The Experiences of Expectant and New Mothers in Accessing Maternal Healthcare Services during the COVID-19 Pandemic in Mmabatho, North-West, South Africa

Round 1

Reviewer 1 Report

The authors of the submitted article report on their findings from a qualitative study of mothers in South Africa during the COVID pandemic. The topic is of interest for those who study maternal well-being and the results are interesting and compelling.  The authors report on the importance of having medical professionals who are caring and empathic, of the emotional toll the pandemic took on mothers in terms of the fear and loneliness they experienced and of the importance of informal social support and traditional practices in caring for new mothers.

While the results offer insight into the experiences of mothers during the pandemic, the paper suffers from a lack of clarity in the writing, particularly in the introduction and methods sections.  The need for editing does unfortunately, reduce the quality of the overall presentation.  The paper will need a high level of re-writing in order to be ready for publication.

Beginning with the abstract and continuing through the introduction, there is a high level of nonspecific language and generalities that reduces the overall effectiveness of the presentation.  For example, the authors write in the abstract that, “compared to previous illness outbreaks, the Coronavirus disease pandemic has differentiated effects across various social groups.” What previous illness outbreaks? What differentiated effects?  What social groups.  This is all too general and needs to be written with much greater specificity. This pattern continues throughout the introduction.

The writing also includes frequent repetitive language.  For example, the term “different” is repeated several times in the first two paragraphs.  This detracts from the overall readability of the paper.

I would suggest the author include a reference after the statement, “Although many interventions and policies incorporate a gendered lens in coming up with mitigations and responses to disease outbreaks, it is usually as an afterthought.”

The authors mention the “Department of Health” in their introduction—what is this in reference to?  Of South Africa?  Of the region that was studied?  Be specific.

The research rationale is weak and lacks clarity.  The authors need to strengthen this section.  Why is it important to understand maternal experiences in this “geographical context”? Just saying there is a dearth of research on this geographical region is not compelling--why is this of interest to a broader audience?

The section on Fear and Mistrust in the introduction is written in a confusing manner and needs to be rewritten in a clearer manner.

The theoretical framework is confusing—again, including more specific language and examples would be helpful. Perhaps a figure to illustrate the theoretical model would be helpful?

In the Materials and Methods section, there is no description of the actual sample used.  How many mothers were ultimately recruited?  Race/ethnicity of the sample? How many were pregnant vs. delivered during the time period?  What was the exact time period for collecting data?  This all needs to be clarified and explained more fully.

The recommendations are targeted primarily at “the government,” but this will be of little benefit to international readers.  What broader implications do the results have that can inform a global audience?

The authors make recommendations that are unsupported by cited literature.  For example, they suggest “counseling should be offered monthly.”  What empirical evidence supports this time frame? The recommendations should be more tied to the literature.

Although the general use of the english language is sufficient, there is a great deal of editing needed to improve clarity in the writing.

Author Response

Response to Reviewer 1Comments

Point 1: While the results offer insight into the experiences of mothers during the pandemic, the paper suffers from a lack of clarity in the writing, particularly in the introduction and methods sections.  Unfortunately, the need for editing reduces the quality of the overall presentation.  The paper will need a high level of re-writing to be ready for publication.

Response 1: The whole paper has been rewritten, and unclear and confusing sentences have been rephrased to ensure the logical flow of ideas.

Point 2: Beginning with the abstract and continuing through the introduction, there is a high level of nonspecific language and generalities that reduces the overall effectiveness of the presentation.  For example, the authors write in the abstract that, “compared to previous illness outbreaks, the Coronavirus disease pandemic has differentiated effects across various social groups.” What previous illness outbreaks? What differentiated effects?  What social groups?  This is all too general and needs to be written with much greater specificity. This pattern continues throughout the introduction.

Response 2: Nonspecific language has been removed from the paper.

The abstract has been written with more specificity as advised: Please see the following example

Access to maternal healthcare has been a challenge for women of African descent. Similar to previous illness outbreaks like the Ebola and Zika outbreaks, the Coronavirus pandemic effects vary from one demographic group to another. Women compared to men, are left in a more vulnerable position due to long-existing social inequalities and disparities. Differentiated effects include amongst others, access to health and healthcare, risk of infection, and coping strategies.

The whole introduction was revised, please see section 1 from page 1

Point 3: The writing also includes frequent repetitive language.  For example, the term “different” is repeated several times in the first two paragraphs.  This detracts from the overall readability of the paper.

Response 3: Repetitive words and sentences were removed. Sentences were rephrased in the whole paper.

Point 4: I would suggest the author include a reference after the statement, “Although many interventions and policies incorporate a gendered lens in coming up with mitigations and responses to disease outbreaks, it is usually an afterthought.”

Response 4: A reference was added (Asi 2022).

Asi, Yara M., Priliantina Bebasari, Emily Hardy, Michelle Lokot, Kristen Meagher, Emilomo Ogbe, Ateeb Ahmad Parray, Vandana Sharma, Claire J. Standley, and Luissa Vahedi. 2022. “Assessing Gender Responsiveness of COVID-19 Response Plans for Populations in Conflict-Affected Humanitarian Emergencies.” Conflict and Health 16 (1). https://doi.org/10.1186/s13031-022-00435-3.

Point 5: The authors mention the “Department of Health” in their introduction—what is this about?  Of South Africa?  Of the region that was studied?  Be specific.

