Delivery Service Utilization Research Articles

Post-natal care: a vital chance to save mothers and infants! Exploring barriers and factors associated with it: a mixed study.

The most effective maternal health intervention for enhancing mother and baby survival is postnatal care, yet it is also the most neglected service in Ethiopia. Less is known about postnatal care despite earlier studies concentrating on pregnancy and delivery service utilization. Postnatal care is the subject of few national and local area studies. Therefore this research aims to evaluate postnatal care utilization and barriers and associated characteristics among women in Ilubabor Zone and Buno Bedele Zone. A mixed-methods study involving women who visited immunization clinics was conducted in Southwest Ethiopia. For the quantitative part, a cross-sectional survey was conducted between June 12 and July 12, 2022. The data collected through interviews was analyzed using SPSS version 26. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value was constructed to evaluate the associations between postnatal care service utilization and explanatory variables. The usage of postnatal care services was determined to be significantly correlated with explanatory variables in multivariable logistic regression with a p-value less than 0.05. This qualitative study used two focused group discussions and two in-depth interviews to gather data from purposely selected mothers, and thematic analysis was used to analyze the data. A total of 422 participants with a 100% response rate were included in the analysis. 234 (55.5%) of these underwent postnatal checks. In the quantitative section, postnatal care counseling and appointment setting, counseling on danger signs, and prior postnatal care utilization all demonstrated a statistically significant association with the use of postnatal care services (AOR = 3.6, 95% CI (1.47-7.23)), [AOR = 2, 95% CI (1.05-3.64)], and [AOR = 3, 95% CI (1.36-58), respectively). At the qualitative level, it was determined that the themes of knowledge and access were obstacles to the use of postpartum care services. Generally this study revealed that the Ilubabor Zone and Buno Bedele Zone have a poor total PNC service utilization rate. Furthermore, ignorance, conventional wisdom, religious activity, distance from facilities, environmental exposure, and waiting time were identified as barriers to postnatal care service utilization. To optimize this service, all parties involved should address these factors.

How has COVID-19 affected the work environment of delivery workers?: An interpretative phenomenological analysis.

The COVID-19 pandemic has sparked a rapid worldwide increase in the utilization of delivery services. This study delves into the experiences of delivery workers as one of the activley developed industries during the COVID-19 pandemic in South Korea and sheds light on the effects of the pandemic on their working conditions. Through in-depth interviews with 10 Korean delivery workers, data analysis employed the hermeneutic phenomenology research method developed by Van Manen. The findings indicate a substantial rise in income levels and a positive societal perception of delivery labor post-COVID-19. The pandemic also attracted many new workers to the industry due to low entry barriers and work flexibility. However, challenges persisted as delivery workers grappled with an uncertain legal status and sometimes jeopardized their safety to boost earnings in shorter time frames. The pivotal role played by delivery workers in enhancing communal quality of life and connectivity during the pandemic cannot be overlooked. As we step into a post-COVID-19 era, comprehensive efforts are needed to enhance the working environment for delivery workers globally. Notably, clarifying the relationship between delivery workers and companies within the novel digital labor landscape is essential, alongside establishing institutional frameworks to safeguard workers' basic rights, including health and safety provisions.

Multilevel logistic regression analysis of factors associated with delivery care service utilization among childbearing women in Ethiopia.

