oa South African Health Review - Maternal care : antenatal, peri and postnatal : women's health
South Africa is performing well on certain selected maternal health process indicators; antenatal care attendance has remained over 90% since 1998; deliveries conducted by skilled health workers have increased from 84% in 1998 to 92% in 2003. Despite this, maternal mortality is on the increase, with the latest Saving Mothers Report showing that maternal mortality in the 2002-2004 triennium increased from the previous three years. The non pregnancy related infections, particularly HIV have impacted heavily on maternal mortality rates. Therefore, antenatal care, delivery and postnatal care need to place a particular focus on screening for and appropriate management of communicable diseases such as HIV infection during pregnancy and beyond.
Although antenatal care attendance is high, the services rendered such as timing of the first visit and providers' attitudes need to be critically assessed as they are also important if optimum quality of care is to be achieved.
Staff shortages, training and staff motivation appear to be particular issues in maternal health care services. The introduction of the prevention of mother-to-child transmission of HIV programme and more recently, the recommendation that women should be initiated into the antiretroviral programme during antenatal care have placed additional challenges on the maternal health services.
Postnatal care in South Africa has not been adequately prioritised as a maternal health care service. With high maternal and perinatal mortality rates found in the postnatal period there needs to be guidelines and systems put in place to ensure that care of the woman and her newborn goes beyond the delivery.
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