Improvements In Maternal Health Research Articles

Male partners’ involvement in antenatal care and its associated factors in West-central Ethiopia

BackgroundMale partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners’ involvement in maternity care, particularly in developing countries.ObjectiveThis study aimed to assess male partners’ involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019.MethodsA community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.ResultsIn this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20–29 years [AOR = 2.14, 95% CI = 1.04–4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02–4.07], [AOR = 3.02, 95% CI = 1.49–6.11] and [AOR = 4.03, 95% CI = 2.06–7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46–5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62–4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10–2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64–4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54–7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19–5.03] were associated with male partners involvement in antenatal care.ConclusionsMale partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners’ involvement in maternal healthcare services utilization.

Determinants of quality antenatal care use in Kenya: Insights from the 2022 Kenya Demographic and Health Survey

Provision of quality antenatal care (ANC) is important to reduce maternal and newborn fatalities worldwide. However, the use of quality ANC by women of reproductive age and associated factors remain unclear in many developing countries. Therefore, this study aimed to determine factors associated with receiving quality ANC in Kenya among women of reproductive age. We analyzed secondary data from the 2022 Kenya Demographic Health Survey, which included 11,863 women. Participants were selected using two-stage stratified sampling. Univariate and multivariable logistic regression analyses were used to analyze the data. Of the 11,863 participating women, 61.2% (95% confidence interval (CI): 59.7%–62.6%) received quality ANC. Participants aged 20–34 years had a 1.82 (95%CI: 1.15–2.87) times higher likelihood of receiving quality ANC compared with those aged 15–19 years. Those who had attended four or more ANC visits were 1.42 (95%CI: 1.14–1.79) times more likely to receive quality ANC than those who attended three or fewer visits. Participants with media access were 1.47 (95%CI: 1.06–2.03) times more likely to receive quality ANC than those without media access. Compared with participants in the “poorest” quintile, the likelihood of receiving quality ANC was 1.93 (95%CI: 1.21–3.08) and 1.44 (95%CI: 1.01–2.06) times higher for participants in the “richest” and “richer” quintiles, respectively. Furthermore, compared with participants from the Coastal region, the odds of receiving quality ANC were 0.25 (95%CI: 0.15–0.31) to 0.64 (95%CI: 0.44–0.92) times lower for those from all other Kenyan regions. Participants whose partners made their healthcare decisions were 0.74 (95%CI: 0.58–0.95) times less likely to receive quality ANC than those who made decisions independently. We found that just over 60% of participating mothers had received quality ANC. Factors associated with receiving quality ANC were: age, region, maternal education, healthcare-seeking decision-making, access to media, time to the health facility, ANC visits, and ANC provider type (doctor, nurse/midwife/clinical officer). Maternal health improvement programs should prioritize promoting access to education for girls. Furthermore, interventions should focus on promoting shared decision-making and autonomy in healthcare-seeking behaviors among pregnant women and their partners, increasing access to care provided by skilled healthcare workers, and addressing regional disparities in healthcare delivery.

Nutraceuticals in Pregnancy: A Special Focus on Probiotics.

The placenta is crucial to fetal development and performs vital functions such as nutrient exchange, waste removal and hormone regulation. Abnormal placental development can lead to conditions such as fetal growth restriction, pre-eclampsia and stillbirth, affecting both immediate and long-term fetal health. Placental development is a highly complex process involving interactions between maternal and fetal components, imprinted genes, signaling pathways, mitochondria, fetal sexomes and environmental factors such as diet, supplementation and exercise. Probiotics have been shown to make a significant contribution to prenatal health, placental health and fetal development, with associations with reduced risk of preterm birth and pre-eclampsia, as well as improvements in maternal health through effects on gut microbiota, lipid metabolism, vaginal infections, gestational diabetes, allergic diseases and inflammation. This review summarizes key studies on the influence of dietary supplementation on placental development, with a focus on the role of probiotics in prenatal health and fetal development.