Response 5: This was changed to “The South African National Department of Health……”

Point 6: The research rationale is weak and lacks clarity.  The authors need to strengthen this section.  Why is it important to understand maternal experiences in this “geographical context”? Just saying there is a dearth of research on this geographical region is not compelling--why is this of interest to a broader audience?

Response 6: This has been corrected to “The rationale for the selection of Mmabatho was that despite the North-West Province being declared the worst performer on maternal health-related issues, there was insufficient literature concerning the effects of disease outbreaks on maternal health care in this context. Furthermore, there is a dearth of literature on understanding the experiences of women accessing maternal health care during disease pandemics. Although the results of this study cannot be generalized to other communities, getting an emic view of expectant and new mothers will assist in designing comprehensive maternal health interventions and programming that can cushion women against the shocks of disease pandemics in rural contexts.”

Please see page 2 of 18

Point 6: The section on Fear and Mistrust in the introduction is written confusingly and needs to be rewritten more clearly.

Response 6:  The whole paragraph has been rewritten. Please see section 1.3.2 on page 3 of 18.

Point 7: The theoretical framework is confusing—again, including more specific language and examples would be helpful. Perhaps a figure to illustrate the theoretical model would be helpful.

Response 8: The theoretical framework has been reworked and a figure was added.

Please see section 1.4

Point 8: In the Materials and Methods section, there is no description of the actual sample used.  How many mothers were ultimately recruited?  Race/ethnicity of the sample? How many were pregnant vs. delivered during the period?  What was the exact period for collecting data?  This all needs to be clarified and explained more fully.

Response 8: The material and methods section has been corrected and clarifications on race, and the number of pregnant and delivered participants were added. The period was also added and explained more fully.

Point 9: The recommendations are targeted primarily at “the government,” but this will be of little benefit to international readers.  What broader implications do the results have that can inform a global audience?

Response 9: The recommendations were reworked to inform the global audience.

Point 10: The authors make recommendations that are unsupported by cited literature.  For example, they suggest “counseling should be offered monthly.”  What empirical evidence supports this time frame? The recommendations should be more tied to the literature.

Response 10: This has been rectified and recommendations have been tied to the literature.

Point 11: Although the general use of the English language is sufficient, a great deal of editing is needed to improve clarity in the writing.

Response 11: The whole article has been edited for a logical flow of ideas.

 

 

Reviewer 2 Report

The article 'The Experiences of Expectant and New Mothers in Accessing Maternal Health Care Services during the Covid-19 Pandemic
in Mmabatho, North-West, South Africa'
aimed to examine the experiences of expectant and new mothers accessing maternal health care
services during the Covid-19 pandemic outbreak. The study is interesting, relevant and valid, with a good framework, a good research process and results consistent with this quality. Still it is considered relevant to consider some issues for review.
Abstract: There is a  mention to the use of a qualitative method, but there is no reference to the technique/s used.
Introduction: The study use the socio-behavioral model (Andersen, 1995), directly referenced. In the case of Bourdieu's work, there are indirect citations, with recourse to other authors, and the concepts of field and (above all) capital are only indicated and not problematized.

Results: In the results, the concepts of capital and field are also not operationalized, and it is difficult to see their convocation for the study and how they might support the results. There is the assumption that the different birth experiences and the dimensions by which they are presented have as determined the pandemic effect. Indeed, not being a comparative study, it is not net that this is so and that certain experiences could not take place in a non-pandemic context. Thus, there seems to be a conjunction of dimensions that will not have the same determination in the pandemic context, which should be explained and problematized.
The concepts of field and capital, being very pertinent, were not addressed either theoretically or in the support of the results and discussion, in order to justify the enunciation of Bourdieu's contributions as the focus of the theoretical support.
Overall, some sentences are unclear to me (e.g. lines 112-223; 333).

Ok.

Author Response

Response to Reviewer 2

Point 1: Abstract: There is a mention of the use of a qualitative method, but there is no reference to the technique/s used.

Response 1:  The technique used was added (in-depth interviews) in the abstract.

Point 2: Introduction: The study uses the socio-behavioral model (Andersen, 1995), directly referenced. In the case of Bourdieu's work, there are indirect citations, with recourse to other authors, and the concepts of field and (above all) capital are only indicated and not problematized.

Response 2: Bourdieu’s work was directly cited, and the concepts of field and capital were indicated and problematized. Please see section 1.4 from page 3.

Point 3: Results: In the results, the concepts of capital and field are also not operationalized, and it is difficult to see their convocation for the study and how they might support the results. There is the assumption that the different birth experiences and the dimensions by which they are presented have determined the pandemic effect. Indeed, not being a comparative study, it is not net that this is so and that certain experiences could not take place in a non-pandemic context. Thus, there seems to be a conjunction of dimensions that will not have the same determination in the pandemic context, which should be explained and problematized.
The concepts of field and capital, being very pertinent, were not addressed either theoretically or in support of the results and discussion, to justify the enunciation of Bourdieu's contributions as the focus of the theoretical support.

Response 3: In the results section, capital is discussed as operationalized in section 1.4. Please see the discussion under section 3.1.2 page 8 of 18. The contribution of this study to the theory of social practice was also added under 4 on page 11 of 18. In line with the revisions, the correct sources were added for the theory of social practice. These are Bourdieu, 1986, Bourdieu and Wacquant, 1992 and Kandt, 2018.

Point 4: Overall, some sentences are unclear to me (e.g. lines 112-223; 333).

Response 4: The language was revised throughout the document.

Round 2

Reviewer 1 Report

I am satisfied with the extensive revisions and appreciate the authors' efforts to improve the manuscript.