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\"Focussing ethnographically on private sector maternity care in South Africa, Privileges of Birth attends to the ways healthcare and childbirth are shaped by South Africa's racialised history. Birth is one of the most medicalised aspects of the life-cycle across all sectors of society and is also deeply divided between what the privileged can afford compared with the rest of the population. Examining the ethics of care in midwife-attended birth, the author situates the argument in the context of a growing literature on care in anthropological and feminist scholarship, offering a unique account of birthing care in the context of elite care services\"-- Provided by publisher.

Maternal physical and mental health during pregnancy are key determinants of birth outcomes. There are relatively few prospective data that integrate physical and mental maternal health measures with birth outcomes in low- and middle-income country settings. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study. Pregnant women attending 2 public health clinics, Mbekweni (serving a predominantly black African population) and TC Newman (predominantly mixed ancestry) in a poor peri-urban area of South Africa were enrolled in their second trimester and followed through childbirth. All births occurred at a single public hospital. Maternal sociodemographic, physical and psychosocial characteristics were comprehensively assessed. Multivariable linear regression models were used to explore associations between maternal health and birth outcomes. Over 3 years, 1137 women (median age 25.8 years; 21% HIV-infected) gave birth to 1143 live babies. Most pregnancies were uncomplicated but gestational diabetes (1%), anaemia (22%) or pre-eclampsia (2%) occurred in a minority. Most households (87%) had a monthly income of less than USD 350; only 27% of moms were employed and food insecurity was common (37%). Most babies (80%) were born by vaginal delivery at full term; 17% were preterm, predominantly late preterm. Only 74 (7%) of babies required hospitalisation immediately after birth and only 2 babies were HIV-infected. Food insecurity, socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age. Primigravida or alcohol use during pregnancy were negatively associated with infant birth weight and head circumference. Maternal BMI at enrolment was positively associated with birth weight and gestational diabetes was positively associated with birth weight and head circumference for gestational age. Smoking during pregnancy was associated with lower infant birth weight. Several modifiable risk factors including food insecurity, smoking, and alcohol consumption during pregnancy were identified as associated with negative birth outcomes, all of which are amenable to public health interventions. Interventions to address key exposures influencing birth outcomes are needed to improve maternal and child health in low-middle income country settings.

Background Nearly 15% of pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labour and complications of abortion. Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two thirds of these deaths occurred in sub-Saharan Africa. Though the majority of maternal mortalities can be prevented, different factors can hinder women’s access to emergency obstetric services. Therefore, this review is aimed at synthesizing current evidence on barriers to access and utilization of emergency obstetric care in sub-Saharan Africa. Methods Articles were searched from MEDLINE, CINAHL, EMBASE, and Maternity and Infant Care databases using predefined search terms and strategies. Articles published in English, between 2010 and 2017, were included. Two reviewers (AG and AM) independently screened the articles, and data extraction was conducted using the Joanna Briggs Institute data extraction format. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The identified barriers were qualitatively synthesized and reported using the Three Delays analytical framework. The PRISMA checklist was employed to present the findings. Result The search of the selected databases returned 3534 articles. After duplicates were removed and further screening undertaken, 37 studies fulfilled the inclusion criteria. The identified key barriers related to the first delay included younger age, illiteracy, lower income, unemployment, poor health service utilization, a lower level of assertiveness among women, poor knowledge about obstetric danger signs, and cultural beliefs. Poorly designed roads, lack of vehicles, transportation costs, and distance from facilities led to the second delay. Barriers related to the third delay included lack of emergency obstetric care services and supplies, shortage of trained staff, poor management of emergency obstetric care provision, cost of services, long waiting times, poor referral practices, and poor coordination among staff. Conclusions A number of factors were found to hamper access to and utilization of emergency obstetric care among women in sub-Saharan Africa. These barriers are inter-dependent and occurred at multiple levels either at home, on the way to health facilities, or at the facilities. Therefore, country-specific holistic strategies including improvements to healthcare systems and the socio-economic status of women need to be strengthened. Further research should focus on the assessment of the third delay, as little is known about facility-readiness. Systematic review registration PROSPERO CRD42017074102

Inadequate utilisation of maternal healthcare services, particularly antenatal care (ANC), poses a challenge in sub-Saharan Africa (SSA). There is a dearth of regional studies that address the socio-economic disparities in the use of ANC in SSA. Therefore, we examined the wealth and education-based inequalities in the utilisation of ANC services among women in SSA. We analysed secondary data obtained from the Demographic Health Survey conducted in fifteen countries in SSA. We estimated the degree of wealth and education-related inequalities using concentration curves, concentration indices (CIX), and decomposition analysis, which identified the factors contributing to the disparities in the utilisation of ANC. All the analyses were conducted using Stata version 17.0 (Stata Corporation, College Station, TX, USA). The results revealed a significant socio-economic gap in utilising ANC in SSA. We found positive and statistically significant wealth index-related (CIX = 0.30; p-value < 0.0001) and education-based inequalities (CIX = 0.33; p-value < 0.0001) in eight or more ANC visits. The extent of wealth index-related and education-based inequalities varied across the fifteen countries. The decomposition analysis showed that educational attainment accounted for about 21% of the inequalities in eight or more ANC visits. Wealth index contributed 12.14% of the inequalities in eight or more ANC visits. Our results further showed that women's education, wealth, parity, and place of residence significantly contributed to the utilisation of eight visits or more among women in SSA. This study shows the disparities in ANC coverage, contingent upon wealth index and educational attainment. Our study highlights the importance of adopting a holistic approach involving robust cooperation between healthcare and other social service sectors. It is crucial to prioritise the primary social factors contributing to disparities in the utilisation of ANC services, including women's education, parity, place of residence, and economic status. Policymakers and stakeholders must prioritise efforts to combat obstacles to healthcare access, including the provision of easily accessible, affordable, and culturally appropriate services.

Background Maternal mortality remains a pressing concern across Sub-Sahara Africa. The ‘Three Delays Model’ suggests that maternal deaths are a consequence of delays in: seeking care, reaching medical care and receiving care. Birth Preparedness and Complication Readiness (BPCR) refers to a plan organised during pregnancy in preparation for a normal birth and in case of complications. Male partners in many Sub-Saharan African communities could play a pivotal role in a woman’s ability to prepare for birth and respond to obstetric complications. This review aimed identify: the extent and quality of research performed on the topic of male partner involvement in BPCR in Sub-Saharan Africa; the degree to which populations and geographic areas are represented; how male partner involvement has been conceptualized; how male partners response to obstetric complications has been conceptualised; how the variation in male partners involvement has been measured and if any interventions have been performed. Methods In this scoping review, articles were identified through a systematic search of databases MEDLINE, EMBASE and Maternity and Infant Care and a manual scan of relevant papers, journals and websites. All authors contributed to the screening process and a quality assessment using the Kmet checklist. The PRISMA checking list for Scoping Reviews was used to guide the search, data charting and reporting of the review The protocol was registered with PROSPERO (ID: CRD42019126263). Results Thirty-five articles met inclusion criteria, reporting: 13 qualitative, 13 cross-sectional, 5 mixed method and 4 intervention studies. Data were contributed by approximately 14,550 participants (numbers were not always reported for focus groups) including: women who were pregnant or who had experienced pregnancy or childbirth within the previous 3 years, their male partners and key informants such as health workers and community leaders. Conclusions The diversity of study designs, aims and source countries in this body of literature reflects an emerging stage of research; as a result, the review yielded strong evidence in some areas and gaps in others. Male partner’s involvement in BPCR and responding to obstetric emergencies can be conceptualised as being centrally involved in responding to complications and having some role in preparing for birth through their position in the chain of decisions and provision of logistic support. However, their knowledge of pregnancy complications and level of preparation for birth is low, suggesting they are making decisions without being fully informed. There is limited evidence on interventions to improve their knowledge. Future research efforts should be focused on producing standardised, culturally appropriate, higher level evidence.

Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA. The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data. There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance. Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities.

Background The maternity continuum of care is a strategy to provide timely and quality maternal and child healthcare through preconception, pregnancy, childbirth, postnatal, and the early childhood periods. The maternity continuum of care effectively reduces global maternal and neonatal deaths. However, several factors are reported to cause low completion of the maternity continuum of care in sub–Saharan Africa. There has been substantial debate in the literature as to whether pregnancy intention influences the completion of the maternity continuum of care. Although several studies have been conducted to determine the influence of pregnancy intention on the completion of the maternity continuum of care, findings are inconsistent and have not been systematically reviewed. Therefore, this review aims to determine the effect of pregnancy intention on the completion of the maternity continuum of care in sub–Saharan African countries. Methods A systematic search of articles was performed from MEDLINE Complete, CINAHL Complete, PsycINFO, EMBASE, Maternity & Infant Care, Global Health, Scopus, and Web of Science. The identified articles were imported into Covidence and independently screened by two researchers for abstract and title, and then full-text. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The Cochran’s Q test and I 2 were used for assessing the potential heterogeneity of the studies. Publication bias was assessed using Egger’s regression test and inspection of a funnel plot. A fixed-effects meta-analysis model was used to compute the effect of pregnancy intention on the completion of the maternity continuum of care. Results Ten studies involving 343,932 participants were included in the final analysis. The pooled estimate of the meta-analysis found that women with intended pregnancy had 2.12 times higher odds of completing the maternity continuum of care (pooled odds ratio: 2.12, 95% CI: 1.33, 3.36) as compared to women with unintended pregnancy. Conclusion Intended pregnancy has a statistically significant positive effect on completing the maternity continuum of care. Policymakers and healthcare providers need to implement strategies to encourage women to plan their pregnancies through the strengthening of pre-conception care and contraceptive counselling to prevent unintended pregnancies. Systematic review registration PROSPERO CRD42023409134.