The Impact of Socio-Economic Factors on Maternal Health in Rural Africa

Maternal health was a critical indicator of societal well-being, reflecting the quality of healthcare systems and socio-economic conditions. In rural Africa, maternal health outcomes were alarmingly poor, with high maternal mortality rates persisting despite global efforts. This review explored the impact of socio-economic factors on maternal health in rural Africa, focusing on economic barriers, educational attainment, gender inequality, access to healthcare services, and social support networks. Economic barriers such as poverty and healthcare costs significantly limit access to essential maternal care. Educational attainment influences health literacy and the utilization of maternal healthcare services, with higher education levels correlating with better health outcomes. Gender inequality and entrenched cultural norms restrict women’s autonomy and decision-making power, negatively affecting maternal health. Access to healthcare services in rural areas is severely constrained by geographic isolation, inadequate infrastructure, and resource limitations. Social support networks, including family, friends, community members, and traditional birth attendants, play a crucial role in maternal health by providing emotional, informational, and practical support. This review used a comprehensive analysis of existing literature to discuss these factors and propose solutions to improve maternal health outcomes in rural Africa. Strategies such as financial assistance programs, expanding educational opportunities, empowering women, improving healthcare infrastructure, and strengthening social support networks are essential for addressing these challenges. By implementing these targeted interventions, significant improvements in maternal health can be achieved, leading to healthier mothers and stronger communities in rural Africa. Keywords: Maternal Health, Socio-Economic Factors, Rural Africa, Gender Inequality, Healthcare Access.

Socio-Cultural Factors Affecting the Use of Modern Family Planning Methods by Married Men in Omala Local Government Area, Kogi State, Nigeria

The use of contraceptives is one of the modern family planning methods across the globe, but not free of the influence of socio-cultural factors. Hence, this study examined the socio-cultural factors influencing the practice of family planning among married men in the Omala Local Government Area. The specific objectives of the study included ascertaining if married men in Omala LGA were aware of modern family planning methods, an investigation into the assessment and utilization of family planning methods, determining the perceived benefits of the practice of family planning methods, identifying the perceived hindrances to its usage and examined the strategies to improve on the practice of family planning among marked men in Omala LGA. Analysis of Variance (ANOVA) was used to test the research hypothesis. The theory of the Health Believe Model was used to buttress the study and by utilizing survey research design, a total of 306 copies of the questionnaire were distributed among the respondents of which 235 copies were completed and returned. The results showed that 51% of the married men in Omala LGA were not aware of modern family planning methods while 34% of the respondents had no access to the utilization of modern family planning methods. The results also revealed that the socio-cultural factors affecting modern family planning methods among married men in the study area were cross-cultural differences, religious beliefs and practices, gender roles, fertility desire and number of living children, childbearing practice, partner discussion and approval. It was found also that reduction in the economic and emotional burden of parenthood, improvements in maternal health and child survival etc were the perceived benefits of modern methods of Family Planning. It was also discovered that the perceived hindrances to the practice of family planning methods included lack of knowledge, limited supplies, high cost of contraceptives, cultural and personal objectives etc. The study further found that adequate sensitization programmes by both health workers and religious organisations should be carried out among their followers on the importance of family planning practice and thereby enhancing their reproductive health. The study concluded that there were significant socio-cultural factors influencing the practice of modern family planning methods in the study area and therefore recommended that the local government through healthcare centres should create awareness programmes as also suggested by the respondents on the use of modern family planning methods in the area.

Does women's decision-making autonomy matter in utilization of antenatal care services in India? An analysis from nationally representative survey.

