期刊论文详细信息
Globalization and Health
“I get hungry all the time”: experiences of poverty and pregnancy in an urban healthcare setting in South Africa
Matthew Chersich3  Vivian Black3  Ashraf Coovadia1  Tessa Dooms2  Duane Blaauw4  Fiona Scorgie3 
[1] Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersand, Johannesburg, South Africa;Department of Sociology, University of Johannesburg, Johannesburg, South Africa;Wits Reproductive Health & HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Centre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
关键词: Social determinants of health;    Nutrition;    Antenatal care;    Poverty;    Pregnancy;    South Africa;   
Others  :  1226204
DOI  :  10.1186/s12992-015-0122-z
 received in 2013-11-15, accepted in 2015-08-11,  发布年份 2015
PDF
【 摘 要 】

Background

For pregnancy to result in a healthy mother and infant, women require adequate nutrition and to be able to access antenatal care, both of which require finances. While most women working in the formal sector in South Africa obtain some form of maternity leave, unemployed women receive no such support. Additional interventions in the form of expanded social assistance to vulnerable pregnant women are needed. To help inform such an approach, we undertook a series of qualitative interviews with low-income pregnant women in Johannesburg.

Methods

Qualitative, in-depth interviews were held with 22 pregnant women at a public sector antenatal clinic in Johannesburg in 2011 to gather data on their greatest needs and priorities during pregnancy, their access to financial resources to meet these needs, and the overall experience of poverty while pregnant.

Results

A total of 22 women were interviewed, 5 of whom were primagravid. One woman was in the first trimester of pregnancy, while nine were almost full-term. All but one of the pregnancies were unplanned. Most participants (15/22) were unemployed, two were employed and on paid maternity leave, and the remaining five doing casual, part-time work. In most cases, pregnancy reduced participants’ earning potential and heightened reliance on their partners. Women not living with the father of their children generally received erratic financial support from them. The highest monthly expenses mentioned were food, accommodation and transport costs, and shortfalls in all three were reportedly common. Some participants described insufficient food in the household, and expressed concern about whether they were meeting the additional dietary requirements of pregnancy. Preparing for the arrival of a new baby was also a considerable source of anxiety, and was prioritized even above meeting women’s own basic needs.

Conclusions

Though pregnancy is a normal life occurrence, it has the potential to further marginalise women and children living in already vulnerable households. Extending the Child Support Grant to include the period of pregnancy would not only serve to acknowledge and address the particular challenges faced by poor women, but also go some way to securing the health of newborn children and future generations.

