FROM WELFARE TO EMPOWERMENT AND WOMEN’S HEALTH

Get Complete Project Material File(s) Now! »

CHAPTER TWO THE LITERATURE REVIEW

INTRODUCTION

This section discusses the literature related to the research topic, the theoretical framework on which this study is based and lessons learnt on the models, public policies, approaches, programmes and services to reduce the risk of maternal and child morbidity and mortality.
Maternal morbidity and mortality and child morbidity and mortality as concepts are ‘unpacked’. The concept of risky conditions is defined as it is used in this study. This study argues that health provisioning is unequally distributed in South Africa and that discriminatory allocation of resources including health care services leads to differential health outcomes for women, mothers and children in South Africa. The meaning of health, power and women in the context of a model that aims at improving reproductive health outcomes is discussed, commencing with an overview of macro-level policies and their impact on women’s health, followed by contributions from women’s perspectives and demands to eliminate risks to reproductive health.
The section concludes with a discussion of the lessons and experiences from the models, public policies and approaches in developing countries to enhance maternal and child health care, thus reducing the risk of dying. The emphasis is on how these countries, through the models, public policies, programmes and services, managed to reduce maternal and child morbidity and mortality. The lessons learnt from experiences might assist in formulating a model that could contribute to reducing the high rates and consistent reproductive morbidity and mortality in South Africa.

UNDERSTANDING MATERNAL AND CHILD HEALTH, MATERNAL MORBIDITY AND MORTALITY AND CHILD MORBIDITY AND MORTALITY

Maternal and child morbidity and mortality are outcomes of a complex web of causal factors that include social, economic, educational, cultural, geographic and environmental factors, the state of physical infrastructure, and the health system (Pandey, Shankar, Rawat & Gupta 2007). According to Maine (2001), progress in the improvement of maternal health and the intimately linked perinatal and new-born health is too slow in the poorest countries, irrespective of increased implementation of the policies to improve maternal and new-born health. Maine (2001) further warns that it is essential to intensify efforts to reduce poverty alongside strengthening health systems in low-income countries for better reproductive health outcomes.
Scholars in several disciplines have begun to examine how women’s agency, including their health-related decision-making, political participation, and organised social movement activities, affect their social circumstances and health (Weisman 2000). The women agency factor offsets the all-embracing view of women as victims of social and political institutions that are assumed to be too remote from women’s experiences (Weisman 2000). The WHO has also begun to recognise that a reduction of women, maternal and child mortality requires a shift from a narrow curative medical approach to a broader comprehensive promoting and preventive approach that looks at causal factors at the social level (WHO 2007b). The proposed approach should facilitate change by reducing health inequities and set up a momentum for new, equity-focused approaches (WHO 2009). To this end, a Commission on Social Determinants of Health (CSDH) was set up by the WHO in 2004 and launched in 2005 (WHO 2009). The main goal of the CSDH was to advance health equity and propose actions to reduce health differences, thus reducing differential mortality rates among the social groups and within and between countries (WHO 2009). The guiding principle of the CSDH is health equity, and the primary responsibility for the protection of health equity rests with national governments (CSDH 2007). The CSDH embraced the international human rights framework as an appropriate conceptual and legal framework within which to advance towards health equity through action on the social determinants of health(CSDH 2007). The CSDH has developed a conceptual framework to address ‘the causes of the causes’ of ill health and premature deaths (CSDH 2007).
In light of the above, the present study assumes that socio-economic factors affect the empowerment position of women, which in turn influences their decision-making capability for their health and the health of their children. The socio-economic determinants of health therefore indirectly determine the reproductive health outcomes. The study is based on the premise that women and new born babies eventually die due to accumulation of and prolonged exposure to such risk factors as the social determinants of health or the intermediary factors. The socio-economic position and power of women or structural drivers operate independently on more than one intermediary variable/social determinants of health, to influence the risk to maternal, neonatal and child mortality. In this study, the socio-economic position and power of women leading to inequitable distribution of resources include income and the differences in exposure to vulnerability of women and consequently their children. The position and power of women are the structural drivers of the intermediary variables/social determinants of health, and are deemed to be the root causes of the persistently high maternal and child mortality. Any effort to reduce maternal and child morbidity and mortality must operate through these events. Implied here is that the interventions and policies to reduce maternal and child health inequities must not limit themselves to intermediary determinants/social determinants of health, but must include models and policies crafted to tackle structural determinants.
The conventional use of the term ‘social determinants of health’ has often encompassed only the intermediary factors. However, interventions addressing intermediary factors only can improve average health indicators while leaving health inequities unchanged. For this reason, action on structural determinants is necessary; however, it must come from outside the health sector (CSDH 2007). The researcher uses the WHO’s conceptual framework to analyse the pathways leading to exposure, vulnerability and risk to ill health and mortality.
Below is a diagram on the determinants of maternal morbidity and mortality which shows how structural determinants work through the intermediary factors to affect the health of women thus contributing to the occurrence of maternal and child morbidity and mortality.
Adapted from the Commission on Social Determinants of Health 2007

The framework of the social determinants of health: elements

It has been highlighted above that within South Africa population groups experience different reproductive outcomes along the racial, geographical, class and gender lines (Coovadia et al. 2009). The choice of the framework on the SDH was informed by:

• its approach and the guiding principle of reducing health differences on the social groups
• its ability to identify the root and trace the pathways from the root that lead to the stark differences in women’s health status

