Maternal Mortality in South Africa Essay (Critical Writing)

Introduction

Research Topic

The constant improvement of health practices and the provision of new health management opportunities, as well as the rise in the accessibility of health services, are traditionally seen as the main health development priorities in the current year. Multiple efforts of varied efficiency have been undertaken globally to improve the speed of health development, yet numerous areas still contain unresolved problems, as the situation in South Africa shows (Kim, Dobra, & Tanser, 2020).

Despite a comparatively high rate of healthcare quality, the South African environment continues to contain the factors that slacken the process of health development for several vulnerable groups, a significant portion of which includes different types of female patients (Kim et al., 2020). In this paper, the health issues encountered by mothers in South Africa, and, particularly, the problem of high maternal mortality rates among South African women, will be considered.

The topic of maternal mortality has been on the global health development agenda for a while. This study seeks to analyze the factors at play in the context of South African maternal healthcare and the threats that mothers face, specifically, those that lead to fatal outcomes. Thus, opportunities for meeting the needs of mothers in the South African healthcare context will be identified. Moreover, the leading causes of maternal death will be located, with the following suggestions concerning the prevention of maternal death.

Research Question

“What factors affect high maternal death rates in South African female patients?”

Rationale

Despite numerous endeavors at researching the issue of maternal death, environment-specific factors still define the consistent presence of threat to mothers’ health. Therefore, it is essential to locate the specific causes of maternal death in the South African setting (Marabele, Maputle, Ramathuba, & Netshikweta, 2020). Although a minor positive change was observed over the past year in maternal death rates in South Africa, the current percentage is still quite high, which suggests that further research should be performed.

Herein lies the key rationale for performing the study. To introduce health development, it is critical to address the problem of maternal mortality, which appears to be rooted in the lack of appropriate health improvement strategies. Namely, the absence of diagnostic tools, the lack of understanding of the target group’s health needs, and the failure to diagnose the health issue in time define the high maternal mortality rates (Black et al., 2016).

Consequently, exploring the issue further and examining the outlined factors along with other contributors to maternal death is vital for health development in South Africa.

Project Description

Problem: Background

The issue of maternal mortality might seem to be a surprising health concern given the advanced health management opportunities offered in the South African context. However, the specified problem has been in existence for quite a while (Mashamba-Thompson, Drain, Kuupiel, & Sartorius, 2019).

Although a recent decrease in the levels of maternal mortality rates indicates that the problem may have been reduced slightly, the lack of consistency in its management indicates that not all factors affecting the death rates among women and especially mothers in the South African context have been examined (Thou, 2018).

The specified gap in the current knowledge of maternal and neonatal mortality indicates the resulting control is sues in managing maternal mortality in neonatal care. In other words, without researching the issues that may affect the levels of maternal mortality in the South Africa context further, one is likely to see a further spike in the death rates among the target vulnerable population. The specified concern is linked inseparably to the issue of health development n South Africa since it proves the lack of focus on the promotion and improvement of health among the target populations.

After examining the target environment loser for the identification of the critical factors that may be looked at specifically in this research, one should bring up the lack of access to healthcare services for pregnant women. Antenatal care has been a particularly contested issue in the South African healthcare context due to the absence of available resources and the inability to cover the expenses associated with quality care (Millham, Agbehadji, Puckree, Mukami, & Li, 2020).

The described concern is aggravated by the presence of multiple complications that pregnant women face in South Africa (Frank & Kovacs, 2020). According to Pavličev, Romero, and Mitteroecker (2020), in South Africa, as well as several other regions, “obstructed and prolonged labor are frequent causes of maternal morbidity and mortality.

Complications can be short term, such as uterine rupture and chorioamnionitis, or long term, such as fistulas and incontinence” (p. 4). The problem of obstructed labor is especially topical for South African obstetrics. As Cummings, Cummings, and Jacobsen (2019) point out, obstructed labor has been an issue for the South African obstetrics for a significant period of time.

In addition, the problem of low patient education rats remains the foundational factor in determining high mortality rates among pregnant and birthing women. According to Garenne’s (2015) report, poor lack of leadership in South African states combined with the unavailability of resources creates premises for low-quality patient education.

Moreover, the specified scenario prevents healthcare authorities and nurse educators from encouraging and increasing patient literacy among vulnerable groups, primarily, pregnant women (Slogrove, Johnson, & Powis, 2019). The resulting lack of understanding of key health concerns leads to the oversight of crucial symptoms of health issues in pregnant women and the resulting fatal outcomes (Hodes, 2016). Therefore, the problem of patient education can be seen as one of the foundational obstacles toward the management of mortality rates in South Africa.

Goals and Objectives

The main goal of this paper is to isolate the factors that have either positive or negative influence on the mortality rates among mothers in the South African environment. The troublingly high mortality rates among women in South Africa signals that there is a problem to be researched and addressed accordingly.