The primary goal is to examine the association between women's decision-making autonomy and utilization of antenatal care services among ever-married women in India. The entire study has been accomplished with the help of secondary data composed from the latest round of the National Family Health Survey (NFHS-5) conducted during 2019-21. A total of 34,618 ever-married women aged 15-49 with at least one live birth preceding five years of the survey have been taken into consideration in this study. Bivariate and multivariate analyses were conducted for proper illustration of the outcome. A sizable proportion of women did not fulfill the WHO-recommended criterion of obtaining ANC services. Utilization of full ANC services is found in some regions of southern, eastern, northern, and northeastern states, and in some districts of Gujarat. After adjusting the other explanatory variables, the result of multivariate analysis indicates that women's autonomy is significantly and positively associated with the utilization of full antenatal care services. Women who participate actively in decision-making are more likely to use full ANC services (AOR: 1.316, 95% CI: 1.197-1.446, p<0.05). Additionally, likelihood of utilization of full ANC services is high among women aged 25-34 years, are educated, have access to the media, come from richest wealth quintile, and are from southern, western, and eastern regions. Therefore, appropriate measures should be adopted to eliminate gender bias and promote women's empowerment for the overall improvement of maternal health as well as societal health.

Knowledge and Perception of Women of Reproductive Age on Utilization of Maternal Health Care Services in Akure South Local Government Area of Ondo State: A Quantitative Approach

Even though Maternal health care services utilization is very important for further improvement of maternal health, limited evidence exists on the utilization of Maternal health care services among women of reproductive age in Nigeria. This has resulted into high rate of maternal mortality. Thus, this study aims to assess the knowledge and perception of women of reproductive age on utilization of Maternal health care services in Akure south local government area of Ondo State, south western Nigeria using a qualitative research methodology. Data were primarily sourced from 384 women of child-bearing age who were purposively selected across the communities in Akure south local government area through a multi-purpose sampling technique. Secondary Data were obtained from journals, hospital, records, government’s publications, newspapers, and some internet materials that are relevant to this study. Analyses of Data were carried out with the aids of descriptive and inferential statistics. The findings revealed that majority of the respondents have good knowledge but poor perception of the Maternal health care services. Majority of the respondents opined that education and religion contributed to the utilization of Maternal health care services in the local government area. The study further revealed that there is a significant association between respondents knowledge and utilization of Maternal health care services (R= 12.29, p&lt; 0.000). There is also a significant association between respondents religion and the utilization of Maternal health care services ( R = 8.44, P &lt; 0.01). Significant association also exists between the respondent level of education and the use of maternal healthcare service (r =16.20, p&lt; 0.01). But here is no significant association between the perception of the respondent and utilization of maternal healthcare service ( R =10.25, p&gt;0.777) . The study, however, concluded that women of reproductive age in Akure South Local Government area have good knowledge and poor perception maternal healthcare service which utilization is influenced by their education especially in rural communities within the study areas and their religious affiliations. Against this background, the study recommends increased enlightenment among child- bearing women on the importance of maternal healthcare services, subsidization of cost of accessing healthcare services by the governments and NGOs, strengthening the National Health Insurance scheme to incorporate family planning into its benefit package, upgrade of the existing health facilities and establishment of more health centres in rural and semi-urban areas with explosive populations.

Do public health expenditures affect maternal and child health in Madagascar?

BackgroundPrevious studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health.MethodsUsing panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified.ResultsThe results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children’s health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries.ConclusionsEquipment endowments contributed more to health improvement and would be more effective than monetary financing.

Year 1 Lessons Learned in Building and Sustaining Community-Academic Interdisciplinary Partnerships to Improve Maternal Health

ABSTRACT To understand current maternal health outcomes and growing health disparities, this interdisciplinary project investigates the development of a community advisory board (CAB), guided by the principles of community-based participatory research (CBPR), which explores the perspectives of providers, community stakeholders, and students. This step-by-step process analysis allows for greater clarity and recognition of areas to consider in future CAB initiatives and use of interprofessional education. Both quantitative and qualitative principles were used to assess and evaluate the process, including survey, observation, and content analysis. While this project remains in the early stages, promising results have emerged supporting strong group dynamics and commitment toward change in the local community while identifying improvements to the overall delivery of the CAB and CBPR process.

Affordable Care Act Medicaid expansions and maternal morbidity.

In this paper, we test whether the Affordable Care Act Medicaid expansions are associated with maternal morbidity. The ACA expansions may have affected maternal morbidity by increasing pre-conception access to health care, and by improving the quality of delivery care, through enhancing hospitals' financial positions. We use difference-in-difference models in conjunction with event studies. Data come from individual-level birth certificates and state-level hospital discharge data. The results show little evidence that the expansions are associated with overall maternal morbidity or indicators of specific adverse events including eclampsia, ruptured uterus, and unplanned hysterectomy. The results are consistent with prior research showing that the ACA Medicaid expansions are not statistically associated with pre-pregnancy health or maternal health during pregnancy. Our results add to this story and find little evidence of improvements in maternal health upon delivery.

Using Modernized Medicaid Data to Advance Evidence-Based Improvements in Maternal Health.

Medicaid is the primary payor for nearly half of all births in the United States and plays a disproportionate role in covering maternity care for low-income people, rural people, and minoritized racial groups. Newly available, modernized Medicaid claims data-the Transformed Medicaid Statistical Information System Analytic Files (TAF)-offer a significant opportunity to conduct novel research that can drive the development of evidence-based programs and policies for Medicaid beneficiaries before, during, and after pregnancy. Yet, the public health research community has so far underused the TAF for maternal health research. We provide an overview of the TAF and how they compare to other major data sets available to study maternal health. We highlight some major limitations of the TAF and offer strategies to maximize the potential of these novel data to accelerate timely, rigorous research to improve maternal health and health equity. (Am J Public Health. 2023;113(7):805-810. https://doi.org/10.2105/AJPH.2023.307287).

The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis

BackgroundMaternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries.ObjectiveThe main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries.MethodsCommon electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane’s risk of bias tool was used to assess the quality of included articles.ResultsThe overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69–2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90–8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46–3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73).ConclusionsThe study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.

Measuring maternal improvement through multi-stakeholder engagement: Documenting developments in the dynamic programmatic context of the global COVID-19 pandemic through outcome harvesting.

To bolster country efforts towards meeting the targets and strategies laid out in WHO's report "Strategies toward ending preventable maternal mortality" (EPMM), a series of seven consultations, known as National Dialogues, were conducted to better understand national priority areas for the improvement of maternal health and to support the adoption and use of EPMM indicators at the national level. The last Dialogue was conducted in March 2020, as the COVID-19 pandemic was beginning to have global impacts. We aimed to explore the circumstantial challenges and opportunities that countries have encountered in meeting the specific stakeholder commitments made in each country by National Dialogue participants during the COVID-19 pandemic. We based our study methodology on outcome harvesting, a qualitative approach that examines how incremental change contributes towards achieving a specified outcome. It collects evidence on what has changed and then works backwards to determine whether and how a programme or intervention led to the observed changes. We collected data from 20 participants in five countries (Bangladesh, India, Mexico, Nigeria, and Pakistan) through key informant interviews and focus group discussions. We analysed the data through inductive coding focused on emergent themes. The onset of the global COVID pandemic overturned plans and upended health systems, bringing new opportunities in some countries and halting progress towards the agenda outlined in the National Dialogue elsewhere. Participants identified adaptations that facilitated continued progress, such as shifting the locus of advocacy and activity from national to sub-national focal areas, catalytic changes in response to the crisis (including the development and improvement of digital communication and data technology), and increased awareness of the importance of identified priorities (including a human rights approach to maternal health). Our data suggest that the priorities for maternal health system performance to drive improvement toward ending preventable maternal deaths and the advocacy commitments designed to increase the relevance of upstream policy and health system-level determinants of maternal health and survival have retained their urgency during the COVID-19 pandemic.

Exploring the factors behind the shift in unwanted childbearing rate in Bangladesh between 2007 and 2017/2018: a cross-sectional study

ObjectivesThis study aimed at exploring the factors associated with the reduction in the proportion of women reporting unwanted births in Bangladesh between 2007 and 2017/2018.Design and settingA cross-sectional analysis of...

Recognizing the need for standardized training for community health workers (CHWs)

AbstractIntroductionDespite global improvements in maternal health, disparities in maternal mortality rates in the United States have worsened in recent years. Community health workers (CHWs) as maternal health educators have previously been studied in low‐ and middle‐income countries, however their use in the United States has been limited.MethodologyTo address the ongoing disparities in maternal mortality, we conducted a mixed methods pilot study consisting of discussion groups and a written survey with CHWs in two boroughs in NYC. The study's goal was to identify and explore CHW professional training, their daily tasks, and roles as well as their insights and perspectives regarding the needs of their pregnant clients.ResultsEighteen CHWs participated in the discussion groups and 11 participated in the survey. Participants were predominantly Black and/or Latina. Key themes were very consistent across group discussion and survey data. Major themes were a lack of standardized training for CHWs on basic maternal health topics, the existence of racism and bias in the provision of care for Black and other minority individuals, along with pregnant peoples’ needs for support to better advocate to overcome systemic barriers.ConclusionThis study suggests that targeted maternal health training of CHWs is needed to better enable them to identify pregnancy risks and advance health literacy and promote self‐advocacy among their pregnant clients. This will ultimately yield a more effective CHW workforce and better health outcomes for pregnant people.

A simulation-based comparative effectiveness analysis of policies to improve global maternal health outcomes

The Sustainable Development Goals include a target to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030, with no individual country exceeding 140. However, on current trends the goals are unlikely to be met. We used the empirically calibrated Global Maternal Health microsimulation model, which simulates individual women in 200 countries and territories to evaluate the impact of different interventions and strategies from 2022 to 2030. Although individual interventions yielded fairly small reductions in maternal mortality, integrated strategies were more effective. A strategy to simultaneously increase facility births, improve the availability of clinical services and quality of care at facilities, and improve linkages to care would yield a projected global MMR of 72 (95% uncertainty interval (UI) = 58–87) in 2030. A comprehensive strategy adding family planning and community-based interventions would have an even larger impact, with a projected MMR of 58 (95% UI = 46–70). Although integrated strategies consisting of multiple interventions will probably be needed to achieve substantial reductions in maternal mortality, the relative priority of different interventions varies by setting. Our regional and country-level estimates can help guide priority setting in specific contexts to accelerate improvements in maternal health.

HUBUNGAN PENGGUNAAN ALAT KONTRASEPSI SUNTIK DENGAN SIKLUS MENSTRUASI PADA AKSEPTOR KB SUNTIK DI POLINDES BUNGBARUH KECAMATAN KADUR KABUPATEN PAMEKASAN

One of the articles of the Millennium Development Goals (MDGs) agreed upon by 189 countries including Indonesia is the improvement of maternal health and well-being throughout the mother's life cycle, including in terms of contraception and contraceptive effects including menstrual cycle disorders. Injectable contraceptives consist of injectable contraceptives of 3 months and injectable contraceptives of 1 month. Problems that often arise are caused by 3-monthly injectable contraceptives, namely: 60% amenorrhea, 20% oligomenorrhea, and 20% polymenorrhea, while 1 monthly injectable contraceptives 85% of birth control acceptors do not experience problems or menstrual cycle disorders. The purpose of the study was to find out the relationship between the use of injectable birth control contraceptives with menstrual cycle disorders Types of quantitative research with a cross sectional approach. The population was all injectable kb acceptors totaling 180 mothers with a sample of 180 people taken with total sampling techniques. Data collection using questionnaires analyzed using chi square tests. The results of the study found that there were 128 (81.7%) respondents who experienced menstrual cycle disorders and there was a total use of injectable contraceptives for 3 months, namely 156 (86.7%) respondents, while respondents with injectable contraceptives I months were 24 (13.3%) respondents. There is a meaningful relationship between the use of injectable birth control contraceptives with the menstrual cycle in Polindes Bungbaruh, Pamekasan district with p vallue: 0.05. OR value = 0.356 means that those who use 3-month injectable birth control contraceptives are 2.78 times more likely to experience menstrual cycle disorders than respondents who use 1-month injectable birth control contraceptives. Advice that can be given to injectable birth control acceptors who have impaired menstrual cycles to use non-hormonal birth control contraceptives to avoid severe side effects. &#x0D; &#x0D;

Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study

BackgroundReducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China.MethodsA cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson’s model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization.ResultsPlace of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC.ConclusionsInequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization.We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women’s health literacy.

A comprehensive study of maternal near-miss and maternal mortality at a rural tertiary care centre in north India

Proper monitoring of maternal near miss as proposed by World Health Organisation provides a good opportunity for checking the quality of obstetric care and forming new strategies for the improvement of maternal health across the globe. The objective of present study was to assess and analyse the incidence of Maternal Near Miss and maternal mortality by using evaluation criteria of World Health Organisation. The present study was prospective observational study conducted at SHKM Government Medical College, Nalhar (Mewat), Haryana from the time period of January 2019 to December 2020. The study population included all the pregnant females who fulfilled the World Health Organisation criteria of maternal near miss were enrolled; their clinical and investigation parameters were recorded. In the present study, a total 7691 obstetric cases were admitted and 7219 were live births. The Maternal Near Miss cases were 292, and 48 were maternal deaths. Majority of patients were post natal and underwent vaginal delivery. The leading cause of near miss in current study was Post Partum Hemorrhage, followed by severe pre-eclampsia/eclampsia. Maternal Near Miss and Maternal Death cases have common pathology with a different outcome. So, monitoring a larger volume of Maternal Near Miss cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths. This approach helps to overcome this issue and ultimately lead to an improved health system, thus decreasing maternal mortality rate.

Women’s healthcare decision-making and unmet need for contraception in Mali

BackgroundContraception plays a significant role in fertility regulation. Evidence suggests that reproductive health rights influence contraception use. Women of Mali are noted to have limited control over their healthcare decisions. As a result, this study aimed at investigating the association between women’s healthcare decision-making capacity and unmet need for contraception in Mali.MethodsThis study comprised 6593 women who participated in the 2018 Mali Demographic and Health Survey. Two binary logistic regression models were built. Whilst the first model (crude) involved healthcare decision-making capacity and unmet need for contraception, the second one was a complete model which controlled for all the socio-demographic characteristics. Sample weight was applied and Stata version 13.0 was used for all analyses.ResultsMost of the women were not taking their healthcare decisions alone (92.8%). Nearly four out of ten of them indicated that they had unmet need for contraception (35.7%). Unmet need for contraception was high among women aged 45–49 (50.9%) and low among those aged 15–19 (19.2%). Unmet need for contraception was more probable among women who took their healthcare decisions alone compared to those who did not take their healthcare decisions alone [AOR = 1.35; CI = 1.08–1.70]. Compared with women aged 15–19, unmet need was higher among women aged 45–49 [AOR = 4.58, CI = 3.05–6.86]. Richer women had lower odds of unmet need for contraception compared with poorest women [AOR = 0.77, CI = 0.61–0.97].ConclusionWomen who took their healthcare decisions alone had higher odds of unmet need for contraception. To increase contraceptive use in Mali, it is imperative to take women’s healthcare decisions into consideration to strengthen existing policies geared towards fertility control and improvement in maternal health to achieve Sustainable Development Goals 3 and 5. Sustainable Development Goal 3 seeks to ensure healthy lives and promote well-being for all at all ages whilst Goal 5 aims at achieving gender equality and empower all women and girls.