Development of Indicator Scores Using Items from the WHO Safe Motherhood Needs Assessment to Examine Utilization of Maternal Health Services in South Africa

OBJECTIVE: The South African Confidential Enquiry into Maternal Deaths has identified low utilization of maternity care as a leading patient-related contributor to maternal deaths in the country. The purpose of this research was to identify the predictors of the utilization of maternal health services in South Africa.

METHODS: Data from three diverse sites were collected using a cross-sectional survey of 178 women. Semi-structured, home-based interviews were used to collect data. The questionnaire was adapted from the Safe Motherhood Needs Assessment and included demographic information, pregnancy history, knowledge on maternal danger signs, barriers to maternal services, women's satisfaction with maternal services and perceived quality of maternal health services.

The analysis of utilization of maternal services, satisfaction with maternal services, barriers to maternal services, perceived quality of maternal care services, socio-economic status and knowledge of maternal danger signs was achieved using a series of indicator scores. Multivariate analysis was employed to understand the impact of the predictors on utilization of maternal health services.

RESULTS: In the stepwise regression analysis, the perceived quality of maternal services score was the strongest predictor of maternal health services utilization (R2=0.214, p<0.0001), followed by knowledge of maternal danger signs (R2=0.063, p=0.0001), and finally, barriers to maternal service utilization (R2=0.045, p=0.001). The best model obtained was: Utilization of maternal services = 4.3019 + 0.0950 (Perceived quality of maternal services) - 0.0131 (Knowledge of maternal danger signs) - 0.2838 (Barriers to maternal services).

CONCLUSION: The study findings provide insights for policy makers who plan to devote resources to improve the quality of maternal health care as part of efforts to achieve higher utilization of maternal health services. In addition, the development of indicator scores using items from the WHO Safe Motherhood Needs Assessment tool for analysis has potential applicability throughout Africa and other developing countries.