The release of the new National Integrated Maternal and Perinatal Care Guidelines (IMPCGs) is a watershed moment for women’s health in South Africa, with clear – and enforceable – provisions for respectful care, mental health and intimate partner violence.
“Good maternal health is a basic human right,” says Associate Professor Simone Honikman, founder and director of the Perinatal Mental Health Project, a Cape Town-based organisation that played a critical role in the drafting of the new IMPCGs. “And these guidelines will ensure that right is better upheld.” The guidelines follow on from the Maternal, Perinatal and Neonatal Health Policy 2021. They were more than two years in the making, the result of a consultative process with researchers, healthcare providers, stakeholders and NGOs, among other experts. “It’s been a long road to get here, but so very worth it,” says Professor Honikman.
Women’s health is in the spotlight this month, with the release by the government of the fifth and latest version of the National Integrated Maternal and Perinatal Care Guidelines for South Africa, bringing much-needed changes to women’s healthcare.
A highlight of the IMPCGs is their coverage of three new areas, each in a dedicated chapter: Respectful Maternity Care, which aims to address issues of disrespect and abuse by healthcare workers; Maternal Mental Health; and Intimate Partner Violence or Domestic Violence. The previous version of the guidelines, published in 2017, was very limited in its coverage of the first issue, and made virtually no mention of the other two.
The National Department of Health has identified maternal and newborn healthcare as a priority area requiring urgent action. According to data from 2022, South Africa has a maternal mortality ratio of 109.6 maternal deaths per 100,000 live births, which is significantly higher than its goal of less than 70 by 2030. This is still far higher than in more developed countries, like the UK – where the ratio is 13.41. The quality of maternity care provided is a major factor in the outcome of the pregnancy, and also influences the postpartum period.
Mental health, too, is of vital importance. During pregnancy and after giving birth, depression and anxiety are common, affecting one in three women in South Africa. The conditions can lead to adverse outcomes for both the mother and child. They are associated with poverty – and partner or domestic violence, among other social factors. Approximately a quarter of women in South Africa face harm from current or past partners during or after pregnancy, and women may also experience harm from other people who live in their home, such as extended family. “As we have a relatively high uptake by women of Maternal and Child Healthcare services in this country, these services are uniquely placed to bring about a substantial positive transformation in the lives of millions of women.” says Professor Honikman, “We have the opportunity to shift the vicious cycles of adversity and mental health problems into virtuous cycles of psychosocial wellbeing.”
The Perinatal Mental Health Project (PMHP) is based at the University of Cape Town. PMHP, within the Alan J Flisher Centre for Public Mental Health, in the Department of Psychiatry and Mental Health and has been operating since 2002 as a non-profit entity. They partner with the Departments of Health and Social Development. PMHP provides comprehensive mental health services at the Hanover Park Midwife Obstetric Unit (MOU), demonstrating a model of integrating mental health into maternity care. The organisation has a national and global footprint in maternal mental health advocacy, research, capacity building and resource development.
“The new IMPCGs are more than mere lip service,” says Professor Honikman. “They apply to all healthcare providers in maternal and perinatal health across the country, and they carry significant weight in a court of law. What this means is that when women sue the government for poor care – as more and more are doing – these guidelines will be used as the benchmark, and the government will be held accountable. This is a real victory for women.”
Now that the IMPCGs have been published, the next step is to ensure implementation, which Professor Honikman hopes will include adequate capacity building and training for healthcare providers, ranging from health and social worker training institutes to clinics and hospitals. “It will also be a matter of pushing the economic and ethical arguments so that there are adequate resources and systems strengthening investments made by the government. Only then will we realise the full potential of these guidelines” she says.
Genie Vittu
Communication Strategist
Ten x Collective
Soweto Sunrise News
