South African Health Review - Volume 2006, Issue 1, 2006
Volume 2006, Issue 1, 2006
Source: South African Health Review 2006, pp 297 –314 (2006)More Less
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.
Source: South African Health Review 2006, pp 315 –332 (2006)More Less
Over half the people currently living with HIV in South Africa are women. Since 2000, considerable progress has been made in expanding access to counselling and testing, prevention of mother-to-child transmission of HIV and antiretroviral therapy. However, HIV-infected women still face challenges and obstacles in accessing comprehensive services for sexual health, prevention of sexually transmitted infections, family planning and contraception, pregnancy, delivery, infant feeding, psycho-social support, counselling and treatment. Provision of comprehensive and holistic care to HIV-infected women requires promotion of optimal therapeutic care and well-being through strengthening sexual and reproductive health services. It also entails enhancing integration of HIV and reproductive health services and providing guidelines for implementation. Other pertinent considerations include improving antenatal, obstetric and postnatal care; strengthening linkages with community based support structures and supporting HIV-positive women in their reproductive choices. It also entails building capacity of health providers in non-judgemental sexual and reproductive health service delivery; expanding access to provider-initiated counselling and testing; empowering women through increasing male involvement in sexual and reproductive health as well as through improvement of the socio-economic environment.
Author Lynette DennySource: South African Health Review 2006, pp 333 –346 (2006)More Less
This chapter reviews the burden of cervical cancer in South Africa and shows that it remains the most common cancer among South African women, particularly women with least access to cervical cancer screening. The chapter explains the rationale behind the South African cervical cancer screening policy, which is to offer all asymptomatic women three free cervical smears in a lifetime, beginning at age 30, 10 years apart. Further, the chapter illustrates that cervical cancer screening offers unique opportunities for prevention at both the primary and secondary levels. The causal association of human papillomavirus infection of the cervix and the possibility for vaccination against the virus is discussed. The history of screening in South Africa and why it has failed to make a major impact to date on the morbidity and mortality of cervical cancer is also discussed. Finally, possible alternative approaches to cervical cytology for the prevention of cervical cancer are briefly reviewed.
Source: South African Health Review 2006, pp 347 –366 (2006)More Less
Mental health is a neglected topic, and that of women's mental health even more so, with the latter receiving little attention within the South African public health sector. This chapter provides a selective, focused overview of women's mental health issues requiring public sector attention in South Africa. It reports global and South African prevalence rates and burden of disease estimates for common mental disorders in women, focusing on depressive and anxiety disorders. Several key factors which impact on the mental health status of South African women are discussed, namely gender disadvantage, poverty, gender violence, HIV and peripartum depression. Policy and programme implications of women's mental health issues are noted, and recommendations for effecting a comprehensive, multi-sectora approach to improving the mental health status of women are outlined.