Moreover, the lack of consistency in the development of maternal mortality statistics proves that the issue is severely underreacted, which calls for the close examination of economic, political, financial, technological, and sociocultural factors affecting the issue of maternal mortality in the target setting (Cooper et al., 2016).

In connection to the goal outlined above, several objectives will be pursued when implementing this project. Specifically, the available literature on maternal mortality will be analyzed in order to understand the factors at play in the changes of maternal mortality dynamics in South Africa. For this purpose, the influences associated with economic changes within the South African environment, sociocultural trends, political factors, and other issues having a tangible impact on the quality of maternal care will be examined.

Expected Outcomes

It is believed that the results of the study will inform the decisions for improving the quality of healthcare for mothers and pregnant women in South Africa, thus reducing the levels of maternal mortality in the target setting. Locating the trends influencing the current levels of mortality rates among mothers in South Africa will require looking not only at healthcare concerns but also at economic, sociocultural, political, financial, and technological problems observed in the South African environment (Matthew, Adeniji, Osabohien, Olawande, & Atolagbe, 2020). Thus, one will be enabled to manage the issue at hand.

Research Methods

Participants

To conduct the research, one will need to recruit an appropriate number of participants for the study. Seeing that women, in general, and pregnant women, in particular, are the priority of this research, the latter should be seen as the target demographic for the research. Therefore, to examine the factors at play in the current rates of maternal mortality, healthcare experts from South African maternity homes will be recruited for the study. Specifically, five hospitals will be selected, with two healthcare representatives from each being viewed as potential recruits for the study.

Sampling

To obtain the sample for the study, convenience sampling will be utilized. Although the specified approach contains several inherent biases, such as the high probability of similar results being observed across the sample due to the similarities in the environments, it is likely to be the least time- and resource-consuming one. Therefore, the application of the convenience sampling framework is deemed to be the most suitable one for this research (Manderson & Ross, 2020).

The sample size for this research will be reduced to 20 due to the qualitative nature of the research. Since the study in question seeks to answer the question concerning the nature of the researched phenomenon, namely, the causes of maternal mortality in South Africa, it will be most sensible to adhere to the qualitative research method. Thus, the selection of 20 participants for the sample size can be deemed as an appropriate amount.

Data Type

With the research being rooted in the qualitative methodology, the type of the data to be obtained for this study will be primarily qualitative. Namely, textual information will be presented during research so that the key factors determining the present maternal mortality rates could be identified and categorized accordingly. For this purpose, interviews with healthcare experts from selected facilities will be conducted. Therefore, interview transcripts will be used as the main data type for the analysis.

However, in addition to the specified type of information, which will serve as the foundation for performing the analysis, other types of data will be incorporated into the paper.

Specifically, statistical information will be included into the analysis to establish the context in which the study is conducted, as well as portray the challenges that women face when accessing healthcare services in South Africa (Wium, Vannevel, & Bothma, 2019). Therefore, apart from the descriptive data, which will provide the foundation for the further qualitative analysis, statistical information will be utilized to introduce the reader to the environment in which the study will be performed.

Data Collection

As emphasized above, the use of interviews aligns with the current goals and objectives of this paper. Therefore, semi-structured interviews will be conducted with the healthcare staff members to be chosen for the research. The application of the semi-structured framework is justified by the necessity to obtain a vast amount of data from which vital factors affecting maternal mortality will be isolated.

The integration of the semi-structured approach is justified by the absence of the clear list of factors and the necessity to identify the ones that have not been located before (Osler et al., 2020). In turn, the adoption of the semi-structured interview approach will allow for previously underresearched factors contributing to maternal mortality to surface.

The adoption of semi-structured interviews as the main data collection tool entails several biases that will need to be managed appropriately. For instance, the threat of subjective interpretation of data provided by the interviewees increases due to the presence of the human factor. However, by acknowledging the presence of the specified bias, one will be able to develop a more objective stance and restrain one’s desire to interpret the data in the way that confirms the initial suppositions of the research (Kuupiel, Tlou, Bawontuo, & Mashamba-Thompson, 2019).

Moreover, the integration of semi-structured interviews allows obtaining a plethora of information for the further analysis (Benova, Moller, & Moran, 2019). Thus, the integration of the proposed framework for data collection is entirely justified.

Data Analysis

To infer essential conclusions concerning the factors that contribute to the current maternal mortality rates in South Africa, one will need the content analysis technique. The described framework will allow singling out the data pieces that contain information about factors affecting mortality rates among the target demographic.

Moreover, implicit connections between the variables in question will be located by applying content analysis (Lyndon, Malana, Hedli, Sherman, & Lee, 2018). The specified framework will require the introduction of coding techniques that will allow determining key trends in the development of factors that affect maternal mortality rates.

