Local level inequalities in the use of hospital-based maternal delivery in rural South Africa.
BACKGROUND
There is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa.


METHODS
We used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts.


RESULTS
In both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery.


CONCLUSIONS
The findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.
Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa. Sheetal.Silal@uct.ac.za.
Sheetal Prakash
SP
Silal
Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. Loveday.Penn-Kekana@lshtm.ac.uk.
Loveday
L
Penn-Kekana
Department of Global Health and Population, Harvard School of Public Health, Boston, USA. tbarnighausen@africacentre.ac.za.|Wellcome Trust Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. tbarnighausen@africacentre.ac.za.
Till
T
Bärnighausen
School of Public Health, University of the Western Cape, Cape Town, South Africa. hschneider@uwc.ac.za.
Helen
H
Schneider
D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology