Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa.
PLoS One. 2013 Sep 6;8(9):e73864. doi: 10.1371/journal.pone.0073864. eCollection 2013.
South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources.
Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data.
Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group.
Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.
南非越来越关注降低孕产妇死亡率。在这个最不平等的国家之一，记录孕产妇保健服务获取情况的差异，可能有助于重新配置资源。
本分析基于一项基于人群的家庭调查，该调查采用多阶段分层抽样。在过去两年内怀孕（1113 人）或生育过（1304 人）的妇女完成了问卷调查和 HIV 检测。使用加权数据评估社会经济、教育和其他人群中获取孕产妇保健服务和健康状况的分布情况。
最贫困的妇女几乎普遍接受了产前保健（ANC），但只有 39.6%的人在妊娠 20 周前就诊；最富裕的四分之一人群中这一比例高 2.7 倍（95%CI 调整后的优势比=1.2-6.1）。农村正规地区的妇女 ANC 覆盖率最低（89.7%），完成四次 ANC 检查的比例（79.7%）最低，只有 84.0%的人接受了 HIV 检测。检测率在最贫困的四分之一人群中最高（过去两年中为 90.1%），但有 10%的 40 岁以上或受教育程度较低的妇女从未接受过检测。熟练接生员覆盖率（总体为 95.3%）在最贫困的四分之一人群（91.4%）和农村正规地区（85.6%）最低。大约三分之二的最富裕的四分之一人群、白人以及受雇于正规部门的妇女在分娩时有医生，是最贫困的四分之一人群的 11 倍。总体而言，只有 44.4%的妊娠是有计划的，31.7%的 HIV 感染者和 68.1%的最富裕的四分之一人群是有计划的。自我报告的健康状况也随着 quartile、教育水平或年龄组的每一次下降而显著下降。
除了 ANC 早期就诊和农村正规地区的护理缺陷外，服务利用不平等主要是小的，一些措施甚至在最贫困的人群中最高。在不同人群中，孕产妇健康状况的差异更大。这可能反映了这些群体在获得的护理质量、HIV 感染和健康的社会决定因素方面的差异。
