The impact of national health promotion policy on stillbirth and maternal mortality in South Africa

Objectives: In 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens. Study design: This was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics. Methods: The author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations. Results: The model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country. Conclusions: NHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

Automated summary

The study aimed to quantify the impact of the South African national health promotion policy (NHPP) on stillbirth and maternal mortality among both the South African population and immigrants. The results showed that NHPP had a greater impact on reducing stillbirth and maternal mortality in the South African population compared to immigrants. These disparities reflect immigrants' inadequate response to the NHPP framework and limited access to the South African health system.