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Pregnancy Supportability Research Instruments: An Intersectional Health Systems Approach

On 28 April 2020, UNFPA predicted a “calamitous impact on women’s health as COVID-19 pandemic continues”. Concerns include loss of access to contraception leading to unintended pregnancies, increased gender-based violence, and women not attending antenatal care for fear of contracting the virus. Early evidence within South Africa confirms challenges regarding sexual and reproductive commodities (including medication abortion), as well as intimate partner violence. Whatever impact COVID-19 has on pregnancy and birth, it is likely that the effects will not be evenly spread across health districts. Maternal health inequalities in South Africa are well-known, and generally worsened between 2008 and 2012. In acknowledgement of such health and social inequities, Hankivsky and Kapilashram argue that “for the ‘pandemic era in which we live’ a sophisticated, intersectional analysis is required”.

The aim of the proposed research is to produce a multi-faceted picture of the factors that enable or hinder positive pregnancy outcomes, thereby facilitating intersectional and holistic multi-sectoral systems responses within specific health districts to supporting pregnancies during and after the COVID-19 pandemic.

The work is based on the concept of ‘supportability’ introduced by Catriona Macleod in a 2015 paper entitled Public reproductive health and ‘unintended’ pregnancies: Introducing the construct ‘supportability’. In this paper she outlines the limitations of the concept of ‘intentionality’ in public reproductive health understandings of pregnancy. “‘Intentionality’, ‘wantedness’ and ‘timing’ place individual cognitions, psychology and/or behaviours at the centre of public health conceptualizations of pregnancies, thereby leaving the underlying social and structural dynamics under-examined.” The supportability model highlights the intersections between macro-level social systems and institutions and the micro-level of interpersonal relationships and health behaviour.

The project will utilise the pregnancy supportability research instruments developed by the CSSR for use in the planning and evaluation of maternal health promotion at district level. It is proposed that the instruments be used to surface a picture of personal and contextual drivers of maternal health and well-being in two districts in the Eastern Cape. This will enable those districts to strengthen, expand or introduce interventions and programmes to support pregnancies.

In addition, the differences, or commonalities, across the two health districts can be ascertained, and the implications of these for broader systemic maternal health promotion in the country determined. At a healthcare delivery level, the evidence generated from the tools could hone clinical and healthcare practice to demand side factors around support, health, and wellbeing during pregnancy.


Cognitive interviews will be conducted for the purpose of honing the questionnaire. The supportability questionnaire will be administered to pregnant women recruited from the antenatal and termination of pregnancy units within the two health districts in the Eastern Cape Province identified by the Eastern Cape Department of Health and those living in the immediate catchment area of the hospital. Narrative interviews will be conducted. Participants in these interviews will be pregnant women recruited from antenatal and termination of pregnancy units in the two districts. Given current COVID-19 restrictions, data collection will take place telephonically or virtually.

The Research Team

Prof Catriona Macleod (CSSR, Rhodes University)

Prof Meredith Manze (Community Health and Social Sciences, City University of New York)

Dr Catriona Towriss (Centre for Actuarial Research, University of Cape Town)

Dr Ulandi du Plessis (CSSR, Rhodes University)

Kudzai Marise (CSSR, Rhodes University)

Megaera Jones (CSSR, Rhodes University)

Megan Reuvers (CSSR, Rhodes University)

Yamini Kalyanaraman (CSSR, Rhodes University)

Last Modified: Wed, 26 Aug 2020 10:01:29 SAST