Delivery service utilization is one of the key and proven interventions to reduce maternal death during childbearing. In Ethiopia, the utilization of health facilities for delivery service is still at a lower level. This study intends to model the determinant factors for the delivery care service utilization of childbearing mothers in Ethiopia using the 2016 Ethiopian demographic and health survey data. A cross-sectional study design was selected to assess factors associated with delivery care among mothers who had at least one child in the last 5 years before the survey aged 15-49 years in the data. Among these eligible mothers, 3,052 (27.7%) mothers had received delivery service care from health professionals. The results of multilevel logistic regression indicated that those at age 35-49 years (AOR = 0.7808, 95% CI: 0.5965-1.1132), an urban place of residence (AOR = 5.849 95% CI: 4.2755-8.0021), woman's higher level of education (AOR = 3.484, 95% CI: 2.0214-6.0038) and partner's higher educational level (AOR = 1.9335, 95% CI: 3,808-2.07352), household wealth index (AOR = 1.99, 95% CI: 1.724-2.3122), most every day exposed to mass media (AOR = 3.068, 95% CI: 1.456-6.4624), 2-4 birth order number (AOR = 0.604, 95% CI: 0.51845-1.4213), using contraceptive type (AOR = 1.4584, 95% CI: 1.2591-1.6249) and visiting more than 4 antenatal care visits (AOR = 7.574, 95% CI: 6.4824-8.84896) were more likely to give birth at a health facility compared to their counterparts. The woman's and partner's educational level, household wealth index, exposure to mass media and number of antenatal care visits had a positive association with delivery assistance whereas birth order had a negative association. The findings of this study were valuable implications to support strategies and interventions to address delivery care service in Ethiopia.

Non-compliance Analysis of Independent Participants Paying BPJS Health Contributions After Utilization of Delivery Services

Losses experienced by BPJS Health due to payment of contributions that have been stopped for participants who have used maternity services of more than 200 billion in a span of 2 years. It was recorded that 64.7% of mothers who were about to give birth registered as participants a month before giving birth and then quit (43%) or did not comply with the payment after delivery. The largest percentage comes from independent participants or non-wage recipients (PBPU). In Jambi Province, non-compliance in paying BPJS Health contributions is the highest in Jambi City. There were 77,489 participants in arrears in 2021 which resulted in a loss of 60.1 billion. Non-compliance in paying dues comes from multiple factors. The purpose of this study is to analyze the factors causing the non-compliance of independent participants in paying BPJS Health contributions after utilizing childbirth services in Jambi City. A quantitative study approach with a cross-sectional design conducted in Jambi City in 2022. There were 96 respondents who were selected based on the accidental sampling technique. The study instrument was a questionnaire. Quantitative data processing through the stages of editing, coding, entry and cleaning with SPSS. Data analysis consisted of univariate analysis and bivariate analysis using chi-square test. The results of the study found that as many as 33.3% of independent participants did not comply in paying BPJS Health contributions after using childbirth services. There is a significant relationship between the number of family members (p = 0.001), knowledge (0.000), perception of illness (p = 0.001), clinical assessment (p = 0.000), and willingness to pay (WTP) with the non-compliance of independent participants in paying BPJS Health contributions. after the use of maternity services. It is recommended for BPJS Health to consider the application of the waiting period method for participants who will take advantage of maternity services. As well as increasing promotive activities for the Jambi City Government in educating and increasing public awareness about the importance of health insurance in protecting household financing.

Young mothers' attitudes towards domestic violence and their maternal healthcare services utilization in Bangladesh: A multilevel cluster analysis.

This paper examined the association between young mothers' attitudes towards domestic violence and four or more antenatal care (ANC) and health-center-based delivery service utilization using two cross-sectional waves of the Bangladesh Demographic and Health Surveys (2014 and 2018) data. We carried out a multilevel logistic regression analysis. Findings show that a strong cluster variation exists in four or more ANC and health-center-based delivery service utilization. Although the utilization of four or more ANC and health-center-based delivery services has increased over the years, it is far behind the targets of SDGs, particularly for young mothers with justified attitudes towards domestic violence. Extension of maternity allowance coverage and motivational programs are important policy recommendations.

Delay in Reaching Institutional Delivery Service Utilization among Mothers Attending Jimma Medical Center, Ethiopia.

Maternal delay in the utilization of delivery services is one of the contributing factors for high maternal mortality in developing countries. However, it is preventable by timely arrival for obstetric care. The difference between life and death in obstetrics might be a matter of timely arrival and management. The objective of this study was to assess factors associated with maternal delay in reaching institutional delivery service utilization among mothers attending Jimma Medical Center. Facility-based cross-sectional study design was employed. The sample size was determined by a single population proportion formula and entered into epi data version 3.1, then exported to SPSS version 23. The data was presented using texts and tables. Binary and multivariable logistic regression analysis with 95% CI for odds ratio (OR) was used to assess the factors. The prevalence of maternal delay in reaching institutional delivery service utilization was 163(40.2%). Low husbands' educational levels were significantly associated with delay in reaching: illiterate (AOR=4.22, 95% CI: 1.10-16.19), primary (AOR=3.88, 95% CI: 1.24-12.1). Mothers who live in rural areas have been delayed 2 times more than mothers who live in urban areas (AOR=2.22, 95% CI: 1.044-4.73). Likewise, mothers who live a long distance from health facilities are 13 times more likely to delay than mothers who live ≤ 10 kilometers (AOR= 12.89,95%CI:6.66-24.94). Delay in reaching institutional delivery service was high. Factors such as husband's education, distance of health facility, and living area were significant factors with delay in reaching.

Maternal health services utilization and its contributing factors among adolescent mothers

Adolescent girls (15-19 years old) experienced childbirth face the higher risk for maternal mortality than older women. This study aimed to assess the utilization level of maternal health services and to identify factors that contribute to the maternal health services utilization in Indonesian adolescent mothers. The study used secondary data from 2017 Indonesia Demographic and Health Survey (IDHS) and included women who had last birth at the age of 15-19 years old which total is 866 women. Among adolescent mothers, the highest level of utilization is post-natal care (PNC) (71.5%) followed by antenatal care (ANC) (67.2%) then delivery services (64.5%). Factors that associated with ANC utilization are husband/partner’s education, mother’s autonomy, region, husband accompanied during ANC, topic discussed during ANC, and intendedness of last birth (p<0.05). Factors contributed to delivery services are mother’s education, mother’s working status, mother’s autonomy, residence, region, wealth index, health insurance, husband accompanied during ANC, and topic discussed during ANC (p<0.05). Whereas, for PNC utilization are knowledge of danger sign during childbirth, residence, region, and delivery services utilization (p<0.05). Therefore, health strategic programs which focused on adolescent mothers are necessary to improve the maternal health in Indonesia.

The effects of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin: a cross-sectional study

BackgroundThe world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is considered a major obstacle hampering the use of appropriate MCH services. Benin, a country where the southern and northern parts belong to different geographical zones, has among the highest maternal mortality rate in the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of geographical accessibility to health facilities on antenatal care and delivery services utilization in Benin, with an emphasis on geographical zones.MethodsWe pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 18,105 women aged 15–49 years (9111 from BDHS-2011/2012 and 8994 from BDHS-2017/2018) who had live births within five years preceding the surveys. We measured the distance and travel time from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of geographical access on pregnancy and delivery services utilization. We conducted a propensity score-matching analysis to check for robustness.ResultsRegression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in straight-line distance to the closest health center reduces the odds of the woman receiving at least one antenatal care by 0.042, delivering in facility by 0.092, and delivering her baby with assistance of skilled birth attendants by 0.118. We also confirmed the negative effects of travel time and altitude of women’s residence on healthcare utilization. Nonetheless, these effects were mainly seen in the northern part of Benin.ConclusionsGeographical accessibility to health facilities is critically important for the utilization of antenatal care and delivery services, particularly in the northern part of Benin. Improving geographical accessibility, especially in rural areas, is significant for further use of maternal health care in Benin.

Utilisation of quality antenatal, delivery and postnatal care services in Nepal: An analysis of Service Provision Assessment

BackgroundNepal has improved access and utilisation of routine maternal and newborn health (MNH) services. Despite improved access to routine MNH services such as antenatal care (ANC), and delivery and postnatal care (PNC) services, the burden of maternal and neonatal deaths in Nepal remains high. Most of those deaths could be prevented by improving utilisation of evidence-informed clinical MNH interventions. However, little is known on determinants of utilisation of such clinical MNH interventions in health facilities (HFs). This study investigated the determinants of utilisation of technical quality MNH services in Nepal.MethodsThis study used data from the 2015 Nepal Services Provision Assessment. A total of 523 pregnant and 309 postpartum women were included for the analysis of utilisation of technical quality of ANC, and delivery and PNC services, respectively. Outcome variables were utilisation of better quality i) ANC services, and ii) delivery and PNC services while independent variables included features of HFs and health workers, and demographic characteristics of pregnant and postpartum women. Binomial logistic regression was conducted to identify the determinants associated with utilisation of quality MNH services. The odds ratio with 95% confidence interval (CIs) were reported at the significance level of p < 0.05 (two-tailed).ResultsWomen utilised quality ANC services if they attended facilities with better HF capacity (aOR = 2.12;95% CI: 1.03, 4.35). Women utilised better quality delivery and PNC services from private HFs compared to public HFs (aOR = 2.63; 95% CI: 1.14, 6.08). Women utilised better technical quality ANC provided by nursing staff compared to physicians (adjusted odds ratio (aOR) =2.89; 95% CI: 1.33, 6.29), and from staff supervised by a higher authority compared to those not supervised (aOR = 1.71; 95% CI: 1.01, 2.92). However, compared to province one, women utilised poor quality delivery and PNC services from HFs in province two (aOR = 0.15; 95% CI: 0.03, 0.63).ConclusionsWomen utilised quality MNH services at facilities with better HF capacity, service provided by nursing staff, and attended at supervised HFs/health workers. Provincial and municipal governments require strengthening HF capacities (e.g., supply equipment, medicines, supplies), recruiting trained nurse-midwives, and supervising health workers.

Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis.

Background Access to and utilization of facility delivery services is low in Ethiopia. The government of Ethiopia introduced a free delivery service policy in all public health facilities in 2013 to encourage mothers to deliver in health facilities. Examining the effect of this intervention on the utilization of delivery services is very important. Objective In this study, we assessed the effect of provisions of free maternity care services on facility-based delivery service utilization in central Ethiopia. Methods Data on 108 time points were collected on facility-based delivery service utilization (72 pre- and 36 postintervention) for a period of nine years from July 2007 to June 2016. Routine monthly data were extracted from the District Health Information System and verified using data from the delivery ward logbooks across the study facilities. An interrupted time-series analysis was conducted to assess the effect of the intervention. Results The implementation of the free delivery services policy has significantly increased facility deliveries. During the study period, there was a statistically significant increase in the number of facility-based deliveries after the 24th and 36th months of intervention (p < 0.05). Program effects on the use of public facilities for deliveries were persisted over a longer exposure period. Conclusion The findings suggested that the provision of free delivery services at public health facilities increased facility delivery use. The improved utilization of facility delivery services was more marked over a longer exposure period. Policy-makers may consider mobilizing the communities aware of the program at its instigation.

Maternal Decision-Making Input and Health-Seeking Behaviors Between Pregnancy and the Child\u2019s Second Birthday: A Cross-Sectional Study in Nepal

ObjectivesMaternal health-seeking behaviors are critical to improving maternal and child health in low-income countries. This study investigates associations between maternal decision-making input and their health-seeking behaviors in the first 1000-day period between pregnancy and a child’s second birthday in Nepal.MethodsWe used data from a cross-sectional survey conducted in 2018 in 16 districts of Nepal. Among the 3648 households surveyed, 1910 mothers of a child 0 to 24 months with complete data were included for analyses. Logistic regression was used to examine associations between decision-making input and the utilization of antenatal, delivery and postnatal care services, and attendance at health mothers’ group (HMG) meetings. We also used negative binomial regression to assess the relationship between her decision-making input and participation in growth monitoring and promotion (GMP) in the 6 months prior to the survey. For each relationship examined, we adjusted for clustering, as well as potentially confounding factors at individual and household levels.ResultsAfter adjusting for confounders, maternal decision-making input had a small but positive and significant association with receiving at least 4 antenatal care visits (OR = 1.09, 95% CI 1.02, 1.17), attendance at GMP in the 6 months prior to the survey (IRR = 1.02, 95% CI 1.00, 1.04), and HMG attendance (OR = 1.10, 95% CI 1.03, 1.17), but not with receiving at least 3 postnatal care visits or delivering in a health institution.Conclusions for PracticeOur findings indicated that empowering women and mothers in household decision-making might warrant greater attention when developing future policies and programs in Nepal.

Institutional delivery service utilization and associated factors in Ethiopia: a systematic review and META-analysis

BackgroundThere is wide variation in the utilization of institutional delivery service in Ethiopia. Various socioeconomic and cultural factors affect the decision where to give birth. Although there has been a growing interest in the assessment of institutional delivery service utilization and its predictors, nationally representative evidence is scarce. This study was aimed to estimate the pooled national prevalence of institutional delivery service utilization and associated factors in Ethiopia.MethodsStudies were accessed through PubMed, Cochrane library, Web of Science, and Google Scholar. The funnel plot and Egger’s regression test were used to see publication bias, and I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of institutional delivery service utilization and associated factors.ResultTwenty four studies were included in this review. The pooled prevalence of institutional delivery service utilization was 31% (95% Confidence interval (CI): 30, 31.2%; I2 = 0.00%). Attitude towards institutional delivery (Adjusted Odd Ratio (AOR) = 2.83; 95% CI 1.35,5.92) in 3 studies, maternal age at first pregnancy (AOR = 3.59; 95% CI 2.27,5.69) in 4 studies, residence setting (AOR = 3.84; 95% CI 1.31, 11.25) in 7 studies, educational status (AOR = 2.91;95% 1.88,4.52) in 5 studies, availability of information source (AOR = 1.80;95% CI 1.16,2.78) in 6 studies, ANC follow-up (AOR = 2.57 95% CI 1.46,4.54) in 13 studies, frequency of ANC follow up (AOR = 4.04;95% CI 1.21,13.46) in 4 studies, knowledge on danger signs during pregnancy and benefits of institutional delivery (AOR = 3.04;95% CI 1.76,5.24) in 11 studies and place of birth of the elder child (AOR = 8.44;95% CI 5.75,12.39) in 4 studies were the significant predictors of institutional delivery service utilization.ConclusionThis review found that there are several modifiable factors such as empowering women through education; promoting antenatal care to prevent home delivery; increasing awareness of women through mass media and making services more accessible would likely increase utilization of institutional delivery.

Maternal health services utilisation among primigravidas in Uganda: what did the MDGs deliver?

BackgroundAchieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.MethodsGuided by Andersen’s Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.ResultsThe analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women’s household decision-making power, place of residence as important determinants of ANC visits and SBAs.ConclusionsBased on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.

Medical Perspective of Childhood Marriage in Nigeria: Body of Evidence from 2013 Nigeria Demographic and Health Survey

Background: Available data from South Asia and sub-Saharan Africa indicates that 12% and 34% of girls were married at age 15years and 18years respectively. This practice of child marriage may debar countries from achieving the Sustainable Development Goals. Objective: To extract and present disaggregated indices in the 2013 Nigeria Demographic and Health Survey (NDHS) on the effect of child marriage on health. Method: This desk review study extracted disaggregated maternal and child health indices on married females aged 15-19 years from the 2013 NDHS. Results: The result showed that married females aged 15-19 years were short, thin, and least likely to receive prophylactic Vitamin A dose postpartum and deworming medication at last pregnancy. Also, while awareness for Family Planning (FP) was high, its utilization was poor at only 1.2%. Their Antenatal clinic attendance, facility delivery, skilled birth attendance at delivery and post natal service utilization were lowest. Similarly, mortality of children under 5 was highest amongst these mothers. Although violence during pregnancy was highest amongst this group, nevertheless more than 20% of them agreed that the practice of female circumcision should be continued. Conclusion: These findings depict some of the negative outcomes of child marriage on maternal and child survival which require integrated multisectoral interventions to ensure that all girls have access to timely sexual reproductive health services and information.&lt;/P&gt;

Male Partner Involvement in the Utilization of Hospital Delivery Services by Pregnant Women Living with HIV in Sub Saharan Africa: A Systematic Review and Meta-analysis.

Objective The level of male partner involvement in hospital delivery by pregnant women living with HIV in sub Saharan Africa (SSA) is low. We conducted a systematic review and meta-analysis to identify the approaches that are used in improving male partner involvement and their impact on the utilization of hospital delivery services by pregnant women living with HIV in SSA. Methods Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies carried out in SSA that reported an approach used in involving male partners and the impact on the uptake of hospital delivery services irrespective of the language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. A forest plot was used to show the impact of various male involvement approaches. A funnel plot was used to report publication bias. Results From an initial 2316 non-duplicate articles, 08 articles were included in the systematic review and meta-analysis. The overall pooled OR was 1.56 (95% CI 1.45-1.68). After stratification, the odds ratios were: 1.51 (95% CI 1.38-1.65), 1.58 (95% CI 1.38-1.80), 3.47 (95% CI 2.16-5.58) for complex community interventions without community health workers (CHWs), complex community interventions with community health workers, and verbal encouragement respectively. The overall I-square was 91.0% but after stratification into the three different approaches, the I-squared within the complex community intervention without CHWs group was 0.0%. Conclusions for Practice Complex community interventions and verbal encouragement increase the utilization of hospital delivery services by pregnant women living with HIV in SSA. The overall heterogeneity was high but very low for studies that used complex community interventions without CHWs. More well conducted studies (including randomized controlled trials) are needed in future to add to the quality of evidence.

Husband Participation in birth Prepareness and complication readiness and Utilization of Delivery Services in Indonesia

Husband has potential to engage in three obstetric delays, so husband is expected to be involved in preparation of childbirth and decision-making action against possible complications, in addition to play a role in maintaining maternal health during pregnancy. Although the government has attempted this in the antenatal care policy, participation of husbands has been less successful in motivating mothers to utilize maternal services. This study identify the association between husband participation in birth prepareness and complication readiness with the utilization of delivery services in Indonesia.

Utilization of Kenya’s free maternal health services among women living in Kibera slums: a cross-sectional study

IntroductionThis study was aimed at determining factors affecting utilization of public health facilities by pregnant Kenyan women living in Kibera slums, Nairobi since the implementation of the Free Maternal Service (FMS) Program in 2013.MethodsThis was a cross-sectional study done on 396 women who delivered between 2014 and 2015. Interview questions addressed socio-demographic characteristics, perception of quality of care in public health facilities, awareness of the FMS Program, antenatal care (ANC) and delivery service utilization.Results43.9% delivered in a public health facility, 30.3% in a private non-profit health facility (NGO), 22.7% in a private health facility and 3.0% at home. Of the 97% of the women who delivered in a health facility, only 43.9% delivered in a public health facility despite these facilities having free maternal services. Factors that favoured the Free Maternal Service uptake included a positive perception of the public health facility, living within close proximity, learning about the Program from a support group and a short waiting time before being examined by the doctor. On the other hand, safe delivery, quality of service, accessing a health facility on foot, ANC attendance at a private and a non-profit health facility were associated with low uptake of the free maternal services.ConclusionThe uptake of the Free Maternal Service program can improve if the Kenyan government directs its efforts towards changing women’s perception on quality of care in public health facilities and to improve access to health facilities in slum areas of Nairobi.

