Institutional Delivery Research Articles

Education of household head and maternal healthcare utilization: the case of Bangladesh

BackgroundThe high maternal mortality ratio in South Asian countries could be attributed to poor maternal healthcare (MHC) utilization. Here household heads (HHs) are the main decision-makers of the households and thus can be key stakeholders in women’s MHC uptake. We aim to investigate the role of HHs’ education in MHC utilization and explore the educational status of male adolescents who will eventually replace today’s HHs in the future.MethodWe investigated antenatal care (ANC), and institutional delivery as two MHC during pregnancy and childbirth using the Bangladesh Multiple Indicator Cluster Survey 2019. Due to the stratified cluster sampling nature of the BMICS 2019, we estimated odds ratios from mixed-effect multiple logistic regression considering women nested within clusters and estimated marginal effects to conclude. Using the Bangladesh Adolescent Health and Wellbeing Survey 2019–20, we estimated region-specific school dropout rates and identified the reasons for and timing of dropout among male adolescents.ResultsThe odds of ANC uptake and institutional delivery decreased by lower levels of HHs’ education. Marginal effects of HHs’ education on institutional delivery across comparable levels of ANC uptake show that less educated HHs diminish the full potential of ANC uptake in facilitating institutional delivery. The heaviest burden (~ 70%) of less educated (up to primary level) HHs was in the northeastern region. The highest rate of school dropout (40%) was also in the northeastern region. Around 60% of dropouts left school before or just after completing primary level. The primary reasons for dropout were lack of interest and financial constraints.ConclusionIntegrating HHs into MHC programs can be the immediate call for action while averting male adolescents’ school dropouts can be the long-term strategy.

Educational inequalities and decomposition of the urban-rural disparities in maternal health care utilization in Ethiopia: further analysis of 2019 intermediate Ethiopian demography and health survey

IntroductionThe utilization of maternal health services is vital to prevent maternal and child health problems. However, there is limited evidence as to why rural women have lower utilization and educational inequality in maternal health services utilization in Ethiopia. Identifying the causes is the first step to achieving maternal and child health initiatives.ObjectiveThe objective of this study was to decompose the urban-rural disparities and educational inequalities in maternal health care utilization in Ethiopia.MethodsThe study used the 2019 Ethiopian Demography Health Survey. Blinder-Oaxaca decomposition and multivariate decomposition analyses were done on a weighted 3,926.7 women to see the urban-rural differences in maternal health service utilization by using Stata 17.0. For the educational inequality of maternal health service utilization, concentration curve and concentration index were used by using conindex. P value < 0.005 was used to declare association.Result84.89% of urban and 70.75% of rural residents use antenatal care and 73% of urban and 44% rural use institutional delivery. There was no urban-rural difference in postnatal care utilization. There was educational inequality in antenatal care (CIx 0.0926; p < 0.001), delivery care (CIx 0.2137; p < 0.001 and postnatal care (CIx 0.1272; p < 0.001) utilization in Ethiopia. 83.3% of antenatal care urban-rural difference was explained by women’s characteristics difference. Secondary (16.51%) and higher (23.01%) educational level difference of urban and rural women widening antenatal care utilization. Living regions (-1.33%) difference of urban and rural women mitigated antenatal care utilization. About 76.07% of the urban-rural difference in institutional delivery was explained by differences in the characteristics of women. Attending primary (3.76%), secondary (11.83%), and higher (8.44%) education, antenatal care (15.81%) difference of urban and rural women were widening institutional delivery utilization.ConclusionThe urban-rural disparity in antenatal care and delivery care utilization is significant in the country. There were educational inequalities in maternal health service utilization. Attending, Secondary, higher, educational levels widening antenatal care and institutional delivery care utilization. Living regions mitigated antenatal care utilization. Antenatal care utilization widening institutional delivery utilization. Special attention is needed for rural women to improve maternal health service utilization through health extension workers and the women’s developmental army.

Systemic corruption: A nightmare to service delivery in Nigeria public tertiary institutions

The level of corruption in Nigeria public tertiary institutions is alarming and has drawn the attention of concerned individuals in both the academics and industries. The aim of this paper is to examine the effect of systemic corruption on service delivery of Nigeria public tertiary institutions. The study utilised a quantitative research approach. Data were collected from 364 staff of selected public tertiary institutions in south-eastern Nigeria using a structured questionnaire. Hypotheses were tested using International Business Machine Statistical Package for the Social Sciences (IBM-SPSS) version 27 that runs multiple regression analysis (MRA). The findings reveal that fraud, nepotism, bribery and abuse of power have significant and negative effect on the service delivery of public tertiary institutions in Nigeria. The study therefore, concluded that systemic corruption has significant and negative effect on service delivery of Nigeria public tertiary institutions. The study recommended that all cases of corruption, regardless of their nature, be handled as serious crimes, carrying lengthier and more punitive prison terms.

DETERMINE THE POLICY TARGET TO INCREASE INSTITUTIONAL DELIVERY AMONG INDONESIAN FEMALE WORKERS

Introduction: Indonesia continues to face a significant challenge in terms of maternal and infant mortality. The government is working to promote the use of health facilities for childbirth to mitigate maternal mortality. Aim: The study aims to determine the policy target to increase the rate of institutional delivery among female workers in Indonesia. Methods: The study analyzed secondary data from the 2023 Indonesian Health Survey. It conducted cross-sectional research on 30,173 female workers. In addition to institutional delivery as the dependent variable, we examined eight independent variables: residence, age, education, marital status, wealth, insurance, antenatal care (ANC), and parity. The analysis involved bivariate method followed by binary logistic regression in the last stage. Results: Approximately 70.6% of female workers had institutional delivery. Female workers in urban areas were 1.157 times more likely than rural workers to perform institutional delivery (95%CI 1.153-1.161). Three worker characteristics (age, education, and marital status) were related to institutional delivery. Wealthier workers had a greater the possibility of executing institutional delivery. Insured workers were more likely than the uninsured ones to deliver in health facilities. Female workers with adequate ANC were 1.210 times more likely than those with inadequate ANC to execute institutional delivery (95%CI 1.166-1.256). Additionally, women with fewer childbirths had a higher probability of performing an institutional delivery. Conclusion: The policy target to increase institutional delivery was women workers in rural areas who were older, had poor education, were divorced/widowed, were the poorest, had inadequate ANC, were uninsured, and were grand multiparous. Keywords: institutional delivery, institutional birth, maternal health, female worker, public health.

Trends and determinants of caesarean section in South Asian countries: Bangladesh, Nepal, and Pakistan.

The prevalence of caesarean sections (C-sections) has remarkably increased in the past few decades worldwide, especially in the lower and middle-income countries (LMICs). To our best knowledge, no studies focused on and compared the C-section scenarios of Bangladesh, Nepal, and Pakistan based on the latest demographic and health survey (DHS) data. To assess the trends and factors associated with C-sections in the three South Asian countries. Mothers aged 15-49 years participated in DHS 1990 to 2017-2018 and gave birth within three years of each of the surveys in Bangladesh, Nepal, and Pakistan. This study analyzed data from five recent DHS rounds in Bangladesh and four in Nepal and Pakistan. Multivariable logistic regression was used to assess the association between C-sections and sociodemographic characteristics. The results show that institutional delivery and C-sections have increased throughout the period in all three countries. In Bangladesh, the hospital birth rate increased from 10.0% in 2004 to 49.9% in 2017, and the corresponding figures [S1 Appendix: Figure A1 and Figure A2] for C-sections increased from 3.5% to 32.8%. In Nepal, the hospital birth rate increased from 11.0% in 2001 to 58.6% in 2016, and the C-sections from 0.8% to 11.0%. Pakistan observed a sharp increase from 13.7% to 66.3% and 2.7% to 22.3% in the respective cases from 1990 to 2017. Results from regression reveal that the mother's age, place of residence, education, partner's education, wealth status, birth order, number of antenatal care visits, and body mass index are associated with C-section deliveries in all three countries. Our findings regarding the association of sociodemographic factors with increased C-sections may help identify subgroups of women susceptible to C-sections and offer better support regarding C-sections plans. However, the substantial increase in C-sections across the three countries warrants further investigation to identify the reasons.

