Challenges to improve antenatal and intrapartum care in South Africa

Abstract

The major causes of maternal and perinatal deaths have been well described in South Africa. These causes are related to HIV infection, placental insufficiency and intrapartum asphyxia. The health system failures that most commonly lead to preventable mortality are related to managing hypertensive disorders in pregnancy (HDP), detecting fetal growth restriction antenatally and managing labour effectively by providing caesarean delivery to those who need it and avoiding it in those who do not. Improving antenatal and intrapartum care are vital aspects in efforts to improve survival, but to achieve this the following challenges need to be overcome: 

managing the increased antenatal care contacts needed to detect HDP 

creating a next level of expertise, and access for women to high-risk care 

creating the environment for respectful care and companionship in labour 

managing labour as physiologically as possible 

detecting and managing placental insufficiency. 

This article provides some exciting solutions to these health system barriers.