Towards a care continuum: A socio-material analysis of intra-acting public-private maternity care in South Africa

Contributing to critical health scholarship, this multi-sited ethnography into private sector obstetrics in Cape Town, South Africa generated comparative public sector data through observation and interviews with seven obstetricians and fourteen pregnant women between 2017 and 2019. Entrenched inequalities in the provision and access to quality obstetric care, provoked in the politics of birth, are significant for broader societal movements and governance approaches towards universal healthcare in Africa. With near universal maternity care, South Africa is an important case study for understanding possible private sector contributions to National Health Insurance reforms aiming to consolidate health services for all. Drawing on feminist new materialist theory and socio-material analysis, I outline a care continuum, which I use to interrogate the logics of care that articulate an interdependent yet dichotomized health system. Dichotomized as poles either end of the care continuum is a generalised public sector and individualised private sector. A continuum helps demonstrate that material, experiential and discursive differences in care are not pre-existing but intra-actively related, meaning their differences are produced and maintained through relatedness. I illustrate this looking at movements of obstetric practices, patients, and providers, spatialities of services, and temporalities in care to propose that that public-private maternity care boundaries are co-produced through their mutual entanglement.