Promoting the journey to health: Healthcare access and transportation in rural South Africa.

The spatial distribution of healthcare facilities can result in inequitable access to health care for persons living in rural communities and developing countries. Low-income women in these areas are disproportionately affected because they tend not to have access to private vehicles, and therefore must walk or rely on public transport, which may not meet their needs or even exist. In addition, the laborious and time consuming tasks of attending to work-related activities coupled with household and childcare responsibilities leave little room for non-work related travel, including traveling to obtain health care. With this in mind, this dissertation explores some of the environmental factors encompassing household responsibilities, travel time, and the culture's social structure that inhibit or support a woman's use of prenatal care services in the Ubombo Magisterial District, a northern area in KwaZulu Natal, South Africa. The study analyzes 327 households and 5 clinics within a rural area of approximately 50 square kilometers. To analyze the data, a standard multinomial logit model and a discrete choice model with individual level characteristics are applied. In addition, geographical information systems (GIS) are used to understand spatially the travel patterns of the respondents. The fundamentals of access according to Stuart Chapin's theory (1974) state that first a desire to engage in the activity must exist, and second, the opportunity to engage in the activity must exist. The results of the study show women are being encouraged to utilize prenatal care services and are attending residential clinics for prenatal care at high rates. There is a varying degree of access to healthcare facilities dependent upon travel time, travel mode, and whether fetching water affects a woman's ability to travel. Furthermore, the results show there are spatial differences in prenatal care utilization patterns. Women tend to use the nearest health facility. Some facilities are being utilized more than others, and the transportation mode has a stronger effect on hospital utilization and a minor effect on clinic utilization. This research contributes to the knowledge of understanding the complex factors that encourage or discourage women to make the journey to a healthcare facility for prenatal care. The factors that significantly affect utilization are in some ways very different and in other ways very similar to those found in developed countries like the United States. Travel time and mode are common factors, however fetching water is only an issue in developing countries where tasks, allocated to women by the culture, involve much travel. Childcare, which often appears as a constraint for women in the United States, is not problematic in the Ubombo Magisterial District because of the polygamous family structure. However, childcare and fetching water are similar in that both are constraints on travel behavior.PhDHealth and Environmental SciencesObstetricsPublic healthSocial SciencesTransportationUrban planningUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/126033/2/3016915.pd