The three (3) core elements of the framework are the socio-economic and political context, the structural determinants and socio-economic position of women and the intermediary determinants that produce certain reproductive health outcomes (CSDH 2007). The first element, socio-economic and political context exerts power and influence that produce patterns of social stratification and hierarchies that determine people’s opportunities. This element encompasses a broad spectrum of factors that cannot be measured directly at individual level (CSDH 2007).
The second element, the structural determinants and socio-economic position constitutes what the CSDH (2007) calls the social determinants of inequities. The structural determinants of health generate, reinforce and define social positions along social hierarchies of power, prestige and access to resources. The socio-economic position is defined by income, education, occupation, social class, gender, race and geography.
The third element of the framework on the social determinants of health, the intermediary determinants, has been referred to by the CSDH as the social determinants of health (CSDH 2007). The categories in this level include the material circumstances such as housing, income and consumption, social environment, behavioural factors, health system as a determinant of health which informs access, differences in exposure and vulnerability (CSDH 2007).
The social determinants of the health inequities are causally antecedent to the social determinants of health which on the other side influences or are linked to a set of individual level influences which includes health related behaviours and psychological factors (CSDH 2007). The intermediary factors therefore determine differences in exposure and vulnerability to health comprising conditions.

CHAPTER 1: INTRODUCTION AND BACKGROUND TO THE STUDY
1.1INTRODUCTION
1.2 THE STATEMENT OF THE PROBLEM
1.3 THE CONTEXT OF THE PROBLEM
1.4 THE PURPOSE OF THE STUDY
1.5 THE OBJECTIVES OF THE STUDY
1.6 THE RESEARCH QUESTIONS
1.7 RATIONALE FOR THE STUDY
1.8 THE CHOSEN RESEARCH APPROACH
1.9 DEFINITIONS OF CONCEPTS AND KEY TERMS
CHAPTER 2: THE LITERATURE REVIEW
2.1 INTRODUCTION
2.2 UNDERSTANDING MATERNAL AND CHILD HEALTH, MATERNAL MORBIDITY AND MORTALITY AND CHILD MORBIDITY AND MORTALITY
2.3 HEALTH / POWER / WOMEN
2.4 A THEORETICAL DISCOURSE: FROM WELFARE TO EMPOWERMENT AND WOMEN’S HEALTH
2.5 PUBLIC POLICIES AND APPROACHES TO REDUCE THE RISK OF REPRODUCTIVE MORBIDITY AND MORTALITY, AND LESSONS FROM OTHER DEVELOPING COUNTRIES
2.6 A CRITICAL OVERVIEW OF MCH/FPSERVICES
2.7 WOMEN’S PERSPECTIVES AND DEMANDS
CHAPTER 3: METHODOLOGY
3.1 THE RESEARCH DESIGN
3.2 MULTI-STAGE QUALITATIVE DATA GENERATION
3.3 THE STUDY OF DOCUMENTS
3.4 ISSUES OF RELIABILITY AND VALIDITY
3.5 THE ANALYTICAL FRAMEWORK
3.6 DATA ANALYSIS AND INTERPRETATION
3.7 ETHICAL CONSIDERATIONS
3.8 SYNTHESISING THE DATA COLLECTED THROUGH VARIOUS MEANS
3.9 CONCLUSION
CHAPTER 4: FINDINGS
4.1 INTRODUCTION
4.2 CONTEXTUAL BACKGROUND OF KZN
4.3 BIOGRAPHICAL DETAILS OF THE RESEARCH PARTICIPANTS
4.4 REPRODUCTIVE HEALTH STATUS OF THE WOMEN ‘AT RISK’
4.5 PERCEPTIONS OF THE AT-RISK INTERVIEWEES ABOUT RISK FACTORS FOR HIGH MATERNAL MORTALITY IN SOUTH AFRICA
4.6 RESULTS FROM VERBAL AUTOPSIES OF THE CIRCUMSTANCES LEADING UP TO MATERNAL AND NEONATAL DEATHS
4.7 RESULTS OF FACE-TO-FACE INTERVIEWS WITH EXPERTS IN THE FIELD OF FEMALE REPRODUCTIVE AND NEONATAL MORTALITY IN SOUTH AFRICA
4.8 RESULTS OF FACE-TO-FACE INTERVIEWS WITH INDIVIDUALS WORKING FOR NGOs IN THE FIELD OF REPRODUCTIVE HEALTH IN STANGER
CHAPTER 5: SUGGESTING A MODEL FOR INTEGRATING SOCIAL INTERVENTIONS INTO PRIMARY HEALTH CARE IN ORDER TO REDUCE MATERNAL AND CHILD MORTALITY IN SOUTH AFRICA
5.1 INTRODUCTION
5.2 MAIN FINDINGS
5.3 A MODEL FOR INTEGRATING SOCIAL INTERVENTIONS INTO THE PRIMARY HEALTH CARE SYSTEM IN ORDER TO REDUCE MATERNAL AND CHILD MORTALITY IN SOUTH AFRICA
5.4 IMPLEMENTING THE MODEL IN SOUTH AFRICA: ADDRESSING THE SOCIAL DETERMINANTS OF REPRODUCTIVE ILL HEALTH AND MORTALITY
5.5 RECOMMENDATIONS FOR FURTHER RESEARCH
5.6 WEAKNESSES, STRENGTHS AND CONTRIBUTION OF THE STUDY
5.7 CONCLUSION
LIST OF SOURCES

GET THE COMPLETE PROJECT