Birth Certificate Research Articles

The Maslahah of State Policy in Responding to Unregistered Marriage: Inclusion of Unregistered Marriage on The Family Card

Based on Minister of Home Affairs regulations No. 108 and No. 109 of 2019, unregistered (siri) marriage couples can now record their marriage in the Family Card. This article aims to analyze the policy of issuing Family Cards for unregistered marriage couples using the Islamic jurisprudence (ushul fiqh) approach. This article is a literature study, with data sourced from the Minister of Home Affairs regulations and various related literatures. The obtained data is then analyzed using a normative-philosophical approach, specifically ushul fiqh theories such as the concepts of public interest (maslahah) and preventing harm (adz-dzari�ah). The article argues that in every policy, there will be potential benefits (maslahah) and harms (mudharat). In the policy of recording unregistered marriages, the government needs to close the means that cause harm (saddu al-dhariah) to ensure this policy is not interpreted as a form of legalizing unregistered marriages. The government also needs to open the means that lead to benefits (fathu al-dhariah) so that the goal of fulfilling children's civil rights with the basis of having a birth certificate, and the purpose of the Marriage Law, namely the validity of marriage, can be achieved through the use of unregistered marriage data for expediting the marriage legalization process (itsbat nikah) in Religious Courts. The conclusion of this article is that to achieve the ideal policy objectives, aspects of benefits and harms need to be considered. This article contributes to understanding state policies from the perspective of ushul fiqh and indicates that it remains a relevant approach.

Racialized inequities in live birth after cancer: A population-based study of 63,000 female adolescents and young adults with cancer.

Fertility after cancer is a top concern for adolescents and young adults with cancer (AYAs) (15-39 years old at diagnosis). The authors characterized live births after cancer by race and ethnicity ("race/ethnicity") in a population-based sample of female AYAs. This study used Texas Cancer Registry data linked to birth certificates (1995-2016) to estimate cumulative incidence of live birth, based on first live birth after cancer, and compared differences by race/ethnicity. Proportional subdistribution hazards models were used to estimate associations between race/ethnicity and live birth, adjusted for diagnosis age, cancer type, stage, year, and prior live birth, overall and for each cancer type. Among 65,804 AYAs, 10-year cumulative incidence of live birth was lower among non-Hispanic Black AYAs than other racial/ethnic groups: 10.2% (95% confidence interval [CI], 9.4-10.9) compared to 15.9% (95% CI, 14.1-17.9) among Asian or Pacific Islander, 14.7% (95% CI, 14.2-15.3) among Hispanic, and 15.2% (95% CI, 14.8-15.6) among non-Hispanic White AYAs (p<.01). In the adjusted overall model, Black AYAs were less likely to have a live birth after cancer than all other groups. In adjusted models for each cancer type, live birth was significantly less likely for Black AYAs with gynecologic cancers or lymphomas (compared to White AYAs) or thyroid cancers (compared to Hispanic AYAs). Black AYAs are less likely than AYAs of other races/ethnicities to have a live birth after cancer, in contrast to patterns of live birth in the general population. Research and action to promote childbearing equity after cancer are imperative.

Implementasi Program Siap Akta Kelahiran Dan Kartu Identitas Anak (Program Si Adik) Pada Tingkat Sekolah Dasar Di Dinas Kependudukan Dan Pencatatan Sipil Kota Binjai

The government always strives to improve the quality of public services provided to the community, one of which is administrative services. Regulation of the Minister of Home Affairs (Permendagri) Number 19 of 2018 concerning Improving the Quality of Population Administration Services in the Population and Civil Registration Office of the Regency / City quickly and precisely through integrated services and / or pick up the ball for the fulfillment of ownership of resident identity. Therefore, the Binjai City Population and Civil Accounting Service issued a program, namely the Ready for Birth Certificates and Child Identity Card (SI ADIK Program) in realizing the improvement of the quality of population administration services through integrated services. The method used in this study is a descriptive method with a qualitative approach. The data collection techniques are interviews, observations and documentation. The results showed that the implementation of the Ready for Birth Certificate and Child Identity Card Program (SI ADIK program) at the Binjai City Population and Civil Registration Service was still not optimal. This can be seen from the need to increase socialization to the target parties of the program, then increase existing resources both in terms of quantity and quality. It requires the commitment and readiness of implementers of effective programs and mechanisms.

