Motherhood in the city: poor urban women and maternal health care provision in sub-Saharan Africa

Despite major achievements in reducing fertility and infant mortality rates in sub-Saharan Africa, progress has been much slower in reducing maternal mortality and improving maternal health. Studies have highlighted the disparities in health care provision between rural and urban areas, but little attention has been paid to possible disadvantages suffered by the urban poor when compared to non-poor urban mothers.

Growing urban populations contain a high proportion of young people, with the result that there is a higher proportion of people of reproductive age in urban than in rural populations. The increasing proportion of young women living in cities brings new problems for provision of health care in the urban setting.

Drawing on Demographic and Health Survey data for 23 countries in sub-Saharan Africa (SSA), researchers with the University of Southampton and the African Population and Health Research Center set out to address the issue of maternal health care among the urban poor.   The authors define as ‘poor’ those living in dwellings that lack electricity, access to minimally safe drinking water and safe waste disposal facilities.   The study focuses on three broad indicators of maternal health care: unplanned births, antenatal care and delivery (child birth) care. Significant research findings include:

• Physical proximity to health facilities does not necessarily guarantee access by the urban poor, who may be constrained by economic deprivation and unwillingness to take time off from income earning activities. 
• Extreme differences in the levels of women defined as living in urban poverty were found between countries, ranging from 10 % to 72 %.   Variation was also found between countries in the levels of fertility, the timing and frequency of antenatal care, and the numbers of women giving birth in a health facility.
• Throughout the region, maternal health care for the urban poor is better than in rural areas, but worse than care for the urban non-poor.  
• Poor urban women are more likely than the non-poor to initiate antenatal care late in pregnancy, make fewer visits to a health facility during pregnancy, and receive non-professional delivery care.
• The differences in quality of care between the urban poor and non-poor are more significant in countries where indicators show better maternal health.  In such countries the indicators show maternal health care for the urban poor is worse than for rural residents.

These significant variations within urban areas imply that policy-makers should:

• prioritise primary health care policy that targets poor women in urban areas, without abandoning rural health problems. Priorities include the reduction of unplanned pregnancies and provision of affordable maternal health care
• recognise that where service access is restricted by cost and time constraints, poverty alleviation is likely to contribute to improving maternal health among the urban poor
• promote further research to discover whether the urban poor in Africa live principally in small cities and towns or the growing slum areas of large cities.

Source(s):
‘The inequality of maternal health care in urban Sub-Saharan Africa in the 1990s’, Population Studies 57 (3): 347-366, by M.A. Magadi, E.M. Zulu and M. Brockerhoff, 2003
'Frequency and timing of antenatal care in Kenya: explaning the variations between women of different communities', Social Science and Medicine 51(4): 551-561, by M.A. Magadi, N. Madise, and R. Rodrigues, 2000
'Unplanned childbearing in Kenya: the socio-demographic determinants and the extent of repeatability among women', Social Science and Medicine 56:167-178, by M.A. Magadi, 2003

Funded by: DFID; Rockefeller Foundation

id21 Research Highlight: 1 March 2004

Further Information:
Monica Akinyi Magadi
Southampton Statistical Sciences Research Institute
Division of Social Statistics, School of Social Sciences
University of Southampton
Southampton SO17 1BJ
UK

Tel: +44 (0) 2380 595 832
Fax: +44 (0) 2380 593 846
Contact the contributor: mmagadi@socsci.soton.ac.uk.

University of Southampton, UK

African Population and Health Research Center

Other related links:
'Keeping it clean: women, living spaces and health in urban Mali' >

'Taking aim: using 'near misses' to evaluate maternal healthcare' >

'The unhappy event: the risk of poor birth outcomes in Kenya' >

'Dicing with death? The impact of hospital choice and other factors on maternal mortality' >

'Antenatal care reborn? Healthcare for pregnant women in developing countries' >

See id21's collection of links relevant to maternal and child health.

See id21's collection of links relevant to health systems and economics.