Free Maternal Health Care Research Articles

Dynamic linear models for policy monitoring. The case of maternal and neonatal mortality in Ghana

Monitoring is a major step in policy analysis used to assess whether a policy is actually working as desired. We provide a general policy monitoring approach based on Bayesian forecasting models. These are employed to predict the evolution of relevant monitoring variables over time and support expected utility calculations to assess the efficiency of the policy. We illustrate the approach by monitoring the Free Maternal Health Care and MDG5 Acceleration Framework policies aimed to reduce maternal and neonatal mortality in Ghana, using dynamic linear models for forecasting purposes. Despite major investments, results at national level suggest no significant improvement in maternal and neonatal survival between pre- and post-policy periods. However, regional analyses show that gains have actually been attained in certain regions, suggesting possible directions for improvements nationwide.

A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana

BackgroundGhana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency facilitated by a free maternal health care policy in Ghana does not correspond with the uptake of IPTp-SP and ITN use among pregnant women. This study sought to elucidate the contextual health system factors influencing the delivery of IPTp-SP and ITN from a related quantitative study conducted in Ghana.MethodsThis is the qualitative section of a mixed-methods study design, where audio recorded key informant interviews (KIIs) were conducted with health workers from across health facilities, districts, regional and national health directorates. The KIIs elicited information on health worker knowledge, perceptions, and rationale for the delivery practices of IPTp-SP and ITN revealed in the quantitative findings. The interviews were transcribed and imported into NVivo for analysis. Using the World Health Organization (WHO) Health Systems Framework as the theoretical basis, thematic analysis was conducted under broad themes of the building blocks. Findings are presented in narrative quotes, with a mindmap used to summarize the various health system factors and their interrelated relationship influencing the delivery of IPTp-SP and ITN.ResultsHealth system factors identified included health staff untrained on malaria delivery directives due to an ineffective trainer of trainer (ToT) system. Additionally, health worker confusion on when to commence SP (at quickening or ≥ 16 weeks) was found to result in delayed start of SP. Stock-outs in facilities due to procurement delays at the national level resulted in missed opportunities to deliver SP to eligible pregnant women at the ANC. Similarly, ITN stock outs led to eligible pregnant women not receiving one at ANC clinics.ConclusionPoor health worker knowledge on policy directives, a consequence of ineffective training strategy led to delayed delivery of IPTp-SP to eligible pregnant women. Supply chain management challenges related to stock of SP and ITN resulted in missed opportunities to deliver the interventions to pregnant women attending ANC.

How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

BackgroundThis study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare.MethodsThe study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests.ResultsThe mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = − 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05).ConclusionDespite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

Influence of Cultural and Religious Practices on the Management of Pregnancy at Mbombela Municipality, South Africa: An Explorative Study

Background: Cultural norms bring substantial weight in women’s decision-making, especially concerning the choice of the birth location. Cultural and religious practices may influence how pregnant women respond to Antenatal Care (ANC) services, feel confident about which questions to ask, or participate in the discussions about their care plan or birth options. Purpose: The study aimed to explore and describe the influence of cultural practices on the management of pregnancy in the Mbombela Municipality of Mpumalanga Province. Methods: Using a qualitative approach, pregnant women who failed to completely attend ANC services were purposively sampled, and individual unstructured in-depth interviews were employed to collect data. The study consisted of a sample size of 18 pregnant women, and data saturation was reached. Tech’s method of analysis was followed for data analysis. Results: Study findings revealed a significant theme: cultural practices and pregnancy management, encompassing three sub-themes: cultural practices in pregnancy, cultural medication taken by pregnant women, and the effects of cultural practices on pregnancy management. Conclusion: It is recommended that women should be given health education concerning ANC services every day while they wait in primary health care clinics. Accordingly, the healthcare professionals should encourage the active involvement of all pregnant women in health promotion gatherings and offer chances for clarity seeking. Despite the availability of free maternal healthcare services in primary healthcare clinics, women still consult traditional healers during pregnancy and believe in cultural practices. It is therefore important that programs developed for maternal services be congruent to the cultural practices of women to be serviced.

Factors influencing place of delivery: Evidence from three south-Asian countries.

BackgroundHigh maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women’s preferences for such in three selected South-Asian countries.MethodsWe extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017–18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted.ResultsOverall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09–1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20–1.67, P<0.001) and Pakistan (aOR = 1.17, 95% CI: 1.03–1.32, P = 0.013). Higher education of husband was a significant predictor for facility delivery in Bangladesh (aOR = 1.73, 95% CI:1.27–2.35, P = 0.001) and Pakistan (aOR = 1.19, 95% CI: 0.99–1.43, P = 0.065); husband’s occupation was also a significant factor in Bangladesh (aOR = 1.30, 95% CI:1.04–1.61, P = 0.020) and Nepal (aOR = 1.26, 95% CI:1.01–1.58, P = 0.041).ConclusionOur findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.

Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers\u2019 and managers\u2019 perceptions

BackgroundFree maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA.MethodsWe used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively.ResultsIn all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff.ConclusionThis study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

Mixed effects analysis of factors associated with health insurance coverage among women in sub-Saharan Africa.

IntroductionIn the pursuit of achieving the Sustainable Development Goal targets of universal health coverage and reducing maternal mortality, many countries in sub-Saharan Africa have implemented health insurance policies over the last two decades. Given that there is a paucity of empirical literature at the sub-regional level, we examined the prevalence and factors associated with health insurance coverage among women in in sub-Saharan Africa.Materials and methodsWe analysed cross-sectional data of 307,611 reproductive-aged women from the most recent demographic and health surveys of 24 sub-Saharan African countries. Bivariable and multivariable analyses were performed using chi-square test of independence and multi-level logistic regression respectively. Results are presented as adjusted Odds Ratios (aOR) for the multilevel logistic regression analysis. Statistical significance was set at p<0.05.ResultsThe overall coverage of health insurance was 8.5%, with cross-country variations. The lowest coverage was recorded in Chad (0.9%) and the highest in Ghana (62.4%). Individual-level factors significantly associated with health insurance coverage included age, place of residence, level of formal education, frequency of reading newspaper/magazine and watching television. Wealth status and place of residence were the contextual factors significantly associated with health insurance coverage. Women with no formal education were 78% less likely to be covered by health insurance (aOR = 0.22, 95% CI = 0.21–0.24), compared with those who had higher education. Urban women, however, had higher odds of being covered by health insurance, compared with those in the rural areas [aOR = 1.20, 95%CI = 1.15–1.25].ConclusionWe found an overall relatively low prevalence of health insurance coverage among women of reproductive age in sub-Saharan Africa. As sub-Saharan African countries work toward achieving the Sustainable Development Goal targets of universal health coverage and lowering maternal mortality to less than 70 deaths per 100,000 live births, it is important that countries with low coverage of health insurance among women of reproductive age integrate measures such as free maternal healthcare into their respective development plans. Interventions aimed at expanding health insurance coverage should be directed at younger women of reproductive age, rural women, and women who do not read newspapers/magazines or watch television.

The effect of government expenditure and free maternal health care policy (FMHC) on household consumption in Ghana

PurposeIn Covid-19 pandemic era when most households' members have lost their jobs and incomes, the government assistance and programs in ensuring household consumption smoothing is very significant. The main objectives of this study are to analyze the impact of government expenditure and free maternal healthcare (FMHC) policy on household consumption expenditure in Ghana in both long run and short run.Design/methodology/approachThey used the ARDL to estimate the impact of government expenditure on household consumption and Segmented Linear Regression to examine impact of FMHC policy household consumption using longitudinal data from 1967 to 2018.FindingsThe results revealed that government expenditure had a negative and statistically significant effect on household consumption expenditure suggesting that government expenditure crowed-out private consumption in Ghana. Also, it was observed that before the implementation of the FMHC policy, there was an increase household consumption expenditure, but after the introduction of the FMHC policy, the study household consumption expenditure decreases significantly suggesting that FMHC policy has strong association with household consumption in Ghana.Research limitations/implicationsDue to limited data availability, this study did not assess the impact of the FMHC policy at the household or district level. Also, Ghana has introduced a free senior high school education policy in 2017 so further research could analyze the implications of these policies for household consumption in Ghana at the micro-level using different estimation technique such as the difference in difference.Practical implicationsThe study suggests the need to increase public spending on basic social amenities and also extend the free maternal healthcare policy to all pregnant women especially those in the rural areas of Ghana as these have a greater impact on household consumption in Ghana. The findings from this study have important implications for household savings and interest rate in Ghana. The findings from this study also have important implications for both fiscal policy and healthcare policy in Ghana and other developing countries.Originality/valueTo the best of my knowledge this is the first empirical study to examine the effect of government expenditure and free maternal healthcare policy on household consumption in Ghana.