Risks of maternal cardiopulmonary events associated with ritodrine for tocolysis: A national database linkage study in 1 831 564 pregnant women.

Real-world data on cardiopulmonary events among pregnant women receiving β-agonist therapy are scarce. In the present study, we aimed to examine the absolute and relative risks of maternal cardiopulmonary events associated with the use of β-agonist ritodrine during pregnancy. By linking Taiwan's National Birth Certificate Application Database with National Health Insurance data, 1 831 564 pregnancies at ≥20 weeks' gestation were identified. Age-standardized incidence rates of cardiopulmonary events among pregnant women exposed to ritodrine were estimated. Nested case-control analyses were conducted to evaluate the relative risk of pulmonary edema, heart failure, and arrhythmia associated with prior ritodrine use. Cases and controls were matched using risk set sampling, and adjusted odds ratios were estimated using conditional logistic regression models. A total of 189 cases of pulmonary edema, 126 cases of heart failure, and 162 cases of arrhythmia were identified (corresponding age-standardized incidence rates: 20.90, 8.35, and 16.63 per 100 000 among pregnant women only exposed to oral ritodrine; 91.28, 36.01, and 14.61 per 100 000 among those ever exposed to intravenous ritodrine). Exposure to oral ritodrine was associated with a lower increased risk of pulmonary edema (aOR 1.76; 95% CI: 1.12-2.76) and arrhythmia (2.21; 1.47-3.32) whereas exposure to ritodrine injection was associated with a significantly higher risk of pulmonary edema (10.56; 6.39-17.45), arrhythmia (4.15; 1.99-8.64), and heart failure (5.58; 2.27-13.74). Pregnant women receiving intravenous ritodrine therapy had higher cardiopulmonary risks and should be intensively monitored. While the relative risk associated with oral ritodrine is not pronounced, it should be used judiciously among pregnant women as well.

The multiracial family as an anomaly: Experiences of monoracism

AbstractObjectiveThrough qualitative in‐depth interviews with interracial parents across the United States, this study explores how multiracial families as a unit experience monoracism via racial surveillance, voyeurism, and dissection.BackgroundDespite increasing representations of mixed‐race families in various media, studies find that many people in the United States assume that family members should phenotypically resemble each other and also represent one obvious racial category. Interracial partners and multiracial families experience the paradox of being both the “ideal” family in a post‐racial US society, but also an anomalous family that challenges assumptions about what family is. This study examines two broad research questions: (1) How do interracial parents and their multiracial families experience racism and/or other forms of discrimination? (2) How do families make sense of and respond to these experiences?MethodThis study utilized qualitative in‐depth interviews with 19 sets of interracial parents, or 38 individuals, in the US Black‐White, Asian‐White, and Black‐Asian families are included in the sample.ResultsInterracial parents in this study discussed experiencing racial dissection, surveillance, and voyeurism in their daily lives, which the author identified as mechanisms of monoracism. Monoracism, typically studied as an experience of multiracial people, is a form of oppression that targets those who do not fit into one racial category. However, monoracism also impacts multiracial family units. As a result, multiracial families were often prepared to prove their familial bonds, such as through birth certificates, or altered their behavior in public as a means of “performing” family in more obvious ways.ConclusionThrough a MultiCrit lens, this study reveals how interracial parents and their children experience monoracism. This study extends previous scholarship by exploring how multiracial families as a unit experience and navigate monoracism in their daily lives.

Patterns of service needs and use by subgroups of youth experiencing homelessness

ABSTRACT Service use predicts exit from homelessness and improvements in physical and mental health among youth experiencing homelessness (YEH). However, service use among YEH remains low. This study uniquely examined youths’ reported needs and patterns of service use during and after the COVID-19 pandemic. Baseline data were examined from a large opioid prevention project conducted in a midwestern, service-rich metropolitan area. YEH (n = 240), between the ages of 18–24 years, were recruited from a drop-in center and other non-service locations. Youth completed self-report questionnaires about their service needs and utilization over the prior three months. The most common services YEH needed were housing (n = 233, 97.5%), drop-in center (n = 194, 81.2%), identification and birth certificates (n = 118, 49.6%), medical care (n = 110, 46.0%), dental care (n = 106, 44.4%), employment counseling (n = 97, 40.6%) and mental health and emotional life counseling (n = 91, 38.1%). Most service needs were unfulfilled. Youth showed extreme service need overall, but other than drop-in centers, the youth reported limited use of most services. The limited use of needed services underscores the importance of future efforts toward improving service use for those in need.

E Grampanchayat

E-Gram Panchayat leverages digital technologies to streamline and improve the efficiency of administrative processes within rural local self-government bodies. It enables the automation of various tasks and reduces paperwork. The use of technology ensures transparency in decision- making and resource allocation. Citizens can access information related to Panchayat activities, budgets, and projects online, fostering greater accountability among local representatives. E-Gram Panchayat platforms often include citizen-centric services, allowing villagers to participate in governance actively. This includes online grievance redressal systems and public feedback mechanisms. It enhances the delivery of essential public services such as birth and death certificates, land records, and social welfare schemes. These services become more accessible to rural residents through online portals

Not all Medicaid for pregnancy care is delivered equally.

Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period. This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months). Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid. In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.

Physician visits for psoriasis and reduced risk of adverse pregnancy outcomes: A nationwide study in Taiwan

Abstract Background: It is unclear whether women with psoriasis who receive adequate management or achieve better control of their psoriasis before and during pregnancy could eliminate the negative effects. Objectives: The objective of this study was to investigate the association between physician visits for psoriasis and adverse pregnancy outcomes. Methods: This study used the National Health Insurance database and Birth Certificate Application in Taiwan. This research further categorized the study subjects into mothers with mild/severe psoriasis who visited physicians for psoriasis before delivery, mothers with mild/severe psoriasis who did not visit a physician for psoriasis before delivery, and mothers without psoriasis. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of adverse pregnancy outcomes, including maternal and neonatal outcomes. Results: 3,339 mothers with severe psoriasis, 41,296 mothers with mild psoriasis, and 2,017,271 mothers without psoriasis were included in this study. The mothers with mild/severe psoriasis demonstrated a significantly higher risk of labor complications and maternal risk factors. After adjusting for confounders, mothers with severe psoriasis who did not visit a physician for psoriasis demonstrated significantly higher odds of labor complications (OR 1.217), maternal risk factors (OR 1.507), having low-birth weight infants (OR 1.236), etc., than mothers without psoriasis. Conclusion: This study demonstrated that mothers with psoriasis had a higher risk of adverse pregnancy outcomes. In addition, seeking medical care for psoriasis, particularly for women with severe psoriasis, appeared to exert a protective effect against adverse pregnancy outcomes.

