Delivery Service Utilization Research Articles

Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal

ABSTRACTUse of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen’s behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother’s education, encouraging them to attend ANC visits and addressing disparities between different regions.

Determinants of institutional delivery service utilization among pastorals of Liben Zone, Somali Regional State, Ethiopia, 2015.

Maternal health service utilizations are poorly equipped, inaccessible, negligible, and not well documented in the pastoral society. This research describes a quantitative and qualitative study on the determinants of institutional delivery among pastoralists of Liben Zone with special emphasis on Filtu and Deka Suftu woredas of Somali Region, Ethiopia. The study was funded by the project “Fostering health care for refugees and pastoral communities in Somali Region, Ethiopia”. This community-based cross-sectional study was conducted during November 2015. Interviews through a questionnaire and focus group discussions were used to collect the data. Proportional to size allocation followed by systematic sampling technique was used to identify the study units. The major determinants of institutional delivery in the study area were as follows: being apparently healthy, lack of knowledge, long waiting time, poor quality services, cultural beliefs, religious misconception, partner decision, and long travel. Around one-third (133, 34.5%) of the women had visited at least once for their pregnancy. More than half (78, 58.6%) of the women had visited health facilities due to health problems and only 27 (19.9%) women had attended the recommended four antenatal care visits. Majority (268, 69.6%) of the pregnant women preferred to give birth at home. Women who attended antenatal care were two times more likely to deliver at health facilities (AOR, 95% confidence interval [CI] =2.38, 1.065–4.96). Women whose family members preferred health facilities had 14 times more probability to give birth in health institutions (AOR, 95% CI =13.79, 5.28–35.8). Women living in proximity to a health facility were 13 times more likely to give birth at health facilities than women living far away (AOR, 95% CI =13.37, 5.9–29.85). Nomadic way of life, service inaccessibility, and sociodemographic and cultural obstacles have an effect on the utilization of delivery services. Increasing access, information, education, and communication need to reach pastoral women in need.

Level of Institutional Delivery Service Utilization and Associated Factors among Women who Gave Birth in the Last One Year in Gonji Kollela District, Amhara Region, Ethiopia: Cross-Sectional Study

Background: Institutional delivery is giving birth in health institution under the Overall supervision of trained health professional. Proper care during pregnancy and delivery is important for the health of both the mother and the baby. Methods: Collected questionnaires were checked for completeness coded and entered into SPSS version 16.0 software package. The strength of association of predictor variables with institutional delivery service utilization was assessed using odds ratio with 95% confidence interval. Results: From a total of 573 respondents, only 97 (16.9%) of them gave birth at health facilities and majority of them (83.1%) delivered at home. Regarding preference of the mothers about delivery place during their last pregnancy, 310 (54.1%) preferred to deliver at home, 148 (25.8%) preferred to give birth in health facilities with the assistance of skilled professionals and 20.1% of the mothers preferred to deliver in their mother’s home. Most of the respondents 315 (55%) of mothers prefer to be attended by their mothers and relatives and 190 (34%) preferred traditional (untrained) birth attendants. Conclusion: Low utilization of institutional delivery service and low antenatal care visit in their last pregnancy. Mothers who gave birth at home without a skilled attendant were account the large proportion. Educational status, monthly incomes, ANC visit, distance of health institute, gravidity and abortion experience were significantly associated with the utilization of institutional delivery service.

Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso.

BackgroundSeveral African countries have recently reduced/removed user fees for maternal care, producing considerable increases in the utilization of delivery services. Still, across settings, a conspicuous number of women continue to deliver at home. This study explores reasons for home delivery in rural Burkina Faso, where a successful user fee reduction policy is in place since 2007.MethodsThe study took place in the Nouna Health District and adopted a triangulation mixed methods design, combining quantitative and qualitative data collection and analysis methods. The quantitative component relied on use of data from the 2011 round of a panel household survey conducted on 1130 households. We collected data on utilization of delivery services from all women who had experienced a delivery in the previous twelve months and investigated factors associated with home delivery using multivariate logistic regression. The qualitative component relied on a series of open-ended interviews with 55 purposely selected households and 13 village leaders. We analyzed data using a mixture of inductive and deductive coding.ResultsOf the 420 women who reported a delivery, 47 (11 %) had delivered at home. Random effect multivariate logistic regression revealed a clear, albeit not significant trend for women from a lower socio-economic status and living outside an area to deliver at home. Distance to the health facility was found to be positively significantly associated with home delivery. Qualitative findings indicated that women and their households valued facility-based delivery above home delivery, suggesting that cultural factors do not shape the decision where to deliver. Qualitative findings confirmed that geographical access, defined in relation to the condition of the roads and the high transaction costs associated with travel, and the cost-sharing fees still applied at point of use represent two major barriers to access facility-based delivery.ConclusionsFindings suggest that the current policy in Burkina Faso, as similar policies in the region, should be expanded to remove fees at point of use completely and to incorporate benefits/solutions to support the transport of women in labor to the health facility in due time.

Ecological and socio-demographic differences in maternal care services in Nepal.

Background. Nepal is set to achieve MDG-5 goals by end of 2015. However, maternal health parameters will remain way below those of developed countries. This study was conducted to assess the factors contributing to utilization of ANC and safe delivery services with the aim of furthering overall maternal health parameters in Nepal.Material and Methods. Using survey data from the Nepal Demographic and Health Survey 2011, socio-economic and demographic factors associated with the utilization of ANC and safe delivery services among women aged 15–49 years who gave births during the last three years preceding the survey are examined. Data was segregated into three ecological zones: Mountain, Hill and Terai zones for univariate analyses. Data from all three zones was then pooled for univariate and multivariate logistic regression analyses of Antenatal Care and Safe Delivery services in Nepal.Results and Conclusion. The analyses show that rural place of residence is at a disadvantage in receiving ANC (OR, 0.8; 95% CI [0.7–0.9]) and ensuring safe delivery (OR, 0.6; 95% CI [0.5–0.7]). Woman’s education, husband’s education and wealth quintile are significant factors in ensuring ANC and safe delivery services. Further, the analyses show that Budh/Muslim/Kirat/Christians are at a significant disadvantage in ensuring safe delivery (OR, 0.8; 95% CI [0.7–0.9]) as compared with Hindus. Though ecological zones lost their significance in receiving ANC, women in the Terai region are at a significant advantage in ensuring safe delivery (OR, 1.7; 95% CI [1.2–2.1]).Recommendation. Segregated targets should be set for the different ecological zones for further improvement in maternal mortality rates in Nepal.

Trends in Maternal Care Utilization in Urban India

The present study attempts to observe the recent changes in the Indian health care utilization pattern based on secondary data from three National Sample Survey Organisation (NSSO) rounds. The study focuses on urban households across different classes of towns emphasizing the most recent births to married women within a recall of period 365 days. Three dimensions of maternal care services have been discussed in this study, namely, prenatal care services, delivery services and postnatal care services. It is found that the utilization of prenatal, postnatal and delivery services are positively correlated with the economic status of households as measured by the per capita monthly consumption expenditure (MPCE). It is also noted that the household educational and employment index are correlated with the level of prenatal and postnatal care utilization and the dimension of correlation is positive and statistically significant. But in case of delivery services the degree of correlation has changed from being highly positive to negative, specifically in case of household employment index. This study also attempts to understand the changes in utilization of maternal health care services with respect to public health infrastructure. It is found that the use of public health facilities has significantly reduced over time. The correlation between household economic status and the use of public facilities for the prenatal, postnatal and delivery care present a strong negative and the degree of correlation becomes stronger over time. A similar dimension of association is found in the case of household educational index. It may be the improvement in utilizing public health infrastructure among households from the formal sector. The discrepancy in access to health facilities among different classes of cities can be cited as one of the reasons for lower utilization of maternal health care services. Such discrepancies are relatively lower in case of small towns especially in the case of delivery and prenatal care services.

The role of obstetric knowledge in utilization of delivery service in Nepal.

Birth Preparedness and Complication Readiness (BP/CR) program has been promoted in Nepal to equip pregnant women with obstetric knowledge so as to motivate them to seek professional care. Using a prospective design of 701 pregnant women of more than 5 months gestation in a central hills district of Nepal, we evaluated if having obstetric knowledge could make a difference in maternal delivery behaviour. The results suggested that BP/CR program was effective in raising women's obstetric knowledge, which was significantly associated with facility delivery according to logistic regression analysis. In particular, women who acknowledged that unexpected problems could occur during pregnancy and childbirth were more likely (odds ratio [OR] 5.83, 95% confidence interval [CI] 2.95-11.52) to deliver at a health facility than others unaware of the possible consequences. Similarly, women who knew any antepartum danger sign (OR 2.16, 95% CI: 1.17-3.98), any intrapartum danger sign (OR 3.80, 95% CI: 2.07-6.96) and any postpartum danger sign (OR 3.47 95% CI: 1.93-6.25), tended to deliver at a health facility. Convincing and counselling the pregnant women of the health consequences of pregnancy and childbirth would increase their utilization of delivery service.

Utilization of Institutional Delivery Services and Factors Associated among Mothers of Reproductive Age Group - A Community Based - Cross Sectional Study in Bangalore

Utilization of Institutional Delivery Services and Factors Associated among Mothers of Reproductive Age Group - A Community Based - Cross Sectional Study in Bangalore

Factors Influencing the Utilisation of Maternal Health Services: The Perspective of Rural Women in Ghana

Maternal mortality is a global issue and WHO recommends the use of maternal health services to help improve the health of women and babies during pregnancy and childbirth. Considering global and national interest in improving maternal health and the fact that Ghana is still battling with reducing maternal mortality, understanding the factors affecting the use of maternal services in rural areas is crucial as the women are seen as more vulnerable due to inequity issues. This study sets to examine the factors that influence the utilisation of antenatal and delivery services among rural women in Ghana, focusing on individual and area factors. A descriptive cross sectional study was carried out in three rural communities using Akuapim North District of Ghana as a case study.. The study adopted the quantitative approach. Structured interviews were used in data collection with the help of interview schedules. Two hundred and ninety-six (296) respondents were sampled using both probability and non probability techniques. Findings reveal that the use of the MHS is inadequate in relation to the WHO standards. Individual characteristics such as age, marital status and family size and the cost and time taken to a health facility were significantly associated with all the maternal health outcomes. Poor access to vehicles hindered women from delivery in a health institution and getting assistance from trained medical personnels. However, no significant association was established between education of respondents and the maternal health outcomes. It is recommended that the Ministry of Health engages in inter-sectoral collaboration to help ensure health equity.Effective integration of TBAs in providing care is needed to help improve utilisation of maternal services in rural areas

Perceived quality of and access to care among poor urban women in Kenya and their utilization of delivery care: harnessing the potential of private clinics?

This paper uses data from a maternal health study carried out in 2006 in two slums of Nairobi, Kenya, to: describe perceptions of access to and quality of care among women living in informal settlements of Nairobi, Kenya; quantify the effects of women's perceived quality of, and access to, care on the utilization of delivery services; and draw policy implications regarding the delivery of maternal health services to the urban poor. Based on the results of the facility survey, all health facilities were classified as 'appropriate' or 'inappropriate'. The research was based on the premise that despite the poor quality of these maternal health facilities, their responsiveness to the socio-cultural and economic sensitivities of women would result in good perceptions and higher utilization by women. Our results show a pattern of women's good perceptions in terms of access to, and quality of, health care provided by the privately owned, sub-standard and often unlicensed clinics and maternity homes located within their communities. In the multivariate model, the association between women's perceptions of access to and quality of care, and delivery at these 'inappropriate' facilities remained strong, graded and in the expected direction. Women from the study area are seldom able to reach not-for-profit private providers of maternal health care services like missionary and non-governmental organization (NGO) clinics and hospitals. Against the backdrop of challenges faced by the public sector in health care provision, we recommend that the government should harness the potential of private clinics operating in urban, resource-deprived settings. First, the government should regulate private health facilities operating in urban slum settlements to ensure that the services they offer meet the acceptable minimum standards of obstetric care. Second, 'good' facilities should be given technical support and supplied with drugs and equipment.

Obstetric outcome following free maternal care at Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, South-eastern Nigeria

SummaryThis study aims to determine the impact of free maternal care on the utilisation of the available delivery services and to evaluate the obstetric outcome. All deliveries at ESUTH, Parklane within the 4 months of free maternal care from 1 September to 31 December 2008 were studied and compared with deliveries that took place 4 months before and after the free services. The results were analysed using Epi-info statistical software version 3:2:2. There was an 88% rise in the number of deliveries with the introduction of free maternal services and a 30% drop within 4 months of its termination. The maternal mortality ratio (MMR) dropped slightly, but morbidity increased significantly, as well as stillbirth rate (77/1,000 births), especially intrapartum stillbirth. Cost barrier limits women’s access to healthcare in developing countries and must be addressed if we aim to achieve Millennium Development Goals (MDGs) 4 and 5.

Strategies for increasing utilization of maternity services in Njeru, Uganda

This paper describes the success of an ongoing community-based maternal and child health project in Njeru, Uganda. The project is a collaboration between the Njeru Town Council and an American university's social work programme and College of Nursing. The goal of the programme is to increase utilization of clinic-based maternity services i.e. pre-natal care and skilled attendant at delivery. Using community mobilization, education and capacitybuilding, community health workers (CHWs) were trained by the university-based nursing professors to educate the community about safe motherhood practices. Traditional birth attendants (TBAs) were trained by a nurse-midwife in techniques to reduce infection and maternal haemorrhage, the two main causes of maternal morbidity and mortality in the region. Over a 2-year span the clinic has doubled utilization of pre-natal services and more than doubled utilization of clinic-based labour and delivery services, resulting in more births at the clinic than by TBAs in the clinic's catchment area—an outstanding achievement in a country where more than 70% of women are assisted at birth by an unskilled attendant, including TBAs.

How Does Schooling Influence Maternal Health Practices? Evidence from Nepal

Women’s schooling is associated with much of the world’s improvement in child survival and maternal and child health since 1960. Evidence for these associations is widely interpreted as representing a causal influence of formal education on health. The relationships of variations in female school attendance at the levels of individuals, populations, and historical periods to reproductive health outcomes raise new questions for comparative educational research concerning the process involved. This article reports the results of a survey designed to test a theoretical model positing that literacy skills acquired by girls in school are retained into their adult years, facilitating their exposure to public health messages in the media, which in turn influence the health knowledge affecting their health behavior as mothers. This survey was conducted in Nepal, a low-income country in which both mass schooling and demographic transition are recent developments, using direct assessment of literacy skills instead of the self-reports or imputation from school attainment levels often used in demographic and health surveys. After a brief review of the relevant studies to provide an empirical basis for

Chinese Maternal Health in Adjustment: Claim for Life

Health sector reforms in China, instituted starting in 1985, have centred on cost recovery, with fee-for-service revenue replacing public budget funding. The share of public funding for maternal health services was reduced greatly, forcing an increasing proportion of pregnant women to pay for deliveries and treatment of pregnancy-related complications out of pocket, as most had no health insurance to cover these costs. This study aimed to identify socio-economic variables associated with utilisation of essential maternal health services and linked to health sector reforms in China, with a focus on cost recovery. A retrospective household survey ( n=5756) was carried out in six counties in three provinces of Central China in 1995. Antenatal service utilisation continued to improve in 1990–95, but only in relation to the number of visits, which were pre-paid if the woman was participating in a maternal pre-payment scheme or covered by another health insurance scheme. Significant decreases were found in the utilisation of skilled attendance at delivery and hospital delivery, as well as differences in adverse pregnancy outcomes (miscarriages and stillbirths) between women paying out of pocket and those covered by insurance. This study confirms a strong association between utilisation of delivery services and financing variables of amount of savings in the bank, maternal pre-payment schemes and health insurance. It also shows the critical importance of out of pocket, fee-for-service payments for maternity care as a barrier to the utilisation of these services.

Maternal health services uptake and its determinants in public primary health care facilities in Edo State, Nigeria

To assess the uptake of maternal health services; its determinants and the perception of users about these services. A descriptive cross sectional study was carried out in Edo North Senatorial Zone of Nigeria. Respondents were selected using a multi- stage sampling technique. A structured, interviewer administered questionnaire was used to collect data from the respondents. The data were analysed using SPSS version 17. Binary logistic regression model was used to identify predictors of utilization of these services. A total of 342 respondents participated in the study; with 171(50%) from the sub-urban communities and the other half from the rural communities. The utilization of the ANC services was 79% and 81% for the sub-urban and rural communities respectively. As for delivery services, it varied from 60.2% to 81.3% for the sub-urban and rural communities respectively. Family planning services uptake was about the same for both types of communities; being 43.7% for the sub-urban communities and 44.4% for the rural communities. Educational status and type of community were significantly associated with delivery service utilization. The predictors of the antenatal services utilization included: educational status, cost per illness, self assessment of health, clean environment and sources of information on maternal care. Marital status, average income and type of community were the predictors of family planning services utilization. The utilization of maternal services was good; being higher than the national average with the exception of postnatal service, which was completely absent. The major determinants of utilization of maternal health services included educational status and the average monthly income of the respondents. Services were perceived by more than half of the respondents to be generally good. There is need for the provision of the minimum service components of maternal health care services especially postnatal service at the PHC facilities.