Determinants of the Uptake of Free Maternity Services among Pregnant Mothers in Malava Sub-County, in Kakamega County, Kenya

Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.

Access and Uses of Free Maternal Health Care Services Among Women in Urban West Zanzibar

The main objective of this study was to examine the access ad uses of free maternal health care services among women in Zanzibar Urban West Region. A quantitative approach adopted in this study and data was analyzed through descriptive statistical analysis. Simple Random and purposive sampling were used to select 262 Respondents. The data were collected through closed ended questionnaires. The findings of the study revealed that, Most of hospitals and clinics visited by maternal mothers were government clinics since 196 respondents which is equal to (74.8%) visited Government clinic, 66 respondents equal to (25.1%) visited private clinics and. In addition the study found that more than 80% of the total respondents were having access and uses of the service provided by the health centers during their pregnancy period. The government of Zanzibar through Ministry of Health should take the special measure to emphasis on the improvement of free maternal health care services in health centres. This may help maternal mother and infants’ to get good treatment. Keywords: Access and Uses, Free Maternal Health Care Services, Descriptive Statistics, Urban west Zanzibar DOI: 10.7176/JHMN/85-07 Publication date: January 31 st 2021

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia.

BackgroundThe government of Ethiopia introduced an exemption policy that guarantees free maternal healthcare services from public providers. This policy aims to ensure financial protection and enhance utilization of services especially for low-income people. However, patients in most cases incur health expenditure when seeking health care. This paper aims to assess direct and indirect medical costs of treating maternal complications and associated factors at a public hospital in Northern Ethiopia.MethodsAn institution-based cross-sectional study design was carried on 267 mothers with complications. A multivariate linear regression model at 5% level of significance was used to analyze factors driving the outcome.ResultsThe median cost was more than seven times the monthly minimum wage, and this may cause severe financial consequences for the poor. Direct medical costs accounted for the major share (68%) of total cost, and this was mainly driven by lack of diagnostic services at public facilities and paying for private providers. Expenditure for treatment of maternal complications is positively associated with income, absence from work, travel time to the facility and being diagnosed at a private facility.ConclusionThe overall evidence in this study poses a concern about the context in which fee exemption reforms are being implemented.

Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: protocol design for historical cohort study

BackgroundGhana introduced what has come to be known as the 'Free’ Maternal Health Care Policy (FMHCP) in 2008 via the free registration of pregnant women to the National Health Insurance Scheme to access healthcare free of charge. The policy targeted every pregnant woman in Ghana with a full benefits package covering comprehensive maternal healthcare.PurposeThis study seeks to measure the contribution of the FMHCP to maternal healthcare utilization; antenatal care uptake, and facility delivery and determine the utilization impact on stillbirth, perinatal, and neonatal deaths using quasi-experimental methods. The study will also contextualize the findings against funding constraints and operational bottlenecks surrounding the policy operations in the Upper East Region of Ghana.MethodsThis study adopts a mixed-method design to estimate the treatment effect using variables generated from historical data of Ghana and Kenya Demographic and Health Survey data sets of 2008/2014, as treatment and comparison groups respectively. As DHS uses complex design, weighting will be applied to the data sets to cater for clustering and stratification at all stages of the analysis by setting the data in STATA and prefix Stata commands with ‘svy’. Thus, the policy impact will be determined using quasi-experimental designs; propensity score matching, and difference-in-differences methods. Prevalence, mean difference, and test of association between outcome and exposure variables will be achieved using the Rao Scot Chi-square. Confounding variables will be adjusted for using Poisson and multiple logistics regression models. Statistical results will be reported in proportions, regression coefficient, and risk ratios. This study then employs intrinsic-case study technique to explore the current operations of the ‘free’ policy in Ghana, using qualitative methods to obtain primary data from the Upper East Region of Ghana for an in-depth analysis.DiscussionThe study discussions will show the contributions of the ‘free’ policy towards maternal healthcare utilization and its performance towards stillbirth, perinatal and neonatal healthcare outcomes. The discussions will also centre on policy designs and implementation in resource constraints settings showing how SDG3 can be achievement or otherwise. Effectiveness of policy proxy and gains in the context of social health insurance within a broader concept of population health and economic burden will also be conferred.Protocol approvalThis study protocol is registered for implementation by the Ghana Health Service Ethical Review Committee, number: GHS-ERC 002/04/19.

Women's adherence to iron supplementation during pregnancy in Kumasi, Ghana

IntroductionAnaemia in pregnancy is caused by factors such as malaria, poor diet and hook worm infestation. Adherence to iron supplementation in pregnancy has been found to correct anaemia and improve fetal outcomes. In Ghana, though iron is given to pregnant women at no cost under the free maternal healthcare policy, anaemia prevalence is high. This calls for investigation into adherence to iron supplementation. This study investigated adherence of pregnant women to prescribed iron supplements in Kumasi, Ghana.MethodsA cross-sectional survey was conducted among postnatal women in Kumasi in November and December 2017. Women were selected through systematic random sampling and given a structured questionnaire to elicit information regarding their sociodemographic characteristics and iron supplementation intake during pregnancy. Results were analysed using descriptive statistics and the chi-square test, with P≤0.05 considered to be significant.ResultsOverall, most of the women were between 22 and 35 years old (69.5%) and had some form of formal education (86.7%). The majority (96.6%) took iron supplements during pregnancy. Most (82.2%) had their supplements prescribed by a midwife or nurse. The majority of women (61.9%) adhered to their prescription. There was a significant relationship between education level and adherence to iron prescription.ConclusionsStrategies to improve education regarding adherence to the use of iron supplements by midwives are required.

Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review

BackgroundThe world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA.MethodsWe employed the Arskey and O’Malley’s framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies.ResultsOut of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system.ConclusionThis study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.

Predictors of home births among rural women in Ghana: analysis of data from the 2014 Ghana Demographic and Health Survey

BackgroundHome births is one of the factors associated with maternal mortality. This study examined the predictors of home births among rural women in Ghana.MethodsData for this study was obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. For the purpose of this study, a sample size of 2,101 women in the rural areas who had given birth within five years prior to the survey and had responses on variables was considered. Data processing, management and analysis were carried out using STATA version 14.0. This study carried out bivariate and multivariate analyses and results were tested at 95% confidence interval. The Adjusted odds ratios were used to present the results and the level of statistical significance was assessed using 95% confidence intervals.ResultsHome births was found to be high among women who resided in the Northern region compared to those in the Western region [AOR, 1.81 CI = 1.10–2.98]. Similarly, the likelihood of home birth was high among women with four or more births [AOR, 1.46 CI = 1.03–2.05] and Traditionalists [AOR, 2.50 CI = 1.54–4.06]. Conversely, giving birth at home was low among women with higher level of education [AOR = 0.58, CI = 0.43–0.78], those with rich wealth status [AOR = 0.19, CI = 0.10–0.38], those with four or more ANC visits [AOR = 0.11, CI = 0.15–0.23] and those who were covered by NHIS [AOR = 0.58, CI = 0.46–0.72].ConclusionsOver the years, there have been efforts by governments in Ghana to make maternal health services free in the country. However, a substantial proportion of women still undergo home births. To reduce the utilization of home births in Ghana, it is essential that government and non-governmental organisations make the cost of delivery services part of the free maternal health care policy and take into consideration the factors associated with the high rates of home births among rural women in Ghana.

