By Tanya Charles, MenEngage Africa Training Initiative (MATI) Coordinator, Sonke Gender Justice
Often times, urban areas are thought of as better serviced than rural spaces. Urban residents are in close proximity to industry and therefore to employment; to schools and thus to education, and to hospitals and clinics thereby allowing them to enjoy access to healthcare. However, urban geography is complex, dynamic and diverse. In a country such as South Africa, where apartheid geography literally shaped where people lived and what services they had access to, attaining resources remains dependent on where one is located in a city. As such, it is not surprising to learn that urbanites who live in South Africa’s overpopulated and underserviced townships share many of the same struggles that poor rural people endure. Nowhere is this more evident than in the area of maternal health. In both rural and urban locations, women and girls experience maternal death and a myriad of health-related problems for the same reason: there is no reliable transportation to get to clinics and hospitals.
A simple scenario: A young woman is pregnant. She starts to haemorrhage. She calls an ambulance but it does not come. She steps outside of her small dwelling to try and make use of public transport meandering through narrow, inaccessible streets that have no names. When eventually she finds a small minibus taxi, the driver insists that she pay a fee, money she does not have. In pain, she starts the journey to the hospital by foot. What would take a few minutes drive in a vehicle turns into hours of arduous walking.
This is the daunting reality for urban (as well as rural) women and girls in the poorest parts of South Africa. A hospital in Khayelitsha Township, located in the peripherals of the bustling tourist city of Cape Town, regularly receives patients who have arrived in this manner. They are almost always too late. This is because there aren’t enough ambulances to service the demand in a township home to millions of shack dwellers living in unmarked homes (with some saying as few as nine ambulances for the entire township). Neither is there adequate, reliable and frequent public transport to these areas.
Policies geared towards improving maternal health focus on what they call “healthcare systems strengthening” which seeks to train health practitioners and develop better medical facilities, all of which are important strategies for improving women’s health. However, these fail to explicitly make the connection between access to transportation and maternal health (or sexual and reproductive health rights of women and girls more broadly). Unless policy and programming improves transportation in poor urban areas, maternal death rates will remain high and many women and girls will continue to experience poor sexual and reproductive health. Without proper transportation, including access to emergency transport services like ambulances, women will not be able to reach hospitals and clinics, even if those facilities are world-class. It is clear that accessing healthcare means accessing safe and adequate transport, especially in emergency situations.