In a global context of a return to user fees for health services, one of the first policies announced by the new South African government in 1994 was free maternal and child health (MCH) care, part of a series of social policies aimed at reducing inequalities in health status and access to health care. Most pregnant women in South Africa receive some form of antenatal care during pregnancy, but a significant proportion deliver without the assistance of a health professional, and access to safe abortion and emergency referral are still low for many women. The impact of free MCH has been to increase utilisation of existing antenatal and paediatric services, but does not appear to have influenced the numbers of deliveries within facilities. Furthermore, strong reactions against these policies have come from front-line providers, e.g. beliefs that the new policies are encouraging women to become pregnant and that pregnant women do not deserve free care. Although definitive conclusions will only be possible in the longer term, early evidence suggests that free maternal health care, on its own, is not a sufficient condition for reducing the large burden of avoidable maternal and perinatal mortality in the country. However, free care should be seen as one of several measures which may help to increase access to and quality of maternal care services . In addition, it has signalled that the state is sensitive to the needs of the poor and disadvantaged, contributing to a sense of entitlement to services, which may have longer-term, beneficial effects.
In: Berer M, Sundari Ravindran T,.(eds.), Safe Motherhood Initiatives: Critical Issues. Oxford: Blackwell Science, for Reproductive Health Matters.