Experiences of deaf women and girls in accessing maternal health rights and services in Uganda.

Ecuador addresses cultural issues for pregnant women

Petra ten Hoope-Bender: a “midwife's midwife”

“They must understand we are people”: Pregnancy and maternity service use among signing Deaf women in Cape Town

Access of Chin and Rohingya women refugees and asylum seekers from Burma to maternal health services in the Klang Valley, Malaysia

Deafness refers to partial or total loss of hearing, which, if not appropriately accommodated, may interfere with day-to-day living experiences. Deaf people encountered challenges in their efforts to access essential services, such as health care. While some attention has been given to general access to reproductive health services, less research has focused on the experiences of deaf women and girls when accessing safe abortion services. With unsafe abortion being a major cause of maternal deaths among women in developing countries, this study attempted to explore the perception of deaf women and girls in Ghana towards safe abortion services. The main aim of this study was to understand the perception and awareness safe abortion services among deaf women and girls in Ghana. In doing this, the contributors towards unsafe abortion practices among deaf women and girls were gathered. Penchansky and Thomas' accessibility to health care theory availability, accessibility, accommodation/adequacy, affordability, and acceptability guides this study. A semi-structured interview guide based on components of the theory was used for data collection from 60 deaf persons. The components of the theory were used as a priori themes that guided the data analysis. The results showed challenges associated with the indicators of health access. For instance, in terms of availability, it was revealed that deaf women had little knowledge about existing laws on safe abortion in Ghana. In relation to acceptability, deaf women were highly opposed to abortion for cultural and religious reasons. However, there was consensus that safe abortion could be conducted under certain conditions. The results of the study have implications for policymaking aimed at attaining equitable access to reproductive health care for deaf women. The need for policymakers to expedite public education and incorporate the needs of deaf women in reproductive health policies, as well as other study implications, are discussed.

BackgroundMaternal mortality rates are still unacceptably high in many countries, indicating violation of women´s human right to life and health. Access to adequate information about maternal health rights and available services are essential aspects of realizing women´s right to accessible health care. This study aimed at assessing awareness of the right to access maternal health services among women who had recently given birth, and the association between such awareness and the utilization of maternal health services in two districts in Tanzania.MethodsThis study was cross sectional in design. Interviews were conducted with women who gave birth within one year prior to the survey in two different district councils (DC) namely Hai DC and Morogoro DC, selected purposively based on the earlier reported rates of maternal mortality. We used a two-stage cluster sampling to select the study sample. Analysis employed Chi-square test and Logistic regression.ResultsA total of 547 respondents were interviewed. Only a third (34.4%) reported to be aware of their right to access maternal health services. Main sources of information on maternal health rights were the media and health care providers. Occupation and education level showed a statistically significant association with awareness of access rights. Hai DC had higher proportion of women aware of their access rights compared to Morogoro DC. Women who were aware of their right of access were almost 5 times more likely to use skilled birth attendants compared to those who were not (AOR 4.61 95% CI: 2.14–8.57).Conclusion and recommendationsAwareness of the right to access maternal health services was low in the studied population. To increase awareness and hence uptake of Pregnancy care and skilled birth attendants at delivery we recommend the government and partners to prioritize provision of information, communication and education on women´s human rights, including the right to access maternal health services, especially to women in rural areas.

Many countries across the world instituted lockdowns as a measure to prevent the spread of COVID-19. However, these lockdowns had consequences on health systems. This study explored effects of the COVID-19 lockdown measures on health and healthcare services in Uganda. The qualitative study employed focus group discussions (FGDs), household interviews, and key informant interviews (KIIs) in both an urban (Kampala district) and rural (Wakiso district) setting in central Uganda. Fourteen FGDs were conducted among community members, local leaders, community health workers, and health practitioners. Interviews were conducted among 40 households, while 31 KIIs were held among various stakeholders including policy makers, non-governmental organisations, and the private sector. Data was analysed by thematic analysis with the support of NVivo 2020 (QSR International). Findings from the study are presented under four themes: maternal and reproductive health; child health; chronic disease services; and mental health. Maternal and reproductive health services were negatively affected by the lockdown measures which resulted in reduced utilisation of antenatal, postnatal and family planning services. These effects were mainly due to travel restrictions including curfew, and fear of contracting COVID-19. The effects on child health included reduced utilisation of services which was a result of difficulties faced in accessing health facilities because of the travel restrictions. Patients with chronic conditions could not access health facilities for their routine visits particularly due to suspension of public transport. Depression, stress and anxiety were common due to social isolation from relatives and friends, loss of jobs, and fear of law enforcement personnel. There was also increased anxiety among health workers due to fear of contracting COVID-19. The COVID-19 lockdown measures negatively affected health, and reduced access to maternal, reproductive and child health services. Future interventions in pandemic response should ensure that their effects on health and access to health services are minimised.