Uptake of Measles Second Dose Vaccine and Its Associated Factors Among Children Age 24-35 Months in Merhabete Woreda, Ethiopia: 2022: A Cross-Sectional Study.

Measles infection in children causes a high degree of morbidity and mortality. Vaccination with two doses of measles vaccine is the best strategy to prevent infection and its spread to other children. However, measles containing vaccination coverage in Ethiopia is below the WHO elimination goal. In this study, our aim was to assess uptake of measles second dose and its associated factors among children's age 24-35 months in Merhabete, North Shoa, Ethiopia, 2022. A community-based cross-sectional study design was conducted in Merhabete Woreda from June 1 to 30, 2022. A total of 732 children aged 24-35 months were included using a multistage and systematic random sampling technique. Data were collected using a semi-structured, interviewer-administered questionnaire. Verbal informed consent was taken regarding their willingness to participate in the study from the guardians. The information was kept confidential and not shared with a third party. Data entered into EpiData version 4.6 and exported to SPSS version 25. A logistic regression model was used to identify associated factors. AOR with 95% CI and p < 0.05 were used to declare statistically significant variables. A total of 732 children with a response rate of 94.6% were included; the median age was 28 months. Uptake of measles vaccine second dose was 63.3% (95% CI 60%-67%). Knowledge of measles second dose schedule (AOR = 2.151, 95% CI 1.053-4.396), birth at a healthcare facility (AOR = 3.502, 95% CI 1.58-7.77), > 4 antenatal care visits (ANC) (AOR = 2.56, 95% CI 1.254-5.225), having immunization card (AOR = 9.958 (4.256-23.298), and mother age 25-34 years (AOR = 2.954, 95% CI 1.298-6.721) were significantly associated with the uptake of measles second dose. The uptake of measles second dose vaccine in Merhabete Woreda was below the WHO measles elimination target of > 95%. Variables such as number of antenatal follow-up visits, institutional delivery, knowing the schedule of measles second dose vaccine, maintaining immunization card records, and maternal age were found to be independent predictors of vaccination. Therefore, Woreda Health Office managers should strengthen periodic monitoring and evaluate the implementation of measles second dose vaccine. Health professionals should also improve mother's awareness on measles second dose vaccine schedule and its importance and retain their immunization chart booklet.

Assessment of services provided by urban ASHAs to mothers of urban slums in Lucknow district – A cross-sectional study

ABSTRACT Context: Maternal and child health is an important public health issue which indicates the level of socioeconomic development in any country. Urban accredited social health activist (U-ASHA) workers in India are the main front-line urban health workers in primary health care delivery for slum and urban poor. Aims: To assess the services provided by U-ASHA workers to mothers of urban slums for antenatal and postnatal care. Settings and Design: Cross-sectional study in urban slums of Lucknow where recently delivered women (up to 2 years) were selected. Methods and Material: To include the desired sample size of 320 recently delivered women (RDW), the U-ASHAs of the selected slums were contacted and a list of RDWs was made for each slum. By simple random sampling, 20 RDWs were selected from each slum. A predesigned and pretested interview schedule was used for data collection. Statistical Analysis Used: SPSS-version-26 was used. P &lt;0.05 was considered statistically significant. Results: The registered pregnancies were 95%. Only 43.1% of RDW had at least four ANC visits. The institutional delivery was 84.7%. Only 27.7% of RDW visited health facilities for PNC services. About 39.4% received Janani Suraksha Yojana incentives. Contraceptive users were only 41.9%. Counseling by U-ASHA workers regarding all the ANC and PNC services had better utilization among counseled RDW except for child-care counseling. Conclusions: Counseling services regarding ANC and PNC services have a significant impact on their utilization. Better results can be achieved if the counseling by U-ASHA is enhanced to reach out more beneficiaries.

A Strategic Health Index for Maternal and Child Wellbeing in Uttar Pradesh using MCDM

Maternal and child health (MCH) is a critical indicator of overall societal well-being, particularly in developing countries. The study presents a comprehensive analysis to evaluate MCH in Uttar Pradesh (UP), a state facing significant public health challenges. Using National Family Health Survey (NFHS-5) data on MCH indicators, we developed a health index to systematically assess and compare health status across various districts. The multi-criteria decision-making (MCDM) technique, specifically Criteria Importance Through Inter-criteria Correlation (CRITIC) and TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) is used to determine the importance of closeness of various criteria affecting MCH care, such as antenatal care, institutional delivery, postnatal care, immunization coverage and nutritional status. The overall performance of each district in terms of MCH was measured to develop a composite index based on the MCDM approach. In contrast, the indicator weights were determined by the CRITIC method. Some districts showed better performance on specific indicators, while others lagged. The resulting index provides a nuanced understanding of the regional disparities within UP, highlighting areas of urgent need for healthcare interventions. The findings underscore the importance of targeted policies and programs to improve MCH outcomes, contributing to the broader goals of sustainable development and public health enhancement in the region.. KEYWORDS :Maternal and child health, CRITIC, TOPSIS, Index.

Growth Monitoring and Promotion Service Utilization and Associated Factors Among Mothers/Caregivers of Children 0-23 Months in Sude District, Southeast Ethiopia.

Inadequate physical growth and poor development are significant global challenges affecting millions of children. Globally, 149.2 million children under five experience stunted growth and 45.4 million suffer from wasting. Growth monitoring and promotion (GMP) programmes aim to identify growth faltering in children before they develop malnutrition. However, understanding the factors influencing GMP service utilization is crucial for improving its effectiveness in the study area. This community-based cross-sectional study in the Sude district of southeastern Ethiopia investigated GMP service utilization among mothers of children aged 0-23 months. The study included 874 participants selected through systematic random sampling. Data collected through a structured questionnaire revealed a GMP service utilization rate of 40.2%. The study identified several factors significantly associated with GMP service utilization. This includes maternal education, husband involvement, institutional delivery, maternal autonomy and birth interval, which are the most significant factors identified to influence GMP service utilization. Mothers with higher levels of education were more likely to utilize GMP services [AOR = 3.70 (95% CI: 2.09, 6.54)]. Discussions about child growth with husbands were linked to increased GMP utilization [AOR = 2.22 (95% CI: 1.24, 3.968)]. Moreover, mothers who delivered at health facilities and with greater autonomy in decision-making showed higher GMP utilization with [AOR = 1.83 (95% CI: 1.23, 2.72)] and [AOR = 3.79 (95% CI: 2.41, 5.96), respectively. Mothers with longer birth intervals were also more likely to utilize GMP services [AOR = 1.947 (95% CI: 1.39, 2.73)]. The study highlights the importance of addressing these factors to increase GMP service utilization and improve child health outcomes in the study area. Behavioural change communication programmes targeting fathers can promote their engagement in child growth discussions. Moreover, empowering women to make decisions about their children's health and access to healthcare services and promoting open communication within families about child growth and development can raise awareness and support for GMP services. Addressing these factors through targeted interventions will promote GMP utilization and improve child growth and development.

Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis.

The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic. Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019). Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery. The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

Population-level trends over a decade in geographical inequality for opportunity in access to maternal care services: a cross-sectional analysis from the National Family Health Surveys in India

ObjectivesThe objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage...