【 授权许可】

   
2015 Scorgie et al.

【 预 览 】
附件列表
Files Size Format View
20150923095349640.pdf 1330KB PDF download
Fig. 2. 20KB Image download
Fig. 1. 105KB Image download
【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】
  • [1]Statistics South Africa: Poverty Profile of South Africa: Application of the poverty lines on the LCS 2008/2009. Pretoria: Statistics South Africa;2012.
  • [2]Meth C. Unemployment and poverty halved by 2014? Working Paper No. 56. University of KwaZulu-Natal, South Africa: School of Development Studies;2009.
  • [3]HSRC: Food security in South Africa. In Food security in South Africa;2009.
  • [4]Labadarios D, Swart R, Maunder EMW, Kruger HS, Gericke GJ, Kuzwayo PMN et al.. Executive summary of the National Food Consumption Survey Fortification Baseline (NFCS-FB-I) South Africa, 2005. South Afr J Clin Nutr. 2008; 21:247-300.
  • [5]Budlender D. Women and poverty. Agenda: Empowering women for gender equity. 2005; 19:30-36.
  • [6]Goldblatt B. Gender and social assistance in the first decade of democracy: a case study of South Africa's Child Support Grant. Politikon. 2005; 32:239-257.
  • [7]Statistics South Africa: General Household Survey, 2010. Pretoria: Statistics South Africa. http://www. statssa.gov.za/publications/P0318/P03182010.pdf webcite
  • [8]Braveman P, Marchi K, Egerter S, Kim S, Metzler M, Stancil T et al.. Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J. 2010; 14:20-35.
  • [9]Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M et al.. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371:243-260.
  • [10]Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L et al.. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371:340-357.
  • [11]Roseboom TJ, Painter RC, van Abeelen AF, Veenendaal MV, de Rooij SR. Hungry in the womb: what are the consequences? Lessons from the Dutch famine. Maturitas. 2011; 70:141-145.
  • [12]Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull. 2001; 60:5-20.
  • [13]Blaauw D, Penn-Kekana M: Maternal Health. In: Padarath A, Fonn S, editors. South African Health Review 2010. Durban: Health Systems Trust. URL:. http://www. hst.org.za/publications/876 webcite
  • [14]Solarin I, Black V. "They told me to come back": women's antenatal care booking experience in inner-city Johannesburg. Matern Child Health J. 2013; 17:359-367.
  • [15]Myer L, Harrison A. Why do women seek antenatal care late? Perspectives from rural South Africa. J Midwifery Womens Health. 2003; 48:268-272.
  • [16]Saving Mothers 2005–2007 Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa. http://www. doh.gov.za/docs/reports/2007/savingmothers.pdf webcite
  • [17]UNDP: Millennium Development Goals: South Africa Country Report 2010. In Millennium Development Goals: South Africa Country Report 2010;2010.
  • [18]Munoz LA, Sanchez X, Arcos E, Vollrath A, Bonatti C. The motherhood experience in the context of social vulnerability: a comprehensive approach to social phenomenology. Rev Lat Am Enfermagem. 2013; 21:913-919.
  • [19]Lovisi GM, Lopez JR, Coutinho ES, Patel V. Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil. Psychol Med. 2005; 35:1485-1492.
  • [20]Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C. Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry. 1999; 175:554-558.
  • [21]Wabiri N, Chersich M, Zuma K, Blaauw D, Goudge J, Dwane N. Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey. PLoS One. 2013; 8: Article ID e73864
  • [22]Silal SP, Penn-Kekana L, Harris B, Birch S, McIntyre D. Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Serv Res. 2012; 12:120. BioMed Central Full Text
  • [23]Cleary S, Birch S, Chimbindi N, Silal S, McIntyre D. Investigating the affordability of key health services in South Africa. Soc Sci Med (submitted). 2012.
  • [24]Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J et al.. Maternal health in poor countries: the broader context and a call for action. Lancet. 2006; 368:1535-1541.
  • [25]Liljestr J. Strategies to reduce maternal mortality worldwide. Curr. Opin. Obstet. Gynecol. 2000; 12:513-517.
  • [26]Donnay F. Maternal survival in developing countries: what has been done, what can be achieved in the next decade. Int J Gynaecol Obstet. 2000; 70:89-97.
  • [27]Murray S, Hunter BM, Bisht R, Ensor T, Bick D. Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries. JBI Library Syst Rev. 2012; 10:4165-4567.
  • [28]Lagarde M, Haines A, Palmer N. The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries. Cochrane Database Syst Rev. 2009; 4:CD008137.
  • [29]Aguero J, Carter M, Woolard I: The Impact of Unconditional Cash Transfers on Nutrition: The South African Child Support Grant, Working Paper 39, Brasilia, International Poverty Centre. 2007.
  • [30]Department of Social Development, South African Social Security Agency, United Nations Children’s Fund, Community Agency for Social Enquiry: Review of the Child Support Grant: Uses, Implementation and Obstacles. 2008.
  • [31]Goldblatt B. The right to social security - addressing women's poverty and disadvantage. South Af J Hum Rights. 2009; 25:442-466.
  • [32]Hassim S. Global constraints on gender equality in care work. Polit Soc. 2008; 36:388.
  • [33]Hassim S. Social justice, care and developmental welfare in South Africa: a capabilities perspective. Soc Dynam. 2008; 34:104-118.
  • [34]Hassim S: Gender and Developmental Social Welfare in South Africa. In Gender and Social Policy in a Global Context: Uncovering the Gendered Structure of 'The Social'. Edited by Razavi S, Hassim, S. Basingstoke: Palgrave Macmillan;2006
  • [35]Maternity and gender policies: women and the rise of the European welfare states, 1880s-1950s. Routledge, Abingdon; 1991.
  • [36]Moolman J. Talking about maternity benefits. Agenda: Empowering women for gender equity. 1997; 35:73-75.
  • [37]Harris B, Goudge J, Ataguba JE, McIntyre D, Nxumalo N, Jikwana S et al.. Inequities in access to health care in South Africa. J Public Health Policy. 2011; 32 Suppl 1:S102-123.
  • [38]Pinto AD, van Lettow M, Rachlis B, Chan AK, Sodhi SK. Patient costs associated with accessing HIV/AIDS care in Malawi. J Int AIDS Soc. 2013; 16:18055.
  • [39]Nakigozi G, Atuyambe L, Kamya M, Makumbi FE, Chang LW, Nakyanjo N et al.. A qualitative study of barriers to enrollment into free HIV care: perspectives of never-in-care HIV-positive patients and providers in Rakai, Uganda. Biomed Res Int. 2013; 2013:470245.
  • [40]van der Merwe K, Chersich MF, Technau K, Umurungi Y, Conradie F, Coovadia A. Integration of antiretroviral treatment within antenatal care in Gauteng Province, South Africa. J Acquir Immune Defic Syndr. 2006; 43:577-581.
  • [41]National Department of Health: The 2011 National Antenatal Sentinel HIV and Syphilis Prevalence Survey, Pretoria, South Africa. 2012.
  文献评价指标  
  下载次数:18次 浏览次数:37次