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#WomenofSU: Accessible healthcare is vital for women's futures
Author: Sandra Mulder
Published: 12/08/2020

Accessible healthcare is a critical policy lever for moving out of poverty, says Dr Anja Smith, who forms part of RESEP, a group of researchers in the Department of Economics at Stellenbosch University. Along with her colleagues, Smith explores issues of poverty, income distribution, social mobility, economic development and social policy.

With a particular interest in the health system, Smith's work highlights the important role that well-functioning health systems play in the lives of individuals, especially women. She tells us more about her research, and how it is making a difference in the lives of women in South Africa.

Tell us more about your research.

I am an economist who focuses on the health system: health-seeking behaviour, the intersection between the supply and demand sides, and the quality of healthcare. Within this area, I have undertaken various research projects on the role of gender in health-seeking behaviour and sexual and reproductive healthcare. I've conducted research on the timing of access to antenatal care for both adult women and adolescents in the Western Cape, measured the quality of contraception healthcare in South Africa, and also looked at gender differences in health-seeking behaviour for tuberculosis symptoms.

Why or how did you become interested in this specific area of research?

I am passionate about solving developmental problems that allow people to move out of poverty, or prevent them from falling into poverty in the first place. Quality, accessible healthcare is a critical policy lever for moving or staying out of poverty.

Why do you think this is such an important area of research for South African women?

Good-quality contraception care is vital for women's futures. Unplanned pregnancies can have very negative consequences for women's health (such as maternal mortality), educational achievement, autonomy and labour market participation, as well as for the overall health and well-being of women and their (other) children.

Good-quality antenatal care at the right time during pregnancy is critical for the health of women and their babies. South Africa has a high maternal mortality rate. Many of these deaths can be prevented by quality antenatal care. Women who receive good-quality antenatal care at the right time give birth to healthier babies. We know that good health at birth has long-term benefits for an individual, both as a child (better educational achievement) and in adulthood (labour market earnings).

What would you consider the greatest impact of your research on women in the country?

I recently had the privilege of working on the health section of the NiDS-CRAM (National Income Dynamics Study – Coronavirus Rapid Mobile) survey. This broad, nationally representative survey measures, among others, the impact of the new coronavirus and government's lockdown response on people's health-seeking behaviour.

We conducted a separate survey, the CRAM-MATCH (Coronavirus Rapid Mobile for Maternal and Child Health), looking more specifically at women who recently gave birth or are currently pregnant. We found that many had not recently accessed important healthcare for their babies or themselves (during pregnancy). These findings were widely shared with policymakers, who will now hopefully put in place service delivery solutions to ensure that pregnancy care and immunisations are not interrupted during the lockdown, or that people do not stay away from important healthcare out of fear for the virus. We have received good feedback from our partners in government and know they are reading and considering our report at this sensitive time for our country.

I recently attended a workshop with officials from the Western Cape Department of Health. We spoke about the research I had been involved in where we measured the quality of contraception care in the Western and Eastern Cape. One of the state doctors in the room said he “loved the research". Signs like these show that policymakers are engaging with my research, and that it will hopefully lead to changes in the way healthcare services are delivered, reaching vulnerable women.

What would your message be for the next generation of women researchers?

Find a research area that you are passionate about and identify good mentors in that area. They do not necessarily have to be women. I have been lucky enough to have excellent women and men as mentors during my career.

If you believe in your research, see it through to the end. Academic research often feels like a long drawn-out process, but there are rewards at various points along the journey. Celebrate every milestone (even just submitting a journal article) and be very kind to yourself when your research does not find fertile ground. If you are working on important and valuable research questions that you feel passionate about, your work will eventually reach the right audience. And once you become successful in your research area, stay humble and kind.​