Low-income Women Research Articles

Impact of family income on the development of gestational diabetes mellitus and the associated birth outcomes: A nationwide study.

The relationship between economic disadvantages and the risk of developing gestational diabetes mellitus (GDM), as well as its impact on birth outcomes, remains uncertain. From the Taiwan Maternal and Child Health Database, we identified 984,712 pregnant women between 1 January 2007 and 31 December 2018. Using propensity score matching, we selected 5,068 pairs of women across four income levels: very low, low, middle and high. We used a multivariable Cox regression model to assess the risk of GDM in these pregnant women and analyzed the birth outcomes. The mean age of the pregnant women was 30.89 years. We found no significant difference in GDM risk among pregnant women with different family income. However, newborns of women with GDM and very low-income were at higher risk for several adverse conditions, such as small for gestational age (adjusted odds ratio (aOR) 1.17, 95% confidence interval (CI) 1.04-1.31), large for gestational age (aOR 1.27, 95% CI 1.08-1.51), hypoxic-ischemic encephalopathy (aOR 3.19, 95% CI 1.15-8.86), respiratory distress (aOR 1.58, 95% CI 1.14-2. 19), congenital anomalies (aOR 1.32, 95% CI 1.08-1.62), jaundice requiring phototherapy or exchange transfusion (aOR 1.14, 95% CI 1.05-1.24) and so on. This study found that low family income alone was not associated with GDM development. However, for a GDM pregnancy, pregnant women with lower income had worse birth outcomes. Improving maternal health and nutrition among low-income pregnant women with GDM might be critical to improving birth outcomes.

Abstract 4134379: Mediterranean-Style Diet and Adverse Pregnancy Outcomes by Race and Overweight or Obesity Status in the Boston Birth Cohort

Introduction: Mediterranean-style diet (MSD) is associated with a lower risk of cardiovascular and metabolic diseases. However, the association of MSD during pregnancy with adverse pregnancy outcomes (APOs) among different racial and ethnic groups and overweight or obesity (OWO) status remains unclear. Question: We examined if MSD during pregnancy is protective for developing any APO and individual APOs in a large cohort of racially and ethnically diverse, urban, low-income women. Methods: Among 8,511 patients in the Boston Birth Cohort (mean age 28.2±6.5 yrs), 47% were non-Hispanic Blacks and 28% were Hispanics. Among 4,343 (51%) with pre-pregnancy OWO status, 25% Black and 12% Hispanic women developed any APO (Figure 1). Individual Mediterranean-style diet score (MDS) was based on maternal diet intake during pregnancy via food frequency questionnaire interviews at 24-72 hours postpartum. Results: Increase in the MDS by one standard deviation was inversely associated with any APO (aOR, 0.86 [95% CI, 0.82–0.90]), preeclampsia or eclampsia or HELLP (aOR, 0.89 [95% CI, 0.82–0.97]), gestational diabetes (aOR, 0.88 [95% CI, 0.81–0.95]), preterm birth (aOR, 0.90 [95% CI, 0.86–0.95]), and low birth weight (aOR, 0.87 [95% CI, 0.83–0.92]) (Table 1). In the subgroup analysis, higher adherence to MSD was associated with lower odds of developing, preeclampsia or eclampsia or HELLP, low birth weight, and preterm birth in Black women with or without OWO. The benefit of MDS was also observed for gestational diabetes in Hispanic women with OWO (Figure 2). Conclusion: Greater adherence to MSD during pregnancy is associated with a lower risk of composite APOs, with benefits varying across types of APOs, racial/ethnic groups, and OWO status.

Digital revolution and the gender divide: factors affecting mobile phone use in India

ABSTRACT As the world digitises, being able to access and use a mobile phone is important in order to be able to participate fully in day-to-day life, accessing digital services and online information. While mobile phone handsets and cheap data plans are now ubiquitous in India, women’s access to and use of mobile phones is significantly more limited than that of men. The availability of the technology is therefore not the only factor affecting women’s access and use of mobile phones. This paper proposes a novel framework operating at three levels – individual, family and community levels, to understand the factors that affect women’s access to and use of mobile phones, and provides a snapshot of mobile phone access and use of low-income women in India based on 60 structured interviews across six states. We find that women’s mobile phone use is often constrained, based on personal factors – confidence to use a phone or adequate digital literacy; family-level factors – permission to use the phone, monitoring of phone use and community-level factors – socio-cultural norms around appropriate type and place of use. This paper contributes to a significant gap in the literature on digitisation and women’s access and use of mobile phones in India. It highlights that while the digital revolution holds great promise, the use of mobile phones is often constrained for women.

Mental Bandwidth is Associated with HIV and Viral Suppression Among Low-Income Women in Philadelphia.

Behavioral economics research suggests poverty may influence behavior by reducing mental bandwidth, increasing future discounting, and increasing risk aversion. It is plausible these decision-making processes are further impaired in the context of HIV or pregnancy. In this cross-sectional study of 86 low-income women in Philadelphia, HIV was associated with lower mental bandwidth (one of two measures) and lower risk aversion. Pregnancy was not associated with any decision-making factors. In secondary analyses, viral suppression was associated with greater mental bandwidth (one of two measures), and antenatal clinic attendance with lower future discounting. Anti-poverty interventions may be beneficial to improve HIV-related health behaviors.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

Postpartum anger among low-income women with high rates of trauma exposure.

Few studies have examined anger concerns among postpartum women despite their risk of mood dysregulation. This study examined the performance of the Dimensions of Anger Reactions-5 (DAR-5) scale, a brief screen for problematic anger, in a sample of 1,383 postpartum women in Wisconsin who received perinatal home visiting services. We aimed to analyze the discriminant validity and measurement invariance of the DAR-5, the occurrence of problematic anger symptoms and their co-occurrence with mental health concerns, and the association between elevated anger levels and exposure to potentially traumatic events in childhood and adulthood. Descriptive statistics for anger symptoms and their associations with depression, anxiety, and PTSD were calculated. Psychometric properties of the DAR-5 were assessed via confirmatory factor analyses, and associations between trauma exposure and anger were evaluated as bivariate and partial correlations. Approximately 21% of the sample exhibited problematic anger based on an established DAR-5 cutoff score (≥ 12). Anger symptoms co-occurred with posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms, though the DAR-5 sufficiently distinguished anger from these correlated symptom profiles. The DAR-5 also demonstrated acceptable measurement invariance across levels of trauma exposure. Higher levels of trauma exposure in childhood and adulthood significantly increased the risk of problematic anger even after controlling for PTSD, anxiety, and depressive symptoms, partial pb range:.07-.16. The findings suggest the DAR-5 is a valid brief screen for anger in postpartum women. Increased attention should be paid to elevated anger and the co-occurrence of other mental health concerns following childbirth.

The Collateral Damage of Policy Reform: Low-Income Women Retirees, State Feminism, and the Pension System in Sweden

In 2014, the Swedish government declared itself the first feminist government in the world. Indeed, the country has been successful in promoting gender equality, yet many retired women, particularly in rural areas, live on an income below the EU poverty line. Based on analysis of Sweden’s pension system, the country’s commitment to gender equality, and interviews with low-income women pensioners in rural Sweden, this article explores why some women end up living in poverty in later life. The article demonstrates how the Swedish pension reform of the 1990s has generated a structural lag; today’s older women have lived during times that were radically different from the world nowadays, yet their pensions are based on forward-looking ideals. Consequently, today’s older women have become “collateral damage” (Bauman 2011) of securing a new form of pension system, and seemingly also neglected in the state’s promise of ensuring gender equality.

The Unique Impacts of COVID-19 on Low-Income and Diverse Canadian Women's Mental Health Profiles: A Latent Transition Analysis.

There is evidence of an overall decline in women's mental health, particularly those with young children, in the wake of the COVID-19 pandemic. However, research has also found heterogeneity in women's mental health responses. This longitudinal study sampled low-income women with young children by recruiting from the government's child care financial subsidy waitlist. To examine heterogeneity in women's mental health responses to COVID-19, a latent transition analysis was employed to identify profiles of anxiety, depression, and stress among 289 low-income mothers. Using these identified profiles, we examined the transitional patterns between profiles before and during COVID-19 and the sociodemographic and familial factors related to these profiles. A three-profile solution was identified prior to COVID-19 and a four-profile solution during COVID-19, with some profiles exhibiting qualitatively different defining characteristics. Latent transition analyses found diverse patterns of mental health changes after the onset of COVID-19. Mothers with better mental health prior to COVID-19 tended to have the most stable mental health during COVID-19. In contrast, mothers who were highly stressed prior to COVID-19 were equally likely to improve or decline after the onset of the pandemic. In addition, the relationships between race, parenting practices, child temperament, and child mental health were significantly related to mothers' mental health profiles. These findings describe mothers' experiences and areas where policymakers and practitioners can tailor support to low-income women with young children.

Miscarriage: cases of unfair incrimination reveal weaknesses in the criminalization of abortion

The article examines the historical, religious and legal context of abortion, highlighting its criminalization in Ecuador and its impact on women's health and rights. Subsequently, it addresses the injustice of criminalization derived from a situation of spontaneous abortion and proposes to evaluate the theoretical elements that should be considered to avoid the issuance of sentences to women who experience this condition. To this end, the methodology employed focused on the analysis of representative cases. The cases analyzed include Sara, Marta, Paola and Maribel, who suffered unjust detentions and cruel treatment in the judicial system due to medical complications or situations of gender violence. The findings reveal a pattern of discrimination and stigmatization against low-income women and marginalized communities and conclude that the criminalization of abortion increases risks to women's health and lives, perpetuating gender-based violence and inequality. This ultimately highlights the urgent need to reform abortion laws and policies in Ecuador to protect human rights and promote gender equality.

Long-Acting Reversible Contraception (LARC) and Early Childbearing Revisited: Births and Birth Intendedness After LARC Removal in a State Medicaid Population (2012-2020).

Objectives. To analyze births and birth intendedness after long-acting reversible contraception (LARC) removal among Medicaid-insured women. Methods. We linked all Delaware women with a Medicaid-covered LARC removal in 2012 to 2020 (n = 8047) to birth records and to Pregnancy Risk Assessment Monitoring System (PRAMS) pregnancy intendedness survey responses (n = 241). Results. Births within 3 years of a Medicaid-covered LARC removal were much more likely to be to women in their 20s compared with all Medicaid births (63.5% vs 53.4%; P < .001). The intended proportion for births within 3 years of Medicaid-covered LARC removal (65.2%) was higher than for all Medicaid-covered births (58.8%; P = .08) and was consistently above 60% across all age groups younger than 30 years. Conclusions. A state Medicaid-insured population's use of highly effective reversible contraception was associated with births being concentrated among women in their 20s and with consistently high fractions of intended births across younger ages at birth. Public Health Implications. Programs and policies may consider LARC access for its potential to increase low-income women's reproductive autonomy by enhancing their ability to achieve births at the age of their choosing. (Am J Public Health. Published online ahead of print October 10, 2024:e1-e8. https://doi.org/10.2105/AJPH.2024.307844).

Derivation of outcome-dependent dietary patterns for low-income women obtained from survey data using a supervised weighted overfitted latent class analysis.

Poor diet quality is a key modifiable risk factor for hypertension and disproportionately impacts low-income women. Analyzing diet-driven hypertensive outcomes in this demographic is challenging due to the complexity of dietary data and selection bias when the data come from surveys, a main data source for understanding diet-disease relationships in understudied populations. Supervised Bayesian model-based clustering methods summarize dietary data into latent patterns that holistically capture relationships among foods and a known health outcome but do not sufficiently account for complex survey design. This leads to biased estimation and inference and lack of generalizability of the patterns. To address this, we propose a supervised weighted overfitted latent class analysis (SWOLCA) based on a Bayesian pseudo-likelihood approach that integrates sampling weights into an exposure-outcome model for discrete data. Our model adjusts for stratification, clustering, and informative sampling, and handles modifying effects via interaction terms within a Markov chain Monte Carlo Gibbs sampling algorithm. Simulation studies confirm that the SWOLCA model exhibits good performance in terms of bias, precision, and coverage. Using data from the National Health and Nutrition Examination Survey (2015-2018), we demonstrate the utility of our model by characterizing dietary patterns associated with hypertensive outcomes among low-income women in the United States.

Experiences of Low-Income Indonesian Pregnant Women Regarding the Challenges of Receiving Health Services: A Qualitative Content Analysis.

The information needs of low-income pregnant women are multisectoral, encompassing both pregnancy-related and non-pregnancy-related information. Barriers to receiving information for low-income pregnant women are specific and complex. This study aimed to explore the experiences of low-income Indonesian pregnant women regarding the challenges of receiving health information. A qualitative study was conducted using content analysis according to Graneheim and Lundman's approach between January and June 2022. A total of 17 women were selected for this study using purposive sampling. In-depth interviews were done following semi-structured interview guidelines, concluding when saturation was reached. Nvivo software version March 2020 was used for organizing data and analysis. Three themes emerged concerning receiving health information among low-income women, including encountering barriers to accessing information and care, access to ineffective information sources, and difficulties in applying pregnancy health information. This study shows that barriers to receiving information are specific to low-income pregnant women. Therefore, solution approaches must also be specific. Efforts to improve receiving health information can be achieved through developing educational materials that are easy to access and understand, improving e-health literacy, refining counseling skills among village midwives, holding culturally tailored educational programs, improving mothers' health literacy by family and husbands, integrating counseling with a focus on critical literacy, and formulating policies to alleviate the midwife's workload.

Decoding Jakarta Women’s Non-Working Travel-Mode Choice: Insights from Interpretable Machine-Learning Models

Using survey data from three dwelling types in Jakarta, we examine how dwelling type, socioeconomic identity, and commuting distance affect women’s travel-mode choices and motivations behind women’s choices for nearby and distant non-working trips. We compared the performance of the multinomial logit (MNL) model with two machine-learning classifiers, random forest (RF) and XGBoost, using Shapley additive explanations (SHAP) for interpretation. The models’ efficacy varies across different datasets, with XGBoost mostly outperforming other models. The women’s preferred commuting modes varied by dwelling type and trip purpose, but their motives for choosing the nearest activity were similar. Over half of the women rely on private motorized vehicles, with women living in the gated community heavily relying on private cars. For nearby shopping trips, low income and young age discourage women in urban villages (kampungs) and apartment complexes from walking. Women living in gated communities often choose private cars to fulfill household responsibilities, enabling them to access distant options. For nearby leisure, longer commutes discourage walking except for residents of apartment complexes. Car ownership and household responsibilities increase private car use for distant options. SHAP analysis offers practitioners insights into identifying key variables affecting travel-mode choice to design effective targeted interventions that address women’s mobility needs.

Breaking Menstrual Inequality: A Multidimensional Approach to Addressing Period Poverty in China

Menstrual poverty is a complex public health problem that cuts across economic, social, and cultural dimensions. It refers not only to women's inability to afford sanitary products due to economic difficulties, but also to a broader lack of relevant knowledge, privacy protection, and social awareness of the importance of menstrual health. China lacks specific policies to address menstrual equity, especially the social disparities between urban and rural areas. This study aims to explore effective policies and community-based interventions to alleviate menstrual poverty among low-income women and girls in China, taking into account economic, social, and educational factors. The study proposes a comprehensive range of intervention strategies through a literature review, qualitative research, and case studies, including tax credits, public health policies, community distribution programs, education system reform, private-sector partnerships with NGOs, economic empowerment, and social and cultural change. The findings highlight the importance of cross-sectoral collaboration, gender-sensitive policy development, and community engagement in addressing menstrual poverty.

Workplace Breastfeeding As Foodwork In Organizational Settings: Advancing Knowledge From Black, Low-Income Women In South Africa

Workplace Breastfeeding As Foodwork In Organizational Settings: Advancing Knowledge From Black, Low-Income Women In South Africa

The Affordable Care Act Dependent Coverage Provision and Unintended Pregnancy.

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability of family planning services among young adults. Furthermore, the impact of this provision may differ by young adult income level as those with lower income are less likely to be insured and thus more likely to benefit from this provision. Our objective was to estimate the association between the ACA dependent coverage provision and unintended pregnancy, overall, and by young adult income level. Methods: We applied a difference-in-differences approach to data from multiple cycles of the National Survey of Family Growth (n = 10,104) and compared trends in unintended pregnancy between those who were eligible to benefit (ages 18-25 years) and those who were ineligible to benefit (ages 26-33 years) from the provision, overall, and among income subgroups. Results: We found evidence that the dependent coverage provision was associated with a -7.4 percentage point reduction (95% CI: -13.5, -1.3) in the prevalence of unintended pregnancy among young adults with lower income (<100% of the federal poverty level). There was limited evidence, however, that the provision was associated with unintended pregnancy among young adults with higher income levels. Conclusions: These findings suggest the ACA dependent coverage provision may have reduced unintended pregnancy among a particularly high-risk group (i.e., young adults with lower income).

Lifestyle Factors, Sociodemographic Characteristics and Incident Hypertension: A Prospective Analysis of the Korean National Health Insurance Service Sample Cohort.

Hypertension is a significant chronic disease globally, and lifestyle modifications are crucial for the prevention of this disease. We conducted a longitudinal analysis of the associations between lifestyle factors and the incidence of hypertension, stratified by sociodemographic characteristics. We analyzed 113,022 adults (65,315 men), aged 20 years or older from the Korean National Health Insurance Service-National Sample Cohort 2.0 who participated in health screening between 2002 and 2003. Lifestyle factors (smoking, drinking, physical activity) were assessed at baseline using self reports, and incident hypertension was defined based on physician diagnoses. Cox proportional hazards regression models were used to assess associations. During an 11.6-year follow-up, 26,812 new cases of hypertension were identified. The risk of hypertension was high among men and women who smoked over 20 cigarettes daily (men: hazard ratio [HR]: 1.15; 95% confidence interval [CI], 1.08-1.21; women: HR: 1.62; 95% CI 1.17-2.25) and those who drank over 1.5 bottles of alcohol daily (men, HR: 1.18; 95% CI, 1.12-1.24; women, HR: 1.23; 95% CI 1.02-1.47). These associations tended to be high in high-income men (HR: 1.09; 95% CI, 1.04-1.14), low-income women (HR: 1.19; 95% CI, 1.05-1.35) and non-obese women (HR: 1.13; 95% CI, 1.01-1.27) who currently smoked. Physical activity was inversely associated with incident hypertension in men (HR: 0.96; 95% CI, 0.93-0.99). Unhealthy lifestyle factors, such as heavy smoking and drinking, was associated with an increased risk of hypertension, with variations by income, BMI, and sex. These findings underscore the importance of tailored, population-specific prevention strategies to address hypertension disparities.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Breaking Barriers: Investigating Technology Adoption in Micro, Small, and Medium Enterprises (MSMEs) Among Low-Income Women Entrepreneurs in Malaysia

In Malaysia, the B40 segment, particularly low-income women entrepreneurs, faces distinct challenges in adopting technology within their businesses. This qualitative study explores the low uptake of technology adoption among these entrepreneurs to understand the underlying dynamics. By addressing the "what" and "why" of low technology adoption, the research aims to provide insights for fostering inclusivity and empowerment within Malaysia's entrepreneurial landscape. The study involved an in-depth focus group discussion with 25 women entrepreneurs from four states across Malaysia, utilizing thematic analysis with Atlas TI. Key findings reveal issues related to technology adoption based on TAM theory. The findings indicate that most entrepreneurs are integrating technology into their business operations, either through social media marketing, e-commerce platforms, cashless payment methods, online delivery services, and machines, regardless of whether they are located in rural or metropolitan areas. The majority of the respondent are utilizing technology through their social media marketing. These situations have arisen as a result of the impact of COVID-19, which has compelled all entrepreneurs to adopt technology, even at a minimal level. The majority use social media platforms like Facebook and WhatsApp for marketing and adopt online banking and cashless payment methods such as DuitNow QR Code, Touch 'n Go, Boost, Shopee Pay, and Sarawak Pay. Despite using online food delivery services like Food Panda and Grab Food, trust issues such as payment delays, non-payment by drivers, and high commission fees make these platforms less appealing. Additionally, entrepreneurs prefer traditional methods over machinery to maintain quality and struggle to meet e-commerce demand due to their small-scale production, limiting their ability to fully use technology for business growth and sustainability. The findings support the theoretical insights of the TAM model and suggest actionable strategies for fostering technology adoption and empowerment among low-income women entrepreneurs in Malaysia.

The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial.

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15-49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0-59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62-2.92, P < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91-0.97, P < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.