Specifically, issues linked to economic, financial, political, sociocultural, technological, and environmental influences on maternal mortality in South Africa will be coded accordingly. Afterward, the identified information will be decoded to be arranged ad labeled based on its belonging to a particular type of factors. As a result, a comprehensive overview of issues affecting the levels of maternal mortality in South Africa will be isolated. Moreover, the proposed technique will help to infer the vital strategies for reducing the extent of maternal mortality in the target environment.

Timeline

Since the project aims at examining the present trends in the current obstetrics and multiple factors that women in South Africa face, it would be reasonable to presume that the research will take a substantial amount of time to conduct. Although the study does not seek to adopt a longitudinal approach and does not suggest overviewing the phenomenon at hand over a long period of time, it will take a certain amount of time due to the necessity to perform a preliminary analysis of the target environment, locate facilities suitable for the research, invite participants, and arrange the research process. As diagram below shows, the entire project is expected to take approximately 4 months (see Figure 1).

The stages involving the collection of data and the preparation for the research to be conducted are believed to be the most time-consuming in the entire process.

Although the timeline provided above will be adhered to very closely, there might be minor unforeseen impediments observed at certain stages. Specifically, problems in data collection, its assessment, and the retrieval of information related to maternal mortality rates in the target setting, can be expected. The described issues may hamper the research process, expanding the time to be taken to perform it and provide accurate results. However, by considering the existing biases carefully and reducing costs by selecting the best options regarding price and quality, one will be able to complete research within the set deadline.

Benefits

It is believed that the outcomes of the research will provide several crucial benefits for the target population. The increased opportunities for patient education and the resulting rise in the chances for preventing the instances of maternal death should be mentioned as the primary positive effect to be anticipated.

It is presumed that the analysis of the essential factors affecting the levels of maternal mortality in South Africa will allow connecting the issue of managing patient-specific needs to the problems of patient education and low health literacy levels (Kim et al., 2020). Indeed, research points to the presence of a serious issue in promoting health awareness, as well as the relevant knowledge and skills needed for the target population to recognize a threat to their well-being and seek help.

The opportunities for building a program aimed at effective patient education is another important benefit that the study of the subject matter provides. Since maternal mortality rates are still comparatively high in South Africa despite the efforts aimed at reducing it, creating a program that will allow establishing some semblance of control over the issue seems to be quite reasonable. Moreover, the introduction of the said program will help to build awareness among the target population, thus helping pregnant women to identify health threats and seek help whenever necessary.

Moreover, healthier lifestyles and the introduction of the necessary changes to the current ones for mothers and pregnant women can be introduced with the development of an education program aimed at reducing maternal mortality. Finally, the introduction of the said program into the South African setting will help to focus on the interdisciplinary aspects of the described concern. Namely, once the program is established, opportunities for a cross-sectional analysis of the factors that affect the current mortality rates among mothers and pregnant women will become possible.

Budget

To implement the project descried above and create the platform for the further program aimed at improving the quality of healthcare and the efficacy of patient education, extensive financial support will be needed. Specifically, the project will require a budget of at least $353,000. As Table 1 below shows, the project will include recruiting experts for promoting patient education and encouraging interdisciplinary collaboration in the South African obstetrics environment. The project will need financial support to purchase and apply the software required for analytical purposes.

Likewise, one will have to take into consideration the costs for developing and conducting interviews, as well as the further analysis of the information obtained with the help of the said interviews, In addition, expenditures associated with communication, transportation, and other minor costs will have to be added to the budget list. Finally, the development of the program that will help women in South Africa to gain the required amount of health literacy will have to be added to the research budget.

Table 1. Research Budget.

The issue of maternal mortality has been a substantial concern in the South African obstetrics setting for a significant time period. Despite the efforts taken to reduce it, a rather minor positive change has been observed over the past few years. Therefore, a more profound, detailed, and comprehensive analysis of the factors affecting the levels of maternal mortality in the target environment will have to be performed. By considering the issues that define the current maternal mortality rates in the South African environment from multiple viewpoints, including the economic perspective, the financial one, as well as the technological and sociocultural factors affecting the quality of care that pregnant women receive in South Africa.

Specifically, the lack of focus on patients’ needs coupled with the gaps in patient education is believed to be the leading cause of the current maternal mortality rates. Despite a minor positive shift observed recently, the problem of maternal mortality remains mostly unaddressed in the South African obstetrics setting.

As a result, the factors affecting the rise in maternal mortality are yet to be discovered, which calls for the introduction of additional measures for preserving women’s health and encouraging them to gain vital knowledge. Presently, it is believed that the focus on health literacy among patients coupled with the cross-disciplinary collaboration between healthcare experts will help to address the issue of maternal mortality in South Africa.

