Beyond the Operating Room: Women’s Surgical Journeys and Perceived Barriers to Care in Peri-urban Cape Town

Introduction: Caesarean-section is the most widely performed surgery in the world. Despite being critical for universal healthcare access, safe and timely surgical care remains limited in poorly resourced settings. This study investigated community perspectives on women’s surgical experiences in a peri-urban South African community. Methods: A cross-sectional household survey was conducted in a peri-urban Cape Town community. The study aimed to describe surgical disease burden, outcomes, health-seeking behaviour, and healthcare service acceptability. Results: The study had 432 responses, with a higher number of females (60%) than males (47%). The surgical burden was substantial: 61% of females had undergone surgery in their lifetime, with 195 surgical procedures performed in the last five years (65% on females). The most common procedures were pregnancy-related, including caesarean deliveries (26.7%) and ectopic pregnancies (3.6%). Most participants (44%) lived within 10km of their nearest healthcare facility, predominantly public (97%). Using the Three Delays Framework, 20% of females reported that they believe the most important barrier to accessing surgical care was, delay in seeking surgical care at 26%; delay in reaching facilities at 33%; and delay in receiving appropriate care; whilst 21% perceived that there were no substantial delays. Conclusion: The study revealed that almost 2/3 of women had a lifetime likelihood of having a surgical operation, with pregnancy related surgeries being the most predominant. Perspectives on access to care varied, with access to reaching a healthcare facility being the most common delay/