ANALISIS KEMISKINAN MULTIDIMENSI DI KABUPATEN SUMBAWA

This research aims to determine multidimensional poverty in Sumbawa Regency. The data analysis used in this research is multidimensional poverty calculation analysis. The results of the research show that Sumbawa Regency, based on the calculation of the Multidimensional Poverty Index in Sumbawa Regency, shows the results of calculating the value of IKM with the nutritional proportion of IKM RT with children under five being 18.3%. The prevalence of diseases that interfere with main work in Sumbawa Regency in 2023 is 32.1%. This figure is higher than the national average of 16.3%, the school enrollment rate in 2023 is 6.98%. The expected length of schooling (AHS) in Sumbawa Regency in 2023 is 11.7 years. The percentage of households with a floor area under 7.2 square meters per person in Sumbawa Regency in 2023 is 14.4%. The percentage of individuals in households who drink from unsuitable drinking water sources in Sumbawa Regency in 2023 is 122.58%. The percentage of individuals in households who use inadequate cooking fuel sources in Sumbawa Regency in 2023 is 65.35%. The percentage of individuals in households who use inadequate cooking fuel sources in Sumbawa Regency in 2023 is 46.67%. The percentage of individuals who do not have a birth certificate in Sumbawa Regency in 2023 is 1.3%. and finally the percentage of households in Sumbawa who did not use the internet during the last 3 months was 21.82%. This figure is higher than the national average of 9.69%. The conclusion of this research is that based on the results of multidimensional poverty measurements to determine priorities for poverty management policies/programs.

Implementation of Birth Certificate Preparation for a Mother's Child through Klampid New Generation (KNG) in Rungkut Menanggal Village

Implementation of Birth Certificate Preparation for a Mother's Child through Klampid New Generation (KNG) in Rungkut Menanggal Village

Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: The modifying role of utilization of mental health services

ObjectiveWe examined the association between antenatal depressive symptoms and adverse birth outcomes in Midland Healthy Start (MHS) participants and determined whether receiving mental health services reduced the odds of adverse outcomes among those with elevated antenatal depressive symptoms. MethodData from a retrospective cohort of participants (N = 1,733) served by the MHS in South Carolina (2010–2019) were linked with their birth certificates. A score of ≥16 on the Center for Epidemiologic Studies Depression Scale was defined as elevated antenatal depressive symptoms. Services provided by MHS were categorized into: (1) receiving mental health services, (2) receiving other services, and (3) not receiving any services. Adverse birth outcomes included preterm birth, low birth weight, and small for gestational age. ResultsAround 31 % had elevated antenatal depressive symptoms. The prevalences of preterm birth, low birthweight, and small for gestational age were 9.5 %, 9.1 %, and 14.6 %, respectively. No significant associations were observed between elevated depressive symptoms and adverse outcomes. Among women with elevated antenatal depressive symptoms, the odds for small for gestational age were lower in those who received mental health services (AOR 0.33, 95 % CI 0.15–0.72) or other services (AOR 0.34, 95 % CI 0.16–0.74) compared to those who did not receive any services. The odds for low birth weight (AOR 0.34, 95 % CI 0.13–0.93) were also lower in those who received mental health services. ConclusionsReceiving screening and referral services for antenatal depression reduced the risks of having small for gestational age or low birth weight babies among MHS participants.

Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid

BackgroundThe rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.MethodsData from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15–44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.ResultsThirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.ConclusionsThe risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

The causal impact of fetal exposure to PM2.5 on birth outcomes: Evidence from rural China

This paper investigates the causal impact of fetal exposure to PM2.5 on birth outcomes, including birth weight, the incidence of low birth weight (LBW), and small for gestational age (SGA), based on a nationally representative birth record dataset in a developing country setting. We employed thermal inversion as the instrument variable (IV) for PM2.5 and leveraged the distinctive characteristics of rural China in the 1990 s to address identification challenges. Our IV estimates indicate that higher fetal PM2.5 exposure leads to lower birth weight and elevated probabilities of LBW and SGA. Due to the mortality selection in utero, weak male fetuses were more likely to be screened out by PM2.5 exposure, resulting in a comparatively lower vulnerability among the surviving male infants. Furthermore, infants born to less educated mothers exhibited increased susceptibility, a phenomenon not entirely explained by the sorting behaviors associated with the preference for cleaner air based on socioeconomic status.

The existence of serial marriage on the position of children in the issuance of birth certificates

&lt;table border="0" cellspacing="0" cellpadding="0"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td valign="top" width="388"&gt;&lt;p class="TableParagraph"&gt;&lt;em&gt;This study examines the issue of the issuance of birth certificates for children resulting from unregistered marriages and knowing how the registration that can be made to bring up civil relations between fathers and children resulting from unregistered marriages at the Department of Population and Civil Registration of Semarang Regency. The research was conducted empirically with a descriptive nature, data obtained from primary and secondary data with qualitative analysis techniques. Based on the results of the research and discussion, it is known that the issuance of the Birth Certificate is carried out in three ways, firstly with a statement of children born out of wedlock with the provisions in the Birth Certificate that only the mother's name is included. Second, with the Surat Pertanggungjawaban Mutlak (SPTJM) the truth as a married couple applies the provisions in the Birth Certificate to include the names of the father and mother with additional phrases and thirdly for Muslims after recording the marriage at the KUA with the results of the marriage itsbat trial, then the child is made a Birth Certificate so that his status can be directly recognized son of a legal father and mother. Registration that can be made to bring up civil relations between fathers and children as a result of unregistered marriages are carried out in two ways, first if the marriage cannot be registered then the provisions for child recognition are enforced with a statement of child acknowledgment made by the biological father approved by his biological mother without trial. The second is the ratification of the child by registering the unregistered marriages first and then the trial of the ratification of the child&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;

Abstract MP46: Recurrent Hypertensive Disorders of Pregnancy and Subsequent Maternal Coronary Heart Disease and Stroke

Introduction: Hypertensive disorders of pregnancy (HDP) complicate 5-10% of pregnancies and lead to maternal morbidity and mortality. Prior HDP increases HDP risk in subsequent pregnancies with little known about coronary heart disease (CHD) and stroke in recurrent HDP. We aimed to assess the relationship between recurrent HDP and subsequent CHD and stroke. Methods: This retrospective cohort study included women aged 12-49 with one or more singleton, live birth in South Carolina from 2004-2016. Deliveries were evaluated for HDP (preeclampsia, eclampsia, gestational hypertension) defined by birth certificate and/or hospitalization/emergency department (ED) visit data. Women were classified as having no, one, or two or more pregnancies with HDP. Hospitalization/ED visit and death certificate data defined incident CHD and stroke. Extended Cox models with time varying covariates were used to evaluate the association of recurrent HDP with CHD and stroke controlling for sociodemographic, behavioral, and clinical characteristics. Results: The 163,598 women (non-Hispanic White (NHW; 57.8%), non-Hispanic Black (NHB; 33.9%), and Hispanic (8.3%) had two or more (3.3%), one (12.0%), or no (84.7%) HDP pregnancies. Women with recurrent HDP were more likely to develop subsequent CHD or stroke after covariable adjustment (Table 1). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of CHD (HR=2.25; 95% CI: 1.97-2.56 and HR=2.98; 95% CI: 2.43-3.67, respectively). Having one or two or more HDP pregnancies compared with no HDP pregnancies increased the subsequent risk of stroke (HR=2.05; 95% CI: 1.61-2.61 and HR=2.97; 95% CI: 2.04-4.32, respectively). Discussion: Women with recurrent HDP are at higher risk of subsequent CHD and stroke. Higher incident CHD and stroke risk appears to persist into the next pregnancy with accumulated HDP conferring higher risk.

Analisis Produktivitas Tenaga Kerja Dinas Kependudukan Kabupaten Ende terhadap Pelayanan Masyarakat

This study aims to find out how the productivity of the Population Service workforce is towards community services at the Ende Regency Population Service Office. Collecting data in this study are observation, interviews and documentation. This research uses a type of qualitative research with the analysis technique used, namely productivity with the Objective Matrix (OMAX) method with criteria for working hours and the products produced. The steps using the OMAX method are determining criteria, determining performance, determining realistic productivity values, determining weights, scores and values, determining productivity indices and determining performance indicators. The results showed that the productivity of the population service workforce towards community services at the Ende Regency Population Service office from April to December fluctuated (up and down). The highest DISPENDUK labor productivity value is in September which is at level 10 and the lowest productivity value is in April which is at level 0. Labor productivity indicators in this study are indicators of hours worked and products produced. The results of the study show that the public services of the Ende Regency Population Service in making KTPs, KKs and birth certificates are not yet responsive to the interests of the community as service users. Based on field observations, many complaints from the people of Ende Regency are related to the services provided by employees or employees of the population service which can lead to fights between employees and the community.

Maternal and neonatal outcomes in women with congenital heart disease: A nationwide population-based study

BackgroundWe evaluated the outcomes of pregnancy in women with congenital heart disease (CHD) and their offspring in Taiwan. We also investigated how different severity levels may influence the outcomes. MethodsWe used data (2009–2017) from the Birth Certificate Application database in Taiwan, which is linked to the National Health Insurance Research Database and Taiwan Maternal and Child Health Database. We identified 2990 women with CHD who had 4227 births. Based on the CHD subtypes, patients were further divided into “severe CHD” and “simple CHD” groups. ResultsWomen with CHD have a significant risk of stillbirth. In maternal cardiac events, they had the highest risk of heart failure, followed by arrhythmia. The severity of CHD had a significant effect on the outcomes as well. The neonatal birth event that mothers with CHD have the highest risk of is preterm birth at < 32 weeks of gestation. The prominent difference in neonatal morbidities between mothers with severe and simple CHD is recurrent CHD in the offspring. The offspring of the severe CHD group had a higher risk of severe CHD, whereas those of the simple CHD group had a higher risk of simple CHD. ConclusionDuring pregnancy, the monitoring of heart function and cardiac rhythm could be more intensive in mothers with CHD. In addition to accurately assessing fetal growth and development during antenatal care, mothers with severe CHD should be provided with careful fetal heart structure assessment and genetic testing along with counseling.

Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women.

American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.

Maternal mortality review in a major tertiary referral hospital in Liberia, 2018–2021

ObjectivesAnecdotal evidence showed increased maternal deaths at the major tertiary hospital over the past two years (2020–2021). We reviewed the maternal death audit data, identified the main causes of maternal death, and associated risk factors. Findings were shared with policymakers to help reduce maternal mortality. Study designWe conducted a secondary data review and descriptive analysis of maternal death at the tertiary hospital located in Monrovia. MethodThe maternal death data were extracted from patient medical records, including death certificates and maternal audit records. The record of live births was obtained from the delivery register. Data were analyzed using Epi Info version 7.2 Maternal mortality ratio (MMR) was estimated, the leading direct and indirect causes of maternal death were identified, and the factors associated with maternal death were explored using logistic regression at a 5% level of significance. ResultsThere are a total of 233 maternal deaths and 14, 879 live births giving a maternal mortality ratio (MMR) of 1565 per 100,000 live births during the period under review. The median age of the mothers at death was 29 (14–45) years. About 40.3% (94/233) of cases died within <1 day of admission, referrals accounted for 59% (137/233) of the cases. Direct causes of death accounted for 66% (147/223). Hemorrhage [30.6% (45/147)], Eclampsia [(30/147) 20.6%] and Sepsis [(30/147) 20.6%] were the main direct causes of death while cardiovascular-related [18.4% (14/76)] and HIV/AIDS [16% (12/76)] were the leading indirect cause of death. Patients from referred other facilities were 7.9 times more likely to die as compared to non-referral (pOR:7.9, 95%CI: 5.9–10.6, p < 0.001). ConclusionThe maternal mortality ratio remained high. Referrals were done late. The Liberia Ministry of Health should equip more secondary-level health facilities and tertiary hospitals to handle maternal emergencies and sensitize the populace and healthcare workers on prompt identification and referral of obstetric emergencies. The MoH also needs to improve the blood transfusion services to help in the management of postpartum hemorrhage.