Changing times? Gender roles and relationships in maternal, newborn and child health in Malawi

BackgroundFor years, Malawi remained at the bottom of league tables on maternal, neonatal and child health. Although maternal mortality ratios have reduced and significant progress has been made in reducing neonatal morality, many challenges in achieving universal access to maternal, newborn and child health care still exist in Malawi. In Malawi, there is still minimal, though increasing, male involvement in ANC/PMTCT/MNCH services, but little understanding of why this is the case. The aim of this paper is to explore the role and involvement of men in MNCH services, as part of the broader understanding of those community system factors.MethodsThis paper draws on the qualitative data collected in two districts in Malawi to explore the role and involvement of men across the MNCH continuum of care, with a focus on understanding the community systems barriers and enablers to male involvement. A total of 85 IDIs and 20 FGDs were conducted from August 2014 to January 2015. Semi-structure interview guides were used to guide the discussion and a thematic analysis approach was used for data analysis.ResultsPolicy changes and community and health care provider initiatives stimulated men to get involved in the health of their female partners and children. The informal bylaws, the health care provider strategies and NGO initiatives created an enabling environment to support ANC and delivery service utilisation in Malawi. However, traditional gender roles in the home and the male ‘unfriendly’ health facility environments still present challenges to male involvement.ConclusionTraditional notions of men as decision makers and socio-cultural views on maternal health present challenges to male involvement in MNCH programs. Health care provider initiatives need to be sensitive and mindful of gender roles and relations by, for example, creating gender inclusive programs and spaces that aim at reducing perceptions of barriers to male involvement in MNCH services so that programs and spaces that are aimed at involving men are designed to welcome men as full partners in the overall goals for improving maternal, neonatal and child health outcomes.

Utilization of institutional delivery service and associated factors in Bench Maji zone, Southwest Ethiopia: community based, cross sectional study

BackgroundAt the end of Millennium development goals, Ethiopia was included among 10 countries which constitutes about 59% of maternal deaths due to complications of pregnancy and/or childbirth every year globally. Institutional delivery, which is believed to contribute in reduction of maternal mortality is still low. Hence this study was conducted in order to assess utilization of institutional delivery and related factors in Bench Maji zone, Southwest Ethiopia.MethodsCross sectional study was employed from September 1st – 30th, 2015 in Bench Maji Zone, Southwest Ethiopia where 765 mothers who deliver 2 years preceding the study provided data for this research. Data were collected by enumerators who were trained. In addition to descriptive statistics, binary and multivariate logistic regression analyses were performed. Statistical significance was considered at a p-value < 0.05. Strength of association was also assessed using odds ratios with a 95% confidence intervals.ResultsAbout 800 mothers were approached but 765 of them who gave birth 2 years preceding the survey participated and gave consent to the data included in the analysis. About 78.30% delivered their last child in health institution while rest gave birth at home. Factors such as maternal age, religion, occupation, availability of information source as TV/Radio, income quartile, residence, knowledge of problems during labor and antenatal follow up had association with institutional delivery which was significant.ConclusionIn Bench Maji Zone institutional delivery was shown to be comparatively good compared to other studies in the region and in Ethiopia in general even though it is below the health sector transformation plan of Ethiopia which aimed to increase deliveries attended by skilled health personnel to 95%. Empowering women, increasing awareness about institutional delivery and proper scaling up of antenatal care services which is an entry point for institutional delivery are recommended.

Barriers to Institutional Delivery-A Study on Tribals of Narmada District

Background: Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy or childbirth.1 as the health of newborn is directly linked with the health and wellbeing of mother, so interventions have been planned to address the issues of maternal health. Through National Rural Health Mission extensive focus has been made on institutional delivery services in order to develop millennium development goals no 1, 4 and 5 2 .In the process of utilization of health care particularly with respect to institutional delivery there are many challenges, and that increases to many fold if it is related to addressing the challenges related to tribal areas. The study explores the barriers to institutional delivery at tribal areas. Methods: Random sampling technique was adopted for the selection of blocks of the district. Qualitative methodology was adopted for the collection of data. The tools used for data collection were In-depth interview, Observation and Case study. The target population for gathering information were pregnant women, Female health workers, Medical officers and staff Nurses of PHC. Results: The main barriers in terms of utilization of institutional delivery services were, Lack of awareness about institutional delivery and government health schemes, Social customs as barriers, poor economic condition of the family, Lack of communication network. Conclusion: The institutional delivery services in tribal areas are affected by various factors which if remain addressed will lead to increase in maternal deaths in the region. The barriers to institutional delivery at tribal areas can be addressed with effective planning.