Reproductive health needs to be front and centre in development

Knowledge, opportunities, challenges, and the way forward for reproductive health rights: a qualitative study of women in the Bethlehem area of the West Bank

BackgroundMaternal mortality and poor reproductive health outcomes remain major public health challenges in low-resource countries. The Sustainable Development Goals have proposed new targets to reduce global maternal mortality ratio to 70 per 100,000 live births and ensure universal access to sexual and reproductive healthcare services by 2030. Inequity in the utilization of maternal and reproductive health services leads to poor reproductive health outcomes and maternal mortality. Despite reduction in global maternal mortality over the decades, the level of maternal mortality remains unacceptably high in Nigeria with limited attention given by governments to addressing health inequities. This study aimed to examine horizontal inequity in the utilization of maternal and reproductive health services in Nigeria.MethodsSecondary data from the 2018 Nigeria Demographic and Health Survey were utilized to examine horizontal inequity in the utilization of maternal and reproductive health services such as postnatal care, delivery by cesarean section, modern contraceptive use, and met need for family planning. Equity was measured using equity gaps, equity ratios, concentration curves, and concentration indices. All analyses were performed using ADePT 6.0 and STATA version 14.2 software.ResultsThe overall coverage level of postnatal care, delivery by cesarean section, modern contraceptive use, and met need for family planning was 20.81, 2.97, 10.23, and 84.22%, respectively. There is inequity in the utilization of postnatal care, delivery by cesarean section, and modern contraceptive favoring the rich, educated, and urban populations. Met need for family planning was found to be almost perfectly equitable.ConclusionThere is inequity in the utilization of maternal and reproductive health services in Nigeria. Inequity in the utilization of maternal and reproductive health services is driven by socioeconomic status, education, and location. Therefore, governments and policymakers should give due attention to addressing inequities in the utilization of maternal and reproductive health services by economically empowering women, improving their level of education, and designing rural health interventions. Addressing inequities in the utilization of maternal and reproductive health services would also be important toward achieving the Sustainable Development Goal targets 3.1 and 3.7.