Background Traditional practices and beliefs influence and support the behavior of women during pregnancy and childbirth in different parts of the world. Not much research has been conducted to examine whether and how cultural traditions continue to shape maternity experiences of Zulu women. The aim of this study is to establish the extent at which women in certain rural communities adhere to traditional food taboos and practices during pregnancy, postpartum recovery, and infants feeding, in comparison to what is recommended by health care workers. Methods A survey was conducted in the rural northern KwaZulu-Natal between 2017 and 2020. A total of 140 women between the ages of 18 and 90 years were interviewed and they were chosen purposively based on their experiences in pregnancy, postpartum recovery, infant care, and their willingness to share the knowledge. Data were analyzed using descriptive statistics. Results Most (64%) of the participants said that they adhered to these cultural food taboos and practices. The most common foods avoided were certain fruits [mango, naartjie, orange, papaya, and peach], butternut, eggs, sweets (sugar, commercial juice, sweet food, and honey), chili, ice, and alcohol. The most recommended foods during pregnancy were leafy vegetables, fruits (except the avoided ones), liver, and fish. For postpartum recovery, women mostly consumed soft porridge, all fruits and vegetables, beetroot, and tea. Food not allowed for children younger than 2 years included meat, sugar and sweets, and chewable foods. Conclusion Differences on food taboos and practices between participants who received formal education and those who did not received it were insignificant. The beliefs about the detrimental effects of some foods were not backed up by scientific research. Restriction of some orange/yellow colored fruits during pregnancy that are rich in vitamin A and/or C may affect daily requirements of these micronutrients, and the foods recommended during pregnancy and postpartum period would not provide all the essential nutrients required for successful pregnancy. However, some of the food taboos would protect women from unhealthy eating. Our findings provide a basis for developing culturally appropriate nutritional mediation programs for Zulu women with a view to provide effective nutritional counseling.

Background In November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women’s empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women’s empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women’s empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model. Methods The most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women’s empowerment captured in the DHS. The 30 variables on women’s empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p -value< 0.05 were used for interpretation of results. Results The proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women’s empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries. Conclusion This study highlights the significant impact of women’s empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.

Men's participation in antenatal care (ANC) in sub-Saharan Africa (SSA) is shaped by diverse conceptions and experiences of fatherhood. However, most discussions rely on biomedical models that typically view men's participation narrowly as a strategy to increase ANC uptake in mainstream health facilities, often marginalizing culturally specific forms of participation. We aimed to consolidate the existing literature on the complex nuances of how attitudes, knowledge, variations in involvement, and decision-making dynamics influence men's participation in ANC in rural SSA. Following the scoping review methodology developed by Arksey and O'Malley, we searched ten databases (African Index Medicus, Africa Journals Online, CINAHL, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, Sociology Collection, Social Sciences Abstract, Social Sciences Citation Index) for peer-reviewed articles published between January 1st, 2000, and October 31st, 2024. We included only studies that systematically analyzed primary or secondary data to examine fatherhood and men's participation in ANC in a rural setting in SSA. We applied no language restrictions. We identified 7665 articles, full-text reviewed 797 articles, and included 77 articles that reported 58 qualitative, 6 quantitative, and 13 mixed-methods studies conducted in 15 SSA countries. We identified nine themes under three categories addressing our review's objective: 1) three themes described men's attitudes and knowledge around participating in ANC; 2) four themes depicted variations in men's participation in ANC throughout pregnancy; and 3) two themes described how men's participation in ANC was shaped by largely collaborative communal decision-making structures in rural SSA. While heterogeneous, the existing body of evidence highlights contextually-valid and socioculturally meaningful nuances that reflect the lived realities of fatherhood and men's participation in ANC across rural SSA. Policymakers and practitioners should leverage these nuances as strengths, and further research should employ Afrocentric approaches to better understand these issues.