title: Determinants of access to and use of maternal health care services in the Eastern Cape, South Africa: a quantitative and qualitative investigation.
abstract: BACKGROUND
  The main aim of the study is to examine whether women in Mdantsane are accessing and using maternal health care services. Accessibility of maternal health care facilities is important in ensuring that lives are saved through the provision and use of essential maternal services. Therefore, access to these health care services directly translates to use--that is, if women cannot access life-saving maternal health care services, then use of such services will be limited.
  
  
  RESULTS
  The study makes use of mixed methods to explore the main factors associated with access to and use of maternal health care services in Mdantsane. For the quantitative approach, we collected data using a structured questionnaire. A sample of 267 participants was selected from health facilities within the Mdantsane area. We analyzed this data using bivariate and multivariate models. For the qualitative approach, we collected data from health care professionals (including nurses, doctors, and maternal health specialists) using one-on-one interviews. The study found that women who were aged 35-39, were not married, had secondary education, were government employees, and who had to travel less than 20 km to get to hospital were more likely to access maternal health services. The qualitative analysis provided the insights of health care professionals regarding the determinants of maternal health care use. Staff shortages, financial problems, and lack of knowledge about maternal health care services as well as about the importance of these services were among the major themes of the qualitative analysis.
  
  
  CONCLUSIONS
  A number of strategies could play a big role in campaigning for better access to and use of maternal health services, especially in rural areas. These strategies could include (a) the inclusion of the media in terms of broadcasting information relating to maternal health services and the importance of such services, (b) educational programs aimed at enhancing the literacy skills of women (especially in rural areas), (c) implementing better policies that are aimed at shaping the livelihoods of women, and (d) implementing better delivery of maternal health care services in rural settings.
authors.forename: Mluleki
authors.initials: M
authors.lastname: Tsawe
authors.affiliation: Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa. sappunni@uwc.ac.za.
authors.forename: Appunni Sathiya
authors.initials: AS
authors.lastname: Susuman
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006293:Health Promotion; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011050:Policy Making; D011247:Pregnancy; D036301:Qualitative Research; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult