Childbirth Services Research Articles

The Cost of Preventive Care During Pregnancy: A Call to Action.

Perinatal care is necessary to prevent and manage adverse outcomes during pregnancy, birth, and the 12 months after delivery, as recommended by the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (Kilpatrick, Papile, & Macones, 2017). However, a recent study found that pregnant families incur significant expenses for perinatal care, paying $4,500 on average for maternal pregnancy and childbirth services (Moniz et al., 2020). In this study, cost-sharing—that is, deductibles, co-insurance, and co-payments for health care services—disproportionately affected those with lower incomes and chronic conditions, populations at an increased risk of adverse outcomes who may particularly benefit from health care during pregnancy.

Regional Disparities of Facility-Based Childbirth in Indonesia

Specifically, the characteristics of regions in Indonesia are unique. The situation is because the division of the region refers to the main islands. The study aims to analyze regional disparities of childbirth services in Indonesia. Meanwhile, the analysis in this study uses raw data from the 2017 Indonesian Demographic Health Survey (IDHS). The IDHS used stratification and multistage random sampling. The sample used in this study was 17,769 women aged 15 - 49 years with live births in the last 5 years. The study employed all region (7 regions) in the analysis, and analyzed data using the binary logistic regression test. The result shows national average of the utilization of healthcare facilities for delivery in Indonesia is 72.0 %. The 3 highest-ranking regions were in the Java-Bali region with 89.5 %, Sumatra region 73.5 %, and Kalimantan region 69.1 %. The study shows a significant disparity between all regions than the Papua region, except for Kalimantan and Sulawesi regions. Sumatra region has 1.475 times more possibilities to utilize healthcare facilities for delivery than the Papua region. The Java-Bali region has 3.010 times more potential to use healthcare facilities for delivery than the Papua region. The Nusa Tenggara region has 1.891 times more opportunities to use healthcare facilities for delivery than the Papua region. At the same time, the Maluku region has lower utilization than the Papua region. Maluku region has the possibility of 0.304 times utilizing healthcare facilities for delivery than the Papua region. The study concluded that there were significant disparities between regions in using healthcare facilities for delivery in Indonesia.
 HIGHLIGHTS
 
 Indonesia has made many efforts in shifting labor into health care facilities. However, this increase is still lacking, and in some cases, the community still feels that the health services received are not expected
 The characteristics of regions in Indonesia are unique. Economic and development movements between regions keep the development gap between areas continuing. Disparity as a result of this development also affects the accessibility of the community to health service facilities
 The study proved there were disparities between regions in using healthcare facilities for delivery in Indonesia
 
 GRAPHICAL ABSTRACT

Perinatal mental health around the world: priorities for research and service development in The Netherlands

The Netherlands has an unique system of perinatal and postpartum healthcare. Pregnancy care is delivered predominantly by primary care midwives and childbirth services predominantly involve hospital care. The first week postpartum, all women receive daily care from maternity nurses. In addition, hospitals and out-patient clinics offer perinatal mental healthcare. More specifically, ‘POP care’ (psychiatry, obstetrics and paediatrics) was developed to promote multidisciplinary collaboration in this regard. Although clinical practices and government initiatives to improve pregnancy-related mental healthcare work well, they have yet to be fully described and evaluated. The current COVID-19 pandemic has an impact on health services and perinatal mental health.

Measuring facility readiness to provide childbirth care: a comparison of indices using data from a health facility survey in Ethiopia

BackgroundActionable information about the readiness of health facilities is needed to inform quality improvement efforts in maternity care, but there is no consensus on the best approach to measure readiness....

Predictors of Satisfaction With Childbirth Services Amongst Postnatal Women in Two Selected Teaching Hospitals in Ogun State, Nigeria

Satisfaction with childbirth service is a multi-dimensional construct embracing satisfaction with self (personal control), and with the physical environment of delivery ward and quality of care. Maternal health care service encompasses family planning, preconception, antenatal, delivery and postnatal care. Goals of preconception care include providing education, health promotion, screening tests for various health problems and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. Women who begin prenatal care early in their pregnancies have better birth outcomes than those who receive little or no care during their pregnancies. This study was conducted to identify predictors of satisfaction with childbirth services and the factors influencing them. A well-structured questionnaire was used to get responses from 81 postnatal women in OOUTH and BUTH. Data was analyzed using Statistical Package for Social Science. Descriptive and inferential statistics were used in analyzing the research questions and hypotheses respectively. Majority of the participants revealed good level of satisfaction with most child birth services rendered by the two selected teaching hospitals, but more than two-third of the respondent’s claims, dissatisfaction in pain control and baby care after birth in the two hospitals. Findings revealed more satisfaction towards child birth services in BUTH than OOUTH, this might be as a result of inadequate equipment, structural facilities and poor waiting areas in the public hospital. It was recommended among others that Government should facilitate focused antenatal care, institutional delivery and postnatal care in terms of reducing maternal and neonatal mortality.

IMPLEMENTATION OF COMPREHENSIVE MIDWIFERY CARE

The research aims: To provide comprehensive midwifery services to mothers since pregnancy, childbirth, newborns and contraception services.
 Research methods: The research design used is descriptive, with a clinical case study method.
 Research result: From the results of the assessment of Mrs. M aged 23 and the comprehensive midwifery care that had been given and it was found that everything was in normal condition. After doing Comprehensive Midwifery Care at Independent Practice Midwives/ BPM Nurkhairiyah, comprehensive midwifery care has been given. The client says he is satisfied and understands the care he has received, and provides great benefits for the client and the baby and family and for the client in providing family planning care, the client has not decided to choose a contraceptive will be used..
 Conclusion: From the midwifery care obtained, the mother said she felt satisfied and appreciated, both in the care of pregnancy, childbirth, postpartum, newborn and the period of choice of using contraception. the mother feels that she can play a role in making choices regarding needs as well as in decision making.
 Suggestion: Midwives should be able to carry out comprehensive care on an ongoing basis so that in the hope of reducing maternal and infant mortality and morbidity, it can be achieved.

Transition into the sexual and reproductive role: a qualitative exploration of Iranian married adolescent girls\u2019 needs and experiences

BackgroundIt is necessary to invest in married adolescent girls’ health because of their roles in promoting the community and health of the next generation. Meanwhile, there are many concerns about their sexual and reproductive health. The International Conference on Population and Development emphasized the importance of access to adolescent girls to reproductive health services and counseling. In Iran, about 24% of registered marriages are to girls under 19, while their sexual and reproductive health needs have neglected. Therefore, this study aimed to identify married adolescent girls’ reproductive and sexual needs.Methods/designData were obtained through in-depth, semi-structured individual interviews with 36 participants, including 11 women who got married at 10 to 21 years of age, two mothers whose daughters were married in adolescence, and 23 healthcare providers and policymakers. The participants were selected through purposive sampling with maximum variation. Data collection continued until data saturation. The interviews were analyzed by qualitative content analysis. Similar codes were merged, and sub-categorization was performed, whereby similar categories were combined until the main categories that emerged.ResultsThe results revealed five main categories: preparing for marriage, enhancing awareness and decision—making power on sexual and reproductive health issues, developing adolescent-friendly sexual and reproductive services, providing tailored pregnancy and childbirth services, and preparing adolescents for motherhood.ConclusionAdolescents step into marital life without the required life skills or physical and mental preparedness. They often become pregnant due to social pressures and lack of access to contraception. Therefore, in countries like Iran, where there is a high frequency of early marriage, families, education, and the health system should prepare the necessary foundation to support these adolescents and provide tailored and comprehensive sexual and reproductive health services.

The impact of national health insurance on the access of maternal care service for women in Indonesia

Background and purpose: The government of Indonesia has established national health insurance or Jaminan Kesehatan Nasional (JKN) since 2014 to meet the basic needs of appropriate public health, including women. However, maternal mortality rate in Indonesia is recorded to be higher than peers and decreases slowly. This paper aims to elaborate the impact of the national health insurance on the access to maternal care and services for women in Indonesia.Methods: This paper employs a secondary data analysis by using Indonesian National Socio-Economic Survey (SUSENAS) 2017 and applies propensity score matching methods. Within the sample, a treatment group is a group of women who are registered in the JKN, including the PBI and non-PBI participants, while the control group is a group of women who are not registered in the JKN, women who have other insurances and those who do not have any insurance. The total sample of the treatment group is 18,886 and the control group is 19,559 participants. There are two outcome variables in the analysis which reflect the access of health care and health services, which are child-birth service facility (CBSF) and Birth Attendant (BA), respectively.Results: The result shows that women who are the member of the JKN have greater probability in accessing formal health care and services during the maternity process. They tend to deliver babies in hospital and get helped by medical personnel. Moreover, by comparing the impact of the JKN in the rural and urban areas, the result shows that the probability of women in rural area to access health care and services is higher than women in cities.Conclusion: Based on these results, we can conclude that the JKN has improved the access for health care as well as medical services for maternity, in both rural and urban areas. However, the JKN program improvements are still needed, particularly in ameliorating the quality of JKN program, as well as expanding the number of participants to achieve a higher impact.

Midwives and Dukun Beranak, the Choices for Handling Childbirth

Since the colonial era, there have been attempts to provide clinical childbirth services by establishing midwifery schools. Although these schools were closed, reorganized then re-opened several times, in an effort to graduate native midwives in the colony. The majority of the European doctors believed the existence of native midwives could reduce mortality rates for difficult deliveries. The colonial government also tried to replace dukun beranak (local midwives) with graduate midwives, as many doctors considered dukun beranak practices unsafe and unhygienic. Of note, even though midwifery school graduates provided childbirth services, most of the population preferred to use dukun beranak. This situation continued until independence. Dukun beranak remained the preferred provider of assistance among the working and lower class. The continued popularity of the dukun beranak can be seen as a colonial failure to replace them. After the proclamation of Indonesian independence, midwives who supported the Indonesian Republic, still provided childbearing assistance although with limited infrastructure and inadequate personnel during the independence war. Midwives also founded a midwifes association, rebuilt the national midwifery system, and discontinued colonial elements. This transformation can be interpreted as the decolonisation of midwifery. Midwives and dukun beranak were the available options for assisting in the labour of an Indonesian woman. The Indonesian government had a different approach to the colonial government toward society and dukun beranak and built cooperation between midwives and the dukun beranak. The cooperative work among midwives and dukun beranak changed awareness of Indonesian women’s reproductive health matters. This article traces efforts to provide safer childbirth services by looking at the problem through the lens of midwives and dukun beranak relations. The evolution of this relationship shows the decolonisation process inside midwifery and childbearing services.

Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

BackgroundCountries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care.MethodsWe explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations.ResultsOur study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi.ConclusionsPrior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

Health-seeking behaviours of immigrants, asylum seekers and refugees in Europe: a systematic review of peer-reviewed articles

PurposeImmigrants, asylum seekers and refugees living in Europe face a number of challenges in accessing or using health information and healthcare services available in their host countries. To resolve these issues and deliver the necessary services, providers must take a comprehensive approach to better understand the types of health information and healthcare services that these individuals need, seek and use. Therefore, the purpose of this paper is to develop that comprehensive approach.Design/methodology/approachIn this paper, a systematic literature review of peer-reviewed publications was performed, with 3.013 articles collected from various databases. A total of 57 qualifying papers on studies conducted in Europe were included in the review after applying the predefined inclusion and exclusion requirements, screening processes and eliminating duplicates. The information seeking and communication model (ISCM) was used in the analysis.FindingsThe findings revealed that while many health information and healthcare services are accessible in Europe for immigrants, asylum seekers and refugees, many of these individuals are unaware of their existence or how to access them. While our findings do not specify what health-related information these groups need, use or seek, they do suggest the importance and value of providing mental health, sexual health and HIV, as well as pregnancy and childbirth information and services. Furthermore, according to our results, health information services should be fact-based, easy to understand and raise awareness about healthcare structure and services available in Europe for this vulnerable population.Practical implicationsThis study has a range of practical implications, including (1) highlighting the need for mental health and behavioural health services and (2) stressing the value of addressing cultural context and religious values while investigating (health) information seeking of people with foreign background.Originality/valueThis is one of the first studies to systematically review and examine the behaviour of immigrants, asylum seekers and refugees in relation to health information and healthcare services in the European context.

Midwives providing maternal health services to poor women in the private sector: is it a financially feasible model?

Governments in many low- and middle-income countries have increasingly turned to the private sector to address the gap in skilled birth attendance in rural areas. They draw on limited, but emerging evidence that the poor also seek private healthcare services. A question not addressed in this policy and strategy is: Can poor women pay the fees required for private-sector maternity care providers to financially sustain their practices? This article examined the financial viability of private-sector midwifery practices established to provide skilled birth services to Afghan refugee women in Baluchistan, Pakistan. An international non-governmental organization established 45 midwifery practices as part of a poverty alleviation project aimed at providing market-based solutions for female poverty. A retrospective micro-cost analysis was conducted on a sample of 11 practices. In-depth interviews were conducted with 33 stakeholders to explore the midwives' experiences of operating private practices, and the facilitators and barriers they experienced. The single midwife-practices saw a mean of 8.7 ANC patients (range 1-19), attended 2.9 births (range 0-10) and provided care to 1.6 postnatal patients (range 0-7). The average net income of the 11 practices in May 2014 was US$81, but the median was just US$12. To contextualize these incomes, the midwives earned, on average, 25% of Pakistan's minimum monthly living wage. The financial analysis showed only 3 out of 11 sampled practices could be considered financially viable. The qualitative data revealed that even in practices with reasonable client volumes, the patients' inability to pay was the critical factor in the midwife practices' low net incomes. The research provides empirical evidence of a potential pitfall of private funding models in resource-poor settings where providers rely on impoverished clients to pay user-fees. Such financial models essentially shift the government's responsibility to provide safe childbirth services onto providers who can least afford to offer such care.

Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: a cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017

IntroductionCaesarean section (C-section) has been a public health concern globally. This study investigated the change in C-section rate in 1998–2017 in Indonesia and explored the socioeconomic, geographic and health system...

Non-profit hospital mergers: the effect on healthcare costs and utilization.

I use a 2010 non-profit hospital merger in Ohio to study the effect of market concentration on market outcomes. Using the Synthetic Control Method and Truven MarketScan data, I document three findings. First, courts are lenient to non-profit mergers, and I cast doubt on this practice by showing that the studied merger led to a 123% increase in the payments for inpatient childbirth services. Second, I provide the first empirical evidence for the conjecture that mergers increase out-of-pocket payments and reduce the utilization of care. Last, I show that the effect of market power on market outcomes is asymmetric: the increase in payments and welfare loss created by a merger persist after the merger is rescinded. Thus, even successful FTC challenges may not revert the effect of harmful mergers, and it is essential to deny such mergers before they proceed.

Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey

BackgroundIn Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon.MethodsData from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15–49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI).ResultsThe coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11–1.91), higher decision making (aOR = 1.88, 95% CI: 1.36–2.59), maternal education (aOR = 2.38, 95% CI; 1.65–3.42), place of residence (aOR = 0.50, 95% CI; 0.33–0.74), religion (aOR = 0.55, 95% CI; 0.35–0.87), economic status (aOR = 5.16, 95% CI; 2.58–10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05–1.65), parity (aOR = 0.62, 95% CI; 0.41–0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01–20.89) were found to be significant predictors of skilled birth attendance.ConclusionsThis study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals.Plain English SummaryGlobally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon.Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance.This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.

Factors Influencing the Utilization of Childbirth Services in Health Care Facilities at UPTD Anggaberi Health Service Center, Konawe District

The childbirth coverage in health facilities (PF) at UPTD Anggaberi Public Health Center in 2017 has reached 72.6%, and increased in 2018 by 76.18%. At district level, the PF indicator at UPTD Anggaberi Public Health Center has exceeded the target in Konawe District by 59,37%, however but the 80% target achievement of PF at the UPTD Anggaberi Public Health Center has not been achieved<sup>6</sup>. Seeing this, the coverage of PF at the UPTD Anggaberi Public Health Center , there are still labors that are not performed in health facilities, so that it can affect the achievement of PF at the UPTD Anggaberi Public Health Center , Konawe District. The aim of the study was to analyze factors that influence utilization of health care facilities at the UPTD Anggaberi Public Health Center. This research is an analytical study with a cross sectional approach. The research instrument used was a structured questionnaire on the factors that affect the utilization of labor service in health care facilities. The number of samples was 51 women who had labor at the Anggaberi Health Center. Bivariate analysis was done with chi square test and multivariate analysis with logistic regression test. The results showed the six factors (education (p = 0.041) and work (p = 0.019) family income (p = 0.041) and accessibility (p = 0.021) husband support (p = 0.011) and health personnel support (p = 0.011) ) on the use of childbirth services in health care facilities at the UPTD Anggaberi Public Health Center , Konawe District. The multivariate results show that all independent variables in this study have a significance limit of p-value ≤ 0.25, so it can be concluded that there is an influence among each independent variable (education, occupation, income, accessibility, husband's support and support of health workers) with the dependent variable. (utilization of childbirth services in health service facilities). Health care centers are expected to improve the partnership with traditional midwife (dukun beranak) within their work area so that the dukun can become well trained and they can collaborate in every childbirth

Satisfaction with Childbirth Services Among Ultra-Orthodox and Non-religious Mothers in Israeli Hospitals: A Comparative Study

Introduction: A mother's satisfaction with her childbirth experience affects her sense of being a mother in the first few postpartum months. Therefore, the labor services provided by hospitals have an important role and have been the topic of numerous studies. Israel enjoys a particularly high birth rate (twice as high as in other OECD countries), with over 99% of deliveries taking place in public hospitals, making it a good case study for examining satisfaction with childbirth services. In addition, Israel has at least two distinct populations – ultra orthodox and non-religious – allowing us to examine possible differences in how the experience of hospital childbirth is perceived in different communities. The current study examines the differences, if any, between Ultra-Orthodox Jewish Mothers (UOJM) and Non-Religious Jewish Mothers (NRJM) in their satisfaction with hospital childbirth services. Aim: The study focuses on the differences between the factors that influence NRJM's and UOJM’s satisfaction with childbirth services Procedure: This is a comparative study based on a sample of 232 non-religious and 161 ultra-orthodox mothers who have given birth in a public hospital in Israel. Eighteen items defining childbirth satisfaction were rated on a 5-point Likert Scale. The items have been grouped together into three dimensions: The Personal Care dimension includes the interaction of the service provider (midwife or healthcare provider) with the mother, their professionalism, empathy, attitude, responsiveness, etc.; the Surrounding Atmosphere dimension contains items related to the delivery room like its hygiene or aesthetics; and the Technical Methods dimension, which relates to the emergency and alternative care equipment. Results: The study shows that in both sectors, satisfaction was significantly influenced by the dimensions of Personal Care and Technical Methods; however, the Surrounding Atmosphere dimension influenced only ultra-orthodox mothers. Conclusions: The results emphasize the importance of personal interaction with the patient, as well as the presence of appropriate technical methods in the delivery room. When a mother is satisfied with these two dimensions, she is more likely be to be satisfied with her overall birth care. Hospitals should therefore focus on the personal interaction of the staff with the mother, as well as on being service oriented and providing high quality and professional obstetric care. They should also emphasize the cleanliness of the delivery room and its general atmosphere, especially when the patient is from the ultra-orthodox community.

Satisfaction with Childbirth Services Given in Public Health Facilities: A Cross-Sectional Survey in Ethiopia

Background: Service satisfaction encourages mothers to continuously utilize and consume the maternal health care package. But no alike work in the current research area reported so far which this research committed to delivering evidence about the contentment of women in delivery care service provision. Objective: To assess mother's satisfaction and determinants toward childbirth service in Mana District, Jimma Zone, Ethiopia, 2018. Methods: A facility-based cross-sectional study was conducted on 674 women who delivered at the health centers in the last one-year prior study. Data were entered into EPI info version 7, exported to SPSS version 21 then descriptive and multiple regression analysis performed. Result: Mothers' delivery service satisfaction in this study was 45 percent. Supplies, perceived average monthly income, numbers of health facility delivery, being a housewife, and the age of women were found as the independent predictors of delivery service satisfaction. Conclusion and recommendation: Poor cleanliness of the delivery room, inadequacy of water during delivery, and not being asked for accord were major sources of dissatisfaction. Older age, low income, being a non- housewife, and delivering only once at a health facility had better chances of satisfaction. Hence health facilities should resolve problems of physical aspects like poor hygiene and water shortage. Care providers better are vigilant of the apprehension of delivering mothers during the care process with consensus.

Low level of community readiness prevails in rural northwest Ethiopia for the promotion of institutional delivery.

Introductionthe health benefits of institutional delivery with the support of skilled professional are one of the indicators of maternal health status which have an impact on the health of women and new coming generation. Despite these benefits, many pregnant women in Ethiopia are not actively bringing delivery at health facility. This study was aimed at determining the readiness level of community for promoting child birth at health facility.Methodsa population-based cross-sectional study was conducted. We interviewed 96 key informants using a semi-structured questionnaire adapted from the community readiness assessment model and translated to Amharic language. The key informants were purposively selected in consultation with the district health office to represent the community. The interviews were transcribed verbatim and survey scores were matched with the readiness stage of 1 of the 9 for the five dimensions using the assessment guidelines.Resultsthis study placed nine kebeles at stage 3 (vague awareness), which indicates the need for more institutional delivery service strategy programming; efforts of the community were not focused and low leadership concern and one kebele was in stage 2 (denial/resistance). Six kebeles were placed at high level of readiness i.e. in stage 7 (stabilization), indicating actions are sustained by the local managers or opinion leaders.Conclusionevidence derived from the present study can be used to match intervention tactics for promoting health facility child birth service utilization to communities based on their level of readiness.

Utilization cost of maternity services for childbirth among pregnant women with coronavirus disease 2019 in Nigeria's epicenter.

ObjectiveTo estimate utilization costs of spontaneous vaginal delivery (SVD) and cesarean delivery (CD) for pregnant women with coronavirus disease 2019 (COVID‐19) at the largest teaching hospital in Lagos, the pandemic's epicenter in Nigeria.MethodsWe collected facility‐based and household costs of all nine pregnant women with COVID‐19 managed at the hospital. We compared their mean facility‐based costs with those paid by pregnant women pre‐COVID‐19, identifying cost‐drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis.ResultsTotal utilization costs ranged from US $494 for SVD with mild COVID‐19 to US $4553 for emergency CD with severe COVID‐19. Though 32%–66% of facility‐based cost were subsidized, costs of SVD and CD during the pandemic have doubled and tripled, respectively, compared with those paid pre‐COVID‐19. Of the facility‐based costs, cost of personal protective equipment was the major cost‐driver (50%). Oxygen was the major driver for women with severe COVID‐19 (48%). Excluding treatment costs for COVID‐19, mean facility‐based costs were US $228 (SVD) and US $948 (CD).ConclusionDespite cost exemptions and donations, utilization costs remain prohibitive. Regulation of personal protective equipment and medical oxygen supply chains and expansion of advocacy for health insurance enrollments are needed in order to minimize catastrophic health expenditure.