: The overall aim of the study was to explore patient experiences and perspectives of
maternal near-misses and their opinions of how these could have been prevented.
Methods: Using a case study design, where the case was women who had experienced severe
acute maternal morbidity (a near-miss event), in-depth interviews were conducted with nearmisses
until a point of saturation was reached after the ninth woman. Each woman was
interviewed twice on two separate occasions between 1st April and 30th September 2009 about
their experiences and opinions of the near-miss event, and access to reproductive health services
and the health system more broadly. Their social and economic circumstances were also
explored.MAXqda was used for data management and a thematic analysis was carried out on the
interview data.
Results: Bureaucracy in accessing reproductive health services, lengthy referral processes, lack of
transport and resources in clinics were seen as major health system barriers that contributed in
women being near-misses. Inadequate knowledge about reproductive health and warning signs of
serious morbidity; although seen as patient factors, were also be attributed to health system
factors. The desire to or not to fall pregnant was not the only factor that influenced contraceptive
use. Power relations between women and their partners affected most women who were in lower
positions of power. Cessation of menstruation as a side effect of contraception resulted in failure
to recognize absence of menstruation during pregnancy. Lack of service integration affected
women irrespective of their demographic characteristics. Patients are at risk of abuse in health
facilities although this is not the norm. Little attention was given to postnatal care of women.
Conclusion: Health systems' issue which according to the AAAQ framework were not
satisfactory contributed in women being near-misses. Women's limited knowledge on reproductive health issues which might be as a result of inadequate information offered at the
clinic affected use of reproductive health services. Educating women and their families about
obstetric emergencies may result in early recognition of warning signs of obstetric emergencies
and prevention of near-misses.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/12566 |
| Date | 19 March 2013 |
| Creators | Mangesi, Lindeka |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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