Association between coordinated counseling from both ASHA and Anganwadi Workers and maternal health outcomes: A cross-sectional study from Madhya Pradesh and Bihar, India.

Community Health Workers (CHWs) play crucial roles in health promotion and services in rural India. Previous research investigating the effectiveness of coordinated health promotion by different community health workers (CHWs) cadres on health practices is scarce. This study examines the effectiveness of coordinated health promotion by different CHW cadres, specifically Accredited Social Health Activists (ASHA) and Anganwadi Workers (AWW), on maternal health outcomes. Using endline data from a 2019 impact evaluation of 6635 mothers with children <12 months in Madhya Pradesh and Bihar, we compared the association between standalone and coordinated counseling by ASHA and AWW on various maternal health practices. Outcomes included four or more antenatal care visits, birth preparedness, institutional delivery, postnatal care visits, and contraceptive uptake. Fixed effects logistic regression with robust standard errors, corrected for multiple hypothesis tests, was used for analysis. Results showed that 39.6% of women received four or more ANC visits, 31.2% adopted birth preparedness practices, 79.6% had institutional deliveries, 23.3% received postnatal care, and 19.5% adopted a postpartum contraceptive method. Coordinated counseling from both ASHA and AWW was associated with a greater prevalence of four outcomes (birth preparedness, institutional delivery, PNC visit, and contraception) compared to standalone counseling from either ASHA or AWWs. These findings suggest that health promotion by AWW complements that of ASHA, collectively associated with improved health outcomes. This study underscores the effectiveness of coordinated health promotion and highlights the need for multisectoral and coordinated efforts among different CHW cadres at the community level. The results emphasize the importance of integrating various CHW roles to enhance maternal health practices and outcomes in rural India. Trial registration number: https://doi.org/10.1186/ISRCTN83902145. Date of registration: 08/12/2016.

Community boat service to promote institutional delivery in the Philippines: a mixed-methods study of a social innovation

BackgroundRemote islands have limited access to institutional obstetric care, and these challenges are further exacerbated by climatic threats. A Health Service Boat Project was implemented in rural Philippines to provide free boats for pregnant people to deliver at facilities and facilitate prenatal outreach.ObjectiveTo evaluate the impact of the boat project on institutional delivery rates and to explore the underlying mechanism.MethodsA sequential mixed-methods study was conducted in Zumarraga Municipality, Philippines. In the quantitative component, we analysed the data from nationally representative household surveys and governmental data to assess the institutional delivery rate before and after the boat project started in 2012. Linear difference-in-difference regression analysis was used to test the intervention effects of the boat project on institutional delivery. Weather information obtained from the Philippine Atmospheric, Geophysical and Astronomical Services Administration was used to compare the institutional delivery rate between cyclone-affected and non-cyclone-affected periods. In the qualitative component, we conducted two focus group discussions and two semistructured interviews to explore how the boat service may have improved the institutional delivery rate.ResultsThe institutional delivery rate significantly increased the year after the boat project started (B=0.38, p&lt;0.001). The median institutional delivery rate during the cyclone-affected period was significantly lower than that during the non-cyclone-affected period but still remained high at 93.3%. Pregnant women who used the boat service to facilitate institutional delivery reported that they trusted the service, which was available regardless of economic status and political affiliations. The boat project also allowed community health workers to conduct more frequent prenatal check-ups in the community, leading to an improved rapport between health workers and women. The main challenge identified during the implementation was the limited budget for long-term maintenance of the boat.ConclusionThe boat project not only facilitated transportation for pregnant people to the facility but also improved community-based prenatal services. In addition, the boat project may mitigate some of the effects of cyclones on access to health services for pregnant people.

Maternal and child health services during COVID-19 in India: Highlighting the role of primary care physicians in maintaining continuum of care

ABSTRACT Background: This study aims to address the lack of substantial evidence regarding the effect of COVID-19 on maternal and child health (MCH) services in India and also highlight the role of primary care physicians in maintaining essential services during a pandemic. While studies conducted worldwide and in India have examined the effects of COVID-19 on these services, a significant gap in robust evidence remains. Methods: Forty-two districts were selected randomly from seven regional states of India. Data on five selected MCH indicators were extracted from HMIS for the months from March to June 2019 and 2020. Relative changes in service utilization for each month from March to June over the two years were compared. Comparisons were also made between the selected districts based on the COVID-19 categorization into red and green zones. Results: COVID-19 and its associated restrictive measures created significant disruption to essential MCH service utilization in India across all states reviewed. Both institutional, and outreach services were impacted; however, hospital-based services were more impacted. Institutional deliveries and emergency obstetric services saw a decline in March and April 2020 which gradually improved between May and June in some states. Immunization sessions held in 2020 observed a decrease in April. Conclusions: The analysis indicates a disruption in service delivery during the initial phase of the lockdown. However, the services resumed gradually as national and state-specific operational guidelines were implemented to maintain a continuum of care.

Association of the distance travelled, and the call to hospital arrival time with early neonatal mortality in neonates born to mothers using emergency medical services at term gestation: a retrospective observational study

BackgroundMost neonatal deaths in India occur due to a lack of timely and proper care just before and during delivery. Timely availability of an ambulance for institutional delivery has led...

SWOT analysis of Janani Suraksha Yojana among women of Western Uttar Pradesh, India

ABSTRACT Introduction: In April 2005, under the umbrella of National Rural Health Mission (NRM) in response to the slow and varied progress in improvement of maternal and neonatal health, the Government of India launched a scheme known as Janani Suraksha Yojana (ISY) Objectives: With the help of this study, we intend to understand the knowledge, source of information, awareness, and barriers to acceptance of JSY among women in Western Uttar Pradesh and conduct a SWOT analysis for the same. Material and Methods: The sample size was 300 and calculated using the prevalence of institutional delivery taken from National Family Health 2015-16 Survey (NFHS-4) in Uttar Pradesh, India, which was 67.8%. Data were analysed using appropriate statistical tests by Statistical Package for Social Sciences (SPSS) software and Microsoft excel. Results: Grassroot-level workers, namely, ASHA, ANM, AWW, and Dai, were an important source of information regarding JSY in the rural area with 68% beneficiaries saying that they got their information about JSY from them compared to only 22% in the urban area. Out of the 105 beneficiaries who delivered at home, the two most common reasons for noninstitutional delivery were the cost of the institutional delivery (51.4%) and home is convenient (47.696). Conclusion: Cash incentives help in the use of health services such as antenatal care, postnatal care, and counselling services. Less focus and ASHA coverage in urban areas as compared to rural areas.

Determinants of rural‑urban child malnutrition disparities in Ethiopia

Child malnutrition is a significant issue in Ethiopia, with high prevalence rates. However, there is limited information on the rural‑urban disparities in child malnutrition of all its forms (stunting, wasting, and underweight) in the country. Therefore, this study aimed to address this gap by analysing data from the 2019 Ethiopian Demographic Health Survey (EDHS). This study examined the rural‑urban child malnutrition gaps in Ethiopia using an extended Oaxaca-Blinder decomposition technique. The analysis reveals significant ruralurban disparities in prevalence rates of wasting, underweight, and stunting. The findings highlighted that children in rural areas are more malnourished than their urban counterparts. Additionally, the study identified key determinants of these disparities, including maternal and parental education, household economic status, women’s age at first birth, childbirth size, and working status of women. The results also indicate that institutional delivery, household size, and dependency ratio contribute to widening the rural‑urban disparities in child malnutrition. This study highlighted the importance of targeted policies and interventions to address these disparities and reduce child malnutrition at the national level.

Institutional Delivery in the Philippines: Does a Minimum of 8 Antenatal Care Visits Matter?

This cross-sectional study investigated the association between the utilization of 8 antenatal care (ANC) visits and delivery in a healthcare institution in the Philippines, using data from the 2022 National Demographic and Health Survey. A sample of women who had given birth within the past 3 years was selected for analysis (n=4452). The association between ANC utilization and institutional delivery was assessed using logistic regression models, covariates by relevant sociodemographic factors, and childbirth history. We found that 97.2% of respondents who completed antenatal care opted for institutional delivery. A higher proportion of rural residents did not undergo institutional delivery than urban residents (12.9% vs. 6.9%). The group aged 20-24 years had the highest coverage (92.8%), and the group aged 40-44 years had the lowest. Higher education levels, employment, and greater wealth were associated with higher institutional delivery rates. Divorced or widowed mothers (85.1%) and grand multiparous mothers had lower rates than other groups. Multivariable logistic regression analysis showed a significant positive association between ANC utilization and institutional deliveries after adjusting for covariates (adjusted odds ratio, 2.486; 95% CI, 2.485-2.487; p<0.001). ANC visits were associated with deliveries in institutions in the Philippines. Policymakers should promote ANC by ensuring 8 WHO-recommended visits, strengthening programs, conducting community outreach, addressing access barriers, and integrating maternal health services to increase institutional births and improve maternal and infant health.

Resident Unions: Why Now and Will They Change Medical Education and Health Care?

During the COVID-19 pandemic, resident unions proliferated. While unionization resulted in increased compensation and benefits, the process of union negotiations may have created adversarial relationships between residents and their institutions' leadership, who residents depend on for supervision and the development of clinical expertise. Such adversarial relationships could affect the learning environment, which is critical to the delivery of high-quality care. In this commentary, the authors suggest that academic medical centers should offer residents an authentic seat at the institutional care delivery leadership table, ensuring residents' full participation in key organizational decisions. Doing so represents an alternative to unionization, with its potentially adversarial relationships, while still achieving a key goal of residents-to be included in the decisions that affect them and the care they provide. In this way, residents can use their unique understanding of the institutions' strengths and weaknesses to improve the quality of patient care and the learning environment. Such engagement can also help residents achieve competence in systems-based practice and provide a vital link between institutions and the patients and community they serve through health policy and advocacy activities.

Exploring Indigenous Ways of Childbirth Management and its Perinatal Outcomes During Cyclonic Periods in Hilly Tribal Homebirth Settings: A Qualitative Observational Study

Objective This study explores the cultural-based management of childbirth vulnerabilities in the hilly regions during cyclone periods, where the land mass has been frequently exposed to floods during and aftermath of cyclones due to low-high cyclonic depressions in the Bay of Bengal coast. Methods The present study was a community-based qualitative observational study conducted for three weeks immediately after the two cyclonic periods occurred between October and December 2022. With the purposive sampling method, 21 postpartum mothers were selected on the inclusion criteria, of having had childbirth around the cyclonic period of ‘Sitrang’ (late October 2022) and ‘Mandous’ (early December 2022). Semi-structured in-depth interview schedules were employed to document socio-demographic profiles and probed for their cultural ways of managing childbirth complications and neonatal exposures to infections during the cyclonic period. Results Views of 21 mothers were coded into three themes with two sub-themes each according to repeated frequencies of information. The themes were (a) Striving for Safe Childbirths; (b) Surviving with Traditional Capacities; (c) Strength and Sustenance. The results indicated that home deliveries were considered safest over institutional deliveries except in the cases of complicated childbirths confirmed difficult by the traditional birth attendants (TBA). Rough climatic conditions compounded by geographical distance, lack of appropriate financial help and timely transportation facilities were the major prevailing factors influencing their childbirth practices during the cyclonic periods. Conclusion Disasters do not alone influence childbirth outcomes, but the evidence is still mixed. The expediency of birth technology has effectively managed childbirth vulnerabilities. Ensured sleep, rest and enough food had also been disturbed during and aftermath cyclones. The results showed an urgent need for focused planning on tribal areas for gestation, birthing and postpartum people during natural disasters.