References

Benova, L., Moller, A. B., & Moran, A. C. (2019). “What gets measured better gets done better”: The landscape of validation of global maternal and newborn health indicators through key informant interviews. PloS One, 14(11), 1-9. Web.

Black, V., Black, A. D., Rees, H. V., Guidozzi, F., Scorgie, F., & Chersich, M. F. (2016). Increased access to antiretroviral therapy is associated with reduced maternal mortality in Johannesburg, South Africa: an audit from 2003-2012. PloS One, 11(12), 1-13. Web.

Cooper, D., Harries, J., Moodley, J., Constant, D., Hodes, R., Mathews, C.,… Hoffman, M. (2016). Coming of age? Women’s sexual and reproductive health after twenty-one years of democracy in South Africa. Reproductive Health Matters, 24(48), 79-89. Web.

Cummings, P. R., Cummings, D. B., & Jacobsen, K. H. (2019). Obstructed labor as an underlying cause of maternal mortality in Kalukembe, Angola, 2017. Journal of Global Health Reports, 3, 1-6. Web.

Frank, O., & Kovacs, P. (2020). Human development and maternal mortality: Evidence from Sub-Saharan Africa. Human Development, 29(6s), 2517-2532.

Garenne, M. (2015). Maternal mortality in Africa: Investigating more, acting more. The Lancet Global Health, 3(7), e346-e347. Web.

Hodes, R. (2016). The culture of illegal abortion in South Africa. Journal of Southern African Studies, 42(1), 79-93. Web.

Kim, H. Y., Dobra, A., & Tanser, F. (2020). Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa. PLoS Medicine, 17(3), 1-17. Web.

Kuupiel, D., Tlou, B., Bawontuo, V., & Mashamba-Thompson, T. P. (2019). Accessibility of pregnancy-related point-of-care diagnostic tests for maternal healthcare in rural primary healthcare facilities in Northern Ghana: A cross-sectional survey. Heliyon, 5(2), 1-16. Web.

Lyndon, A., Malana, J., Hedli, L. C., Sherman, J., & Lee, H. C. (2018). Thematic analysis of women’s perspectives on the meaning of safety during hospital-based birth. Journal of Obstetric, Gynecologic & Neonatal Nursing, 47(3), 324-332. Web.

Manderson, L., & Ross, F. C. (2020). Publics, technologies and interventions in reproduction and early life in South Africa. Humanities and Social Sciences Communications, 7(1), 1-9. Web.

Marabele, P. M., Maputle, M. S., Ramathuba, D. U., & Netshikweta, L. (2020). Cultural factors contributing to maternal mortality rate in rural villages of Limpopo Province, South Africa. International Journal of Women’s Health, 12, 691-699. Web.

Mashamba-Thompson, T. P., Drain, P. K., Kuupiel, D., & Sartorius, B. (2019). Impact of implementing antenatal syphilis point-of-care testing on maternal mortality in KwaZulu-Natal, South Africa: An interrupted time series analysis. Diagnostics, 9(4), 218-228. Web.

Matthew, O., Adeniji, A., Osabohien, R., Olawande, T., & Atolagbe, T. (2020). Gender inequality, maternal mortality and inclusive growth in Nigeria. Social Indicators Research, 147(3), 763-780. Web.

Millham, R. C., Agbehadji, I. E., Puckree, T., Mukami, V., & Li, T. (2020). Feasible E-health strategies to reduce maternal mortality in Kenya. International Journal of Extreme Automation and Connectivity in Healthcare (IJEACH), 2(2), 26-36. Web.

Osler, M., Cornell, M., Ford, N., Hilderbrand, K., Goemaere, E., & Boulle, A. (2020). Population‐wide differentials in HIV service access and outcomes in the Western Cape for men as compared to women, South Africa: 2008 to 2018: A cohort analysis. Journal of the International AIDS Society, 23, 1-12. Web.

Pavličev, M., Romero, R., & Mitteroecker, P. (2020). Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma. American Journal of Obstetrics and Gynecology, 222(1), 3-16. Web.

Slogrove, A. L., Johnson, L. F., & Powis, K. M. (2019). Population-level mortality associated with HIV exposure in HIV-uninfected infants in Botswana and South Africa: A model-based evaluation. Journal of tropical pediatrics, 65(4), 373-379. Web.

Tlou, B. (2018). Underlying determinants of maternal mortality in a rural South African population with high HIV prevalence (2000–2014): A population-based cohort analysis. PloS One, 13(9), 1-9. Web.

Wium, L., Vannevel, V., & Bothma, S. (2019). Obstetric medical care and training in South Africa. Obstetric Medicine, 12(1), 27-30. Web.