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Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa

Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa
Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa

Objectives Despite free primary healthcare services and social protection system for mothers and children, significant nutrition inequalities occur across the globe, including in South Africa. This study aimed to explore what determines mothers' ability to access and turn available services into nutrition benefits. Design An exploratory qualitative study was conducted including semistructured interviews with employees from community-based organisations and focus groups with pregnant women and mothers. Discussions focused on existing services perceived as important to nutrition, differences in mothers' ability to benefit from these services, and the underlying unmet needs contributing to these disparities. Data were analysed thematically using a novel social needs framework developed for this study where social needs are defined as the requisites that can magnify (if unmet) or reduce (if met) variation in the degree to which individuals can benefit from existing services. Setting A resource-constrained urban township, Soweto in Johannesburg. Participants Thirty mothers of infants (<1 year old) and 21 pregnant women attending 5 primary healthcare facilities participated in 7 focus groups, and 18 interviews were conducted with employees from 10 community-based organisations. Results Mothers identified social needs related to financial planning, personal income stability, appropriate and affordable housing, access to government services, social support and affordable healthier foods. The degree to which these needs were met determined mothers' capabilities to benefit from eight services. These were clinic-based services including nutrition advice and social work support, social grants, food aid, community savings groups, poverty alleviation projects, skills training workshops, formal employment opportunities and crèches/school feeding schemes. Conclusion Findings demonstrate that while current social protection mechanisms and free health services are necessary, they are not sufficient to address nutrition inequalities. Women's social needs must also be met to ensure that services are accessed and used to improve the nutrition of all mothers and their children.

community child health, health equity, health policy, public health, qualitative research
2044-6055
Erzse, Agnes
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Desmond, Chris
ea386a5f-c492-452d-9bde-6fec77d1c65c
Hofman, Karen
ed913811-6e00-4873-a8ff-e2ecb05ce1fe
Barker, Mary
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Christofides, Nicola Joan
7f1e7928-1047-426a-9ca7-a9a77a2b587c
Erzse, Agnes
f2a28c48-d101-4a56-b26d-de9aa773f0e8
Desmond, Chris
ea386a5f-c492-452d-9bde-6fec77d1c65c
Hofman, Karen
ed913811-6e00-4873-a8ff-e2ecb05ce1fe
Barker, Mary
374310ad-d308-44af-b6da-515bf5d2d6d2
Christofides, Nicola Joan
7f1e7928-1047-426a-9ca7-a9a77a2b587c

Erzse, Agnes, Desmond, Chris, Hofman, Karen, Barker, Mary and Christofides, Nicola Joan (2023) Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa. BMJ Open, 13 (11), [e073716]. (doi:10.1136/bmjopen-2023-073716). (In Press)

Record type: Article

Abstract

Objectives Despite free primary healthcare services and social protection system for mothers and children, significant nutrition inequalities occur across the globe, including in South Africa. This study aimed to explore what determines mothers' ability to access and turn available services into nutrition benefits. Design An exploratory qualitative study was conducted including semistructured interviews with employees from community-based organisations and focus groups with pregnant women and mothers. Discussions focused on existing services perceived as important to nutrition, differences in mothers' ability to benefit from these services, and the underlying unmet needs contributing to these disparities. Data were analysed thematically using a novel social needs framework developed for this study where social needs are defined as the requisites that can magnify (if unmet) or reduce (if met) variation in the degree to which individuals can benefit from existing services. Setting A resource-constrained urban township, Soweto in Johannesburg. Participants Thirty mothers of infants (<1 year old) and 21 pregnant women attending 5 primary healthcare facilities participated in 7 focus groups, and 18 interviews were conducted with employees from 10 community-based organisations. Results Mothers identified social needs related to financial planning, personal income stability, appropriate and affordable housing, access to government services, social support and affordable healthier foods. The degree to which these needs were met determined mothers' capabilities to benefit from eight services. These were clinic-based services including nutrition advice and social work support, social grants, food aid, community savings groups, poverty alleviation projects, skills training workshops, formal employment opportunities and crèches/school feeding schemes. Conclusion Findings demonstrate that while current social protection mechanisms and free health services are necessary, they are not sufficient to address nutrition inequalities. Women's social needs must also be met to ensure that services are accessed and used to improve the nutrition of all mothers and their children.

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Accepted/In Press date: 25 October 2023
Additional Information: Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords: community child health, health equity, health policy, public health, qualitative research

Identifiers

Local EPrints ID: 485004
URI: http://eprints.soton.ac.uk/id/eprint/485004
ISSN: 2044-6055
PURE UUID: 0982ba4d-ab97-4149-b281-38554f606382
ORCID for Mary Barker: ORCID iD orcid.org/0000-0003-2976-0217

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Date deposited: 28 Nov 2023 17:33
Last modified: 23 Mar 2024 02:35

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Contributors

Author: Agnes Erzse
Author: Chris Desmond
Author: Karen Hofman
Author: Mary Barker ORCID iD
Author: Nicola Joan Christofides

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