Intervention Time Series Modeling of Infant Mortality: Impact of Free Maternal Health Care

Infant mortality is an important marker of the overall society health. The 3rd goal of the Sustainable Development Goals aims at reducing infant deaths that occur due to preventable causes by 2030. Due to increased infant mortality the Kenyan government introduced Free Maternal Health Care as an intervention towards reducing infant mortality through elimination of the cost burden of accessing medical care by the mother and the infant. The study examines the impact of Free Maternal Health Care on infant mortality using Intervention time series analysis particularly the intervention Box Jenkins ARIMA (Autoregressive Integrated Moving Average) model. There was significant support that Free Maternal Health Care had a significant impact on infant mortality which was estimated to be a decrease of 10.15% in infant deaths per month.

Maternal Healthcare in Rural Uttar Pradesh: Influence of free Services on Healthcare-Seeking behaviour of Women

This field-based study evaluates the impact of free maternal healthcare services on the healthcare-seeking behaviour of 125 pregnant women in six villages of Uttar Pradesh. The 87 Muslim and 38 non-Muslim women participating in this project appreciated the antenatal and postnatal care processes on offer. Yet, various government efforts to encourage women to give birth in government hospitals to comply with international benchmarks on reduction of maternal mortality rates were unsuccessful. The study explores the various reasons for the strategic choices made by these rural women, who continue to favour home-based delivery. The findings raise policy implications about how state financing of maternal healthcare provisions in India is to be delivered, in the best possible manner, at local levels.

Impact evaluation of the free maternal healthcare policy on the risk of neonatal and infant deaths in four sub-Saharan African countries: a quasi-experimental design with propensity score Kernel matching and difference in differences analysis

ObjectiveDespite the huge financial investment in the free maternal healthcare policy (FMHCP) by the Governments of Ghana and Burkina Faso, no study has quantified the impact of FMHCP on the...

Inequalities in access to birth by caesarean section in the context of user fee exemption for maternal health services in southwest and north central Nigeria.

BackgroundUser fee exemption for maternal healthcare services was introduced with a focus on providing free maternal health services, including caesarean sections (CS), in Nigeria. This policy has had a positive impact on access to facility-based delivery; however, the extent to which inequality in access to CS exists in the context of user fee exemption is unclear. The objective of this study was to examine inequalities in access to birth by CS 5 y after the implementation of the user fee exemption policy.MethodsData were obtained from 1227 women who gave birth between 2011 and 2015 and were selected using cluster random sampling between May and August 2016 from two of the six main regions of the country. Adjusted and unadjusted binary logistic regression models were performed.ResultsAn overall CS rate of 6.1% was found, but varied by income, education and place of residence. Women who earned a monthly income of ≤20 000 naira (USn}{}{}150) were 50% less likely to have a birth by CS compared with those who earned more. Compared with women who were educated to the tertiary level, women who had a secondary education or less were 51% less likely to give birth by CS.ConclusionsThis study shows that inequality in access to CS persists despite the implementation of free maternal healthcare services.

Ghana's national health insurance, free maternal healthcare and facility‐based delivery services

AbstractGhana implemented the National Health Insurance Scheme (NHIS) in 2005 and introduced free maternal healthcare (FMH) into the scheme in 2008. These reforms aimed at improving the utilization of healthcare, especially for expectant mothers. Using data from the 2008 and 2014 Ghana Demographic and Health Surveys (GDHS) with a sample of 8,081, this study employed multivariate probit and conditional mixed process (CMP) estimators to analyze the NHIS enrolment and the use of facility‐based delivery services among expectant mothers within the context of Sustainable Development Goal 3 in Ghana. The influence of birth order on these policies has also been explored. Before and after analysis was used for the effect of the FMH on NHIS enrolment and the use of delivery services while CMP was used for the effect of NHIS on delivery services. It is concluded that higher birth order reduces the likelihood of NHIS enrolment and health facility delivery. Moreover, the FMH policy has improved both NHIS enrolment and facility‐based delivery. Finally, the NHIS policy proves to be a reliable factor to induce utilization of facility‐based delivery services. It is recommended that maternal health education at antenatal care visits should be enriched with potential consequences and complications associated with multiple births. The National Health Insurance Authority (NHIA) should provide registration desks for expectant mothers at health facilities.