The Western Cape is the fifth most populous province and has two medical schools. It is acknowledged as having the best health infrastructure of any province. The province is divided into four health regions, the Metropole, West Coast, Boland/Overberg and South Cape/Karoo. The province has had a well-established system of reporting of births within the public sector for many years. This coupled with good reporting of maternal deaths within the public sector allows for the calculation of a MMR. This is 49.8 per 100 000 live births, and is the lowest in the country. This MMR estimate is probably higher than the true figure, because deliveries from the private sector were not included in the calculation as the information was not available. However, deaths from the private sector were recorded and included. In future, the total deliveries, (including private sector deliveries) will be collected, allowing for a more accurate assessment of the MMR.
The pattern of disease is shown in Table 12i.1.
Avoidable factors, missed opportunities and substandard care are shown in Tables 12i.2-4. The data is not stable because of the low numbers of maternal deaths recorded, but an indication of the problems is nevertheless obtained.
The good quality of care is shown by the relatively few instances of substandard care.
Concern still exists in the province about the reporting of deaths from private sector hospitals. There is also concern about the delays in reporting deaths, and the completeness of information obtained from the public hospitals.
Proportionally, more deaths occurred in the Western Cape due to pre-existing medical diseases than in other provinces in South Africa. There needs to be more focus on liaison with physicians to prevent maternal deaths in women with pre-existing medical conditions.