Background: High maternal and neonatal mortality rates in Mozambique, are due to adolescent pregnancies, difficulties in accessing health services, traditional constraints, and gender inequalities. An implementation research project, Alert Community to Prepared Hospital in Natikiri, Nampula, Mozambique was developed to reduce maternal and newborn mortality. From 2016 to 2020, it implemented activities to improve population knowledge and function in sexual and reproductive health, and to enable community participation in maternal health services. In this paper, we assessed and discussed the impact of community participation on improving sexual and reproductive health. Methods: The “Alert Community to Prepared Hospital” was an implementation research program with community intervention and programmed mid-term evaluations. It used mixed methods research design such as descriptive quantitative surveys, qualitative focus group discussions, and interviews, applied from 2017 to 2020. Local health committees, traditional birth attendants, traditional healers, and local leaders all participated: trained in sexual and reproductive health and participated in radio discussion groups; community and hospital members of the co-management committee enabled local programming. Maternal and child health indicators were evaluated with the health unit’s statistical operational data. Quantitative data were captured in Microsoft Office Excel, analysed with SPSS21 to find the frequency, percentage, mean and standard deviation; qualitative data were registered in Microsoft Office Word and analysed with Nvivo software. This research received bioethical approvals from both the Mozambican and Canadian universities and followed all Helsinki Declaration recommendations. Results: Comparing changes from 2016 to 2019, the number of health committees operating in Natikiri rose from 7 to 20. Each committee integrated four Family Health Champions, who attained 24738 residents with health education interventions on reproductive health and rights. A theatre group developed dramas about the same key messages and presented the plays in local communities. Population access to contraceptives was facilitated, from 42% to 91% in women and from 65% to 90% in men. At Marrere Health Centre, women with four ante-natal visits rose by 185%, and children less than one year of age’ surveillance visits raised by 89%; at Marrere General Hospital’ maternity deliveries rose 60%. Conclusion: Community participation, at all levels of maternal and child health service care continuum, from families, health committees, and communities to health centres and hospitals, enhanced with complementary interventions well contextualized, sexual, and reproductive health and rights key messages broadcasted, discussed, and presented by local theatre groups, is effective in improving adolescent and adult sexual and reproductive health. Plain English summary An Alert Community to a Prepared Hospital Implementation Research Project was carried out in Natikiri, Nampula, Mozambique, from 2016 to 2020, aiming to reduce maternal and neonatal mortality rates, considered priority public health problem in this country. It deployed activities to improve population knowledge and behaviour in sexual and reproductive health and rights and enable community participation in maternal and newborn health services: classroom training, community radio discussion groups, and drama performances. Using mixed-methods research to evaluate results with local health committees, traditional birth attendants, traditional healers, and local leadership, we compared the evolution of maternal and child health indicators at health units. Comparing changes from 2016 to 2019, the number of local health committees rose, attaining 24738 residents with health education interventions, population access to contraceptives was facilitated, from 42% to 91% in women and from 65% to 90% in men, women with four antenatal visits rose by 185%, children less than one year of age’ surveillance visits rose by 89%; and hospitals’ maternity deliveries rose by 60%. Community participation in maternal and child health service care has been demonstrated to be effective in improving adolescent and adult sexual and reproductive health. Trial registration This maternal and child health study was approved by the Lúrio University Bioethics Committee (02/CBISUL/16) and the Behavioural Ethics Board at the University of Saskatchewan (BEH#15-112), and was not registered in any database. Keywords: Maternal and child health, community, family planning, health services, implementation research, Mozambique, participation, pregnancy, reproductive and sexual health.

BackgroundThe effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI + population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper presents the findings from the qualitative component of a broader mixed-methods scoping study aimed at establishing a priority research agenda to address healthcare gaps affecting the SRMHR of vulnerable populations. The qualitative component focused on identifying key challenges hindering progress in SRMHR and access to health services for these populations in the LAC region, drawing on the perspectives of key informants at both regional and national levels.MethodsQualitative research approach employing semi-structured interviews with key informants. A purposive sample comprised of stakeholders from relevant regional organizations and local stakeholders in selected countries (Argentina, Colombia, Peru, Mexico, Guatemala, Jamaica, and Guyana), encompassing government representatives, civil organizations, and academia. A rapid content thematic analysis was conducted to analyze the data obtained from the interviews.ResultsWe interviewed 27 key informants in SRMHR, six at a regional level and 21 at a country level. The region faces barriers around establishing and sustaining agency agendas, such as a lack of political will, political instability, and opposition from civil society groups regarding SRMHR agendas. Policy implementation presents difficulties due to insufficient and unstable funding, weaknesses in sexual and reproductive health programs, unequal policy implementation in federal countries, and the absence of evidence-based policies. The lack of high-quality data and quality indicators poses obstacles, leading to limitations in evidence generation. Access to SRMHR services faces barriers such as the low-quality provision of services, discrepancies between legislation and effective access, insufficient healthcare resources, and resistance from certain healthcare providers.ConclusionAddressing these multifaceted challenges will be crucial in advancing the agenda of sexual, reproductive, and maternal health rights and ensuring effective access to health services for the most vulnerable populations in the LAC region.

ObjectiveThe aim of this study was to assess the level of continuum of maternal, newborn, childand reproductive health coverage using the composite coverage index (CCI) and to identify its determinants, including socioeconomic, community context, individual and family, and health service-related factors, among postpartum women one year after childbirth in Ethiopia.DesignThis study was a secondary analysis of longitudinal data from the second cohort of the performance monitoring for action (PMA) Ethiopia survey, which was conducted from 2021 to 2023. Data were collected at four intervals: a baseline survey, a 6 week postpartum survey, a 6 month postpartum survey and a 1 year postpartum survey to track reproductive, maternal, newborn, and child health indicators.SettingsThe study was conducted from the major regions of Ethiopia, namely Amhara, Oromia, Southern Nations, Nationalities and Peoples’ and the city administration of Addis Ababa.ParticipantsA total of 2297 women enrolled in cohort two of PMA Ethiopia. Of these, 2072 completed the 6 week, 1874 the 6 month and 1858 (along with their 1800 children) the 1 year postpartum follow-up surveys. The final analysis was based on a weighted sample of 1793 participants.Outcome measuresThe outcome variable for this study was the continuum of maternal, newborn, child and reproductive health services, assessed using the CCI. We applied quantile regression analyses at the 10th, 25th, 50th, 75th and 90th quantiles of the outcome variable. Statistical significance of predictors was determined based on p values <0.05. Estimates for the regression coefficient, standard errors, p values and CIs were generated across the quantiles.ResultThe findings revealed that the mean CCI was 56.2% (95 % CI 52.5% to 59.8%), indicating the proportion of maternal, newborn, child, and reproductive health services received. Notably, only 4% of women received all 12 maternal, newborn, child, and reproductive health services as part of the continuum of care, while 1.1% did not receive any intervention. The study identified several factors significantly associated with CCI across different quantile levels, including maternal age, maternal education level, household wealth index, first antenatal care visit (ANC1), parity, previous facility delivery, partner encouragement, use of maternity waiting homes, and administrative regions.ConclusionBased on the findings of this study, the coverage of continuum of maternal, newborn, child and reproductive health services in Ethiopia remains low. This highlights a substantial gap in Ethiopia’s progress toward the 2030 sustainable development goal target. Ethiopia must significantly accelerate efforts to improve maternal, newborn, child and reproductive health services in order to achieve the set goals. Policymakers and programme implementers should carefully consider the identified determinants when designing policies and programmes aimed at enhancing maternal, newborn, child and reproductive health outcomes.

BackgroundNepal has one of the highest rates of maternal mortality in the South Asia region, partly due to the underutilization of maternal health services and the high number of adolescent pregnancies. This study explores married Nepali adolescent girls’ healthcare-seeking behaviour throughout their pregnancies, during their delivery and postpartum.MethodsWe conducted a prospective qualitative study in Banke district, Nepal. In-depth interviews were conducted with 27 married adolescent girls before and after delivery. In addition, a focus group discussion was conducted with community health works and key-informant interviews were conducted with family members of adolescent girls, representatives from the government and health care providers. We applied the Social-Ecological Model (SEM) as a framework to guide thematic content analysis and presentation of our qualitative data.ResultsSeveral factors in the SEM influenced maternal health care-seeking behaviour of adolescents. At the individual level, girls’ perceptions, their lack of knowledge about maternal and reproductive health, certain traditional practices, their sole dependency on their husbands and mothers-in-laws and their low decision-making autonomy towards their own health care negatively influenced their utilization of skilled maternal health services. Mothers-in-law and other family members played a critical role in either encouraging or discouraging the use of skilled maternal health services. At the health systems level, lack of adolescent-friendly maternal health services, difficulties in accessing quality maternal health services, and the fixed operating hours of public health facilities restricted their ability to obtain services. The existence of the Safe Motherhood Programme, knowledge sharing platforms such as “women’s groups” and the active role of Female Community Health Volunteers (FCHVs) positively influenced utilization of skilled maternal health services among these girls.ConclusionInfluences on married adolescent girls’ use of skilled maternal health services in Banke District, Nepal were multi-factoral. Ensuring easy access and availability of adolescent-friendly maternal health services are important to encourage adolescent girls to use skilled maternal health services. Moreover, interventions are needed to improve adolescent girls’ knowledge of maternal health, keep them in school, involve family members (mainly mothers-in-law) in health interventions, as well as overcome negative traditional beliefs within the community that discourage care-seeking for skilled maternal health services.

Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP)