Maternal Child Health Services Research Articles

Understanding Women's Preferences for Prevention of Mother-to-Child HIV Transmission Services in Kenya.

Understanding the preferences of women living with HIV (WLH) for the prevention of mother-to-child HIV transmission (PMTCT) services is important to ensure such services are person-centered. From April to December 2022, we surveyed pregnant and postpartum WLH enrolled at five health facilities in western Kenya to understand their preferences for PMTCT services. WLH were stratified based on the timing of HIV diagnosis: known HIV-positive (KHP; before antenatal clinic [ANC] enrollment), newly HIV-positive (NHP; on/after ANC enrollment). Multivariable logistic regression was used to determine associations between various service preferences and NHP (vs. KHP) status, controlling for age, facility, gravidity, retention status, and pregnancy status. Among 250 participants (median age 31 years, 31% NHP, 69% KHP), 93% preferred integrated versus non-integrated HIV and maternal-child health (MCH) services; 37% preferred male partners attend at least one ANC appointment (vs. no attendance/no preference); 54% preferred support groups (vs. no groups; 96% preferred facility - over community-based groups); and, preferences for groups was lower among NHP (42%) versus KHP (60%). NHP had lower odds of preferring support groups versus KHP (aOR 0.45, 95% CI 0.25-0.82), but not the other services. Integrated services were highly preferred by WLH, supporting the current PMTCT service model in Kenya. Further research is needed to explore the implementation of facility-based support groups for WLH as well as the reasons underlying women's preferences.

The effects of COVID-19 Pandemic on maternal and childhood health services in Meru County, Kenya

Background: The outbreak of coronavirus put unprecedented burden on healthcare systems, governments and health professionals worldwide. It caused a global crisis of unequalled magnitude on service delivery and accessibility of essential health services. Women and children in poor countries were most affected. In view of the foregoing, it became necessary to examine the effects of COVID -19 outbreak on Maternal Child Health (MCH) in Meru County Kenya, to recommend mitigation strategies and safeguard the gains previously made in MCH indicators. Methods: Ethical clearance for the study was sought from Meru University of Science and Technology Institute Research Ethics and Review Committee (MIRERC). Data were gathered through focus group discussions, key informant interviews and review of health records in Meru County. A period of one year before and one year after COVID-19 pandemic were compared in the nine sub-counties. Analysis was done using SPSS computer package and statistical tests carried out using 2t test. Descriptive and inferential statistics were employed to summarize the data. Results: There were no significant changes in the overall BCG coverage (p=.30), FIC (p=.098), proportion of pregnant adolescents 10-19 years (p=.83), pregnant women attending at least one ANC visit (p=.41) and the number of WRA who received FP commodities (p=.66). Nevertheless, the proportion of women with 4th antenatal care visit and adolescents 10 - 14 years pregnant at the first ANC visit had lower and higher mean scores during the pandemic with significant changes at p=.05 of (p=0.011) and (p=0.003) respectively. Conclusions: COVID- 19 pandemic did not fundamentally affect MCH services during the first year of the sickness in Meru County. However, the proportion of teenage pregnancies increased significantly, while the proportion of women with 4th antenatal care visit decreased.

Birth Plan Utilization and Associated Factors among Post Natal Women Attending Maternal Child Health Services in Moyale Sub County, Kenya

Purpose: Maternal and neonatal mortalities continue to pose big public health concern in Kenya despite several interventions. These deaths are partly attributed to three delays; delay by the mother in deciding to seek timely care, delay in arriving at the point of health service delivery and delay in receiving adequate health care once at the health facility. Birth planning is important in addressing these delays. A birth plan serves to promote positive pregnancy outcome. There is however, a paucity of data showing level of birth plan utilization and factors associated to the utilization in many areas of Kenya. This hampers efforts in promoting its utilization in reducing maternal mortality ratio. This study sought to find out extent of utilization of individual birth plan and factors that are associated with it among post-natal women attending Maternal Child Health Services in Moyale Sub County, Kenya.
 Methodology: The study was a health care facility based cross sectional study that employed multi stage sampling methods. A total of 548 post-natal women attending Maternal Child health services within Moyale Sub County were interviewed. Data was collected through a structured quantitative questionnaire and FGD guide between May 2021 and July 2021 and analyzed using binomial logistic regression in SPSS version 22. To address confounding, significant variables were put through multinomial regression analysis.
 Findings: Overall, 42.3% of interviewed women had used a birth plan. Socio-demographic factors associated with utilization of a birth plan was secondary level of education (OR=1.214(1.1-2.4), p=0.000), Diploma and above level of education (OR=5.7(0.5-62.1), p=0.042). Maternal factors influencing utilization of birth plan included previous complications (OR=2.6(1.3-3.0), p=0.039), four or more ANC visits (OR=2.4(1.28-3.69, p=0.000), trimester of first ANC (OR=1.4(1.3-3.7), p=0.000), PNC visits (OR=2.3(1.4-3.8), p=0.001). Health system related factors influencing utilization included time of more than one hour in reaching health care (OR=0.999(0.9-1.0), p=0.048), availability of staff at health facility (OR=3.6(1.9-3.9), p=0.024). Treating women with respect at health facility (OR=1.049(1.16-6.5), p=0.034) and availability of drugs/supplies at health facility (OR=3.3(2.2-4.5), p=0.000).
 Unique Contribution to Theory, Policy and Practice: The study showed that there is need to improve quality of ANC services given in health care facilities. Health care workers in health facilities offering ANC need to initiate timely IBP counselling for pregnant mothers. There is also a need for Community health volunteers under the community health strategy to offer counselling on IBP during routine household visitations. Health care providers and patient interactions also need to improve, health workers need to be trained/sensitized on good customer relations to build patient trust. Further research is also recommended to assess quality of ANC services offered in health facilities in the region. Quality of health education and counselling offered by CHV’s during home visits to pregnant mothers also needs to be examined.

To leave no one behind: Assessing utilization of maternal newborn and child health services by all the 13 particularly vulnerable tribal groups (PVTGs) of Odisha, India.

Indigenous tribal people experience lower coverage of maternal, newborn and child healthcare (MNCH) services worldwide, including in India. Meanwhile, Indian tribal people comprise a special sub-population who are even more isolated, marginalized and underserved, designated as particularly vulnerable tribal groups (PVTGs). However, there is an extreme paucity of evidence on how this most vulnerable sub-population utilizes health services. Therefore, we aimed to estimate MNCH service utilization by all the 13 PVTGs of the eastern Indian state of Odisha and compare that with state and national rates. A total of 1186 eligible mothers who gave birth to a live child in last 5years, were interviewed using a validated questionnaire. The weighted MNCH service utilization rates were estimated for antenatal care (ANC), intranatal care (INC), postnatal care (PNC) and immunization (for 12-23-month-old children). The same rates were estimated for state (n = 7144) and nationally representative samples (n = 176843) from National Family Health Survey-5. The ANC service utilization among PVTGs were considerably higher than national average except for early pregnancy registration (PVTGs 67% versus national 79.9%), and 5 ANC components (80.8% versus 82.3%). However, their institutional delivery rates (77.9%) were lower than averages for Odisha (93.1%) and India (90.1%). The PNC and immunization rates were substantially higher than the national averages. Furthermore, the main reasons behind greater home delivery in the PVTGs were accessibility issues (29.9%) and cultural barriers (23.1%). Ours was the first study of MNCH service utilization by PVTGs of an Indian state. It is very pleasantly surprising to note that the most vulnerable subpopulation of India, the PVTGs, have achieved comparable or often greater utilization rates than the national average, which may be attributable to overall significantly better performance by the Odisha state. However, PVTGs have underperformed in terms of timely pregnancy registration and institutional delivery, which should be urgently addressed.

Prevalence of Depression and Anxiety Disorders among Perinatal Teenage Girls Accessing Maternal Child Health Services in Nairobi County, Kenya

Depression and anxiety are categorized as common mental health disorders and the prevalence vary in different contexts. Perinatal teenage girls experience heightened stress levels that could increase the prevalence of depression and anxiety disorders. This study was conducted to determine the prevalence of depression and anxiety disorders among perinatal teenage girls accessing maternal child health services in Nairobi County, Kenya. This was a cross sectional study which involved teenage girls between the age of 10-19 years who were accessing maternal child health (MCH) services during pregnancy and within one-year post-delivery. Non-probability purposive sampling technique was used to identify four health care facilities offering MCH services where the participants were selected purposively. Socio-demographic questionnaire, Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) tools were utilized in collecting data from a sample of 175 perinatal teenage girls. Data analysis was done by using Statistical Package for Social Sciences SPSS (SPSS®) Version 28. The study established that the prevalence of depression was 70.8% at varying levels of severity: Mild depression was 16.6%, Moderate depression was at 24.0% while severe depression was 30.3%. The prevalence of anxiety was at 33.7% at varying levels as well, moderate anxiety was 26.3% while high anxiety was 7.4%. Depression and anxiety are prevalent during teenage perinatal period and therefore, antenatal, and postnatal teenagers should be screened for depression and intervention provided promptly.

Inequity of maternal-child health services in ASEAN member states from 1993 to 2021

IntroductionInequity in maternal-child health services is a challenge to global health as it hinders the achievement of Sustainable Development Goals (SDGs) and Universal Health Coverage. Though the Association of Southeast Asian Nations (ASEAN) has made remarkable achievements in maternal-child health, there remain gaps in reaching global goals. This study aimed to compare and investigate the inequity in maternal-child health (MCH) services in ASEAN member states to help guide policy decisions to improve equitable health services in the SDG era and beyond.MethodsUsing the WHO Health Inequality Monitor, we identified inequity summary measures for five MCH services in ASEAN member states from 1993 to 2021: antenatal care, births attended by skilled health personnel, diphtheria, tetanus and pertussis (DTP3) immunization, measles immunization, and polio immunization. We divided the analysis dimension of inequity into urban–rural inequity, economic status inequity, and sub-regional inequity. Trends of absolute and relative inequity in every dimension of MCH services in ASEAN member states were examined with the principal component analysis (PCA).ResultsThe mean coverages of MCH services are 98.80% (Thailand), 86.72% (Cambodia), 84.54% (Viet Nam), 78.52 (Indonesia), 76.94% (Timor-Leste), 72.40% (Lao PDR), 68.10% (Philippines) and 48.52% (Myanmar) in 2021. Thailand have the lowest MCH services absolute inequity indexes of -1.945, followed by Vietnam (-1.449). Lao PDR and Myanmar have relatively higher MCH services absolute inequity indexes of 0.852 and 0.054 respectively. The service in Cambodia, Indonesia, and the Philippines is pro-specific regions (with subnational region absolute inequity indexes of -0.02, 0.01, and 1.01 respectively). The service in Myanmar is pro-rich (with economic status absolute inequity index of 0.43). The service in Lao PDR and Timor-Leste is pro-urban areas, pro-rich, and pro-specific regions.ConclusionThe inequity of MCH services in ASEAN persists but is in a declining trend. Thailand and Vietnam have performed well in ensuring MCH services equity, while Laos and Myanmar are still facing serious inequity dilemmas. The progress of MCH service equity in Myanmar, Cambodia, the Philippines, and Indonesia is uneven. It is acceptable to learn from the successful experiences of Thailand and Vietnam to improve the equities in other ASEAN countries. Policies should be developed according to the specific types of MCH inequity in member states to improve equity levels.

Uptake of universal health care provided maternal neonatal child health services in Machakos County Kenya

Background: The Universal Health Coverage (UHC) offers an essential package of health services to citizens while protecting them financially in case of an illness. It has been given a top priority globally as a health-related aim. In Kenya, whereas MNCH services have continued to attract investment over the years, reports still show high rates of maternal and child mortality. The study was sought to assess the level of uptake of universal health coverage provided MNCH services and the associated factors. Methods: This was a cross-sectional study undertaken in 422 households in Machakos Sub-County on women of reproductive age (WRA). The data was collected using questionnaires. Multiple logistic regression with (p<0.05) at 95% CI was used for inferential statistics. Results: The results show that all respondents had sought at least one MNCH service. Time taken to reach facility (OR 12.26; 95% CI 1.07 to 140.48) and feeling that a CHV could attend to them during an emergency (OR 4.14; 95% CI 1.23 to 13.91) were significant patient related factors. Supply side factors found to be significant were visit from a CHV (OR 125.93; 95% CI 18.37 to 863.27), feeling that services were of quality (OR 684.411; 95% CI 50.65 to 9248.93, adequacy of staff (OR 1.00; 95% CI 1.0004 to 0.021 and hospital commodities (OR 19.83; 95% CI 1.67 to 235.93). Demographic factors established to be significant were marital status, education level, occupation and monthly income. Conclusions: Patient-related, supply-side and demographic factors had a significant influence on uptake of UHC provided MNCH services.

The role of local government in tackling a global pandemic: A lesson from Nepal

This paper critically analyses the scope of leadership in Nepal at the local government level when tackling the wider impacts of COVID-19, with a particular focus on health service delivery in line with World Health Organisation (WHO) frameworks. In-depth interviews with 66 representatives from local governments (LG) in the Madhesh and Sudurpaschim provinces were conducted, along with analysis of routine data from health management information systems. We found that Maternal Child Health (MCH) services at local health institutions were largely unimpacted, stocks of essential medicine were available, and the LGs exhibited determination and capability in getting to grips with the crisis, despite inadequate knowledge and resources. Nevertheless, there was sizeable shrinkage in the utilisation of services, which triggered public health concerns of a different nature, the LGs were inadequately prepared in regards to the capacity and availability of human resources, and there were explicit gaps in terms of coordination among all three tiers of government and a lack of role clarity that delayed the response to the pandemic at the local level. Our recommendations include continued investment in local MCH services, capacity building for local leaders with a focus on human resource management in emergency contexts, and the simplification of public procurement processes, particularly during crises, enabling LGs and other local actors to expediate procurement and improve response times.

Is the Frequency of Postpartum Breastfeeding Counseling Associated with Exclusive Breastfeeding at Six Months? An Analytical Cross-Sectional Study.

Breastfeeding counseling is an essential public health tool in postpartum maternal and infant health. In this study, we aimed to explore the relationship between the frequency of postpartum breastfeeding counseling and the type of feeding outcome at six months. The study design was an analytical, cross-sectional study on mothers of 6-24-month-old children living in Riyadh, Saudi Arabia. We conducted an analysis with descriptive statistics as well as logistic regression models. The findings from our study can be summarized in the following points: First, only 31.9% of the women in our study received postnatal breastfeeding counseling in the first six months after delivery, with the majority receiving fewer than four sessions. Second, there seemed to be a drop in exclusive breastfeeding with time: from 35.3% in the first two months to 29.7% in the second two months and then 20.7% in the final two months. Third, previous exclusive breastfeeding increased the odds of exclusive breastfeeding in the proceeding delivery. Finally, exposure to one or more postnatal breastfeeding counseling sessions increased the odds of exclusive or predominant breastfeeding in the first six months. This study helps to guide decision makers in planning maternal child health services and relevant community-based efforts.

Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis

ObjectiveThis case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic.DesignA qualitative...

HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique.

Repeat HIV testing during pregnancy and breastfeeding identifies women with incident infections, those living with HIV who have been lost to care, and infants at risk for HIV infection. We report data from repeat testing for women in maternal and child health (MCH) services at 10 health facilities in Mozambique. Routinely collected data from health facility registers are reported from April-November 2019. From antenatal care (ANC), we report numbers and proportions of women eligible for retesting; returned for care when retesting eligible; retested; and HIV-positive (HIV+) at retesting. From child welfare clinics (CWC), we report mothers retested; tested HIV-positive; HIV+ mothers linked to ART services; HIV-exposed infants (HEI) tested for HIV with polymerase chain reaction (PCR) tests; HEI testing PCR positive; PCR-positive infants linked to care. In ANC, 28,233 pregnant women tested HIV-negative at first ANC visit, 40.7% had a follow-up visit when retesting eligible, among whom 84.8% were retested and 0.3%(N = 26) tested HIV+. In CWC, 26,503 women were tested; 0.8%(N = 212) tested HIV+ and 74.1%(N = 157) of HIV+ women were linked to care. Among 157 HEI identified in CWC, 68.4%(N = 145) received PCR testing and 19.3%(N = 28) tested positive. In ANC, less than half of pregnant women eligible for retesting returned for follow-up visits, and test positivity was low among women retested in ANC and CWC. In CWC, linkage to infant testing was poor and almost 20% of HEI were PCR-positive. Implementing retesting for pregnant and breastfeeding women is challenging due to high numbers of women and low testing yield.

Evaluation of the Factors that Affect Family Planning Methods in Clients Attending Maternal Child Health Services at Kyabugimbi Health Centre IV, Bushenyi District, Uganda

Family planning can help reduce maternal mortality by reducing the number of pregnancies, the number of abortions, and the proportion of births at high risk in Bushenyi District. It has been estimated that meeting women’s need for modern contraceptive use would prevent about one quarter to one third of all maternal deaths. This study was aimed at assessing the factors affecting utilization of family planning methods among clients attending child health (MCH) Clinic at Kyabugimbi health Centre IV. A cross-sectional study design was used. According to this study, most of the respondents, were aged 25-34(48%), had no formal education (60%), married(45%) by marital status, peasants (65%) by occupation, while by religion, majority were protestants (41%). Majority (87%) had ever heard about family planning while the minority (13%) had never. The sources of information were health workers (36%), 30% radio and 20% from friends. 38% of the clients reported to be using at least one method of family planning while the majority (56%) was not. Majority of participants reported to be using injecta-plan (14%), pill-plan (9%), condoms (6%), IUDs (4%) and minority (2%) calendar and 6% reported to be using other methods not listed above. This study revealed that majority of the clients reported not to utilize family planning services because they feared side effects (83%), 75% could not afford to travel long distance to the health facility, 67% reported that their religions were against the use of family planning methods while 41% reported that they were not effective in preventing pregnancy. Holding family planning campaigns, educating these clients about the benefits of family planning as well as giving them detailed information in order to put an end to the misconceptions and false beliefs they have about family planning services. More research should be carried on bigger populations for instance referral hospitals to capture larger sample sizes and urban settings. Keywords: Family planning, maternal mortality, abortions, contraceptives.

Correlates of maternal, newborn and child health services uptake, including male partner involvement: Baseline survey results from Bangladesh

ABSTRACT South Asia bears a substantial proportion of the global maternal mortality burden, with adolescents disproportionately affected. Bangladesh has one of the highest adolescent pregnancy rates in the world, with low utilisation of maternal newborn and child health (MNCH) services. This hampers the country’s efforts to achieve optimal health outcomes as envisioned by the Sustainable Development Goals. Male partner involvement is a recognised approach to optimise access to services and decision-making. In South Asia data on male involvement in MNCH service uptake is limited. Plan International’s Strengthening Health Outcomes for Women and Children was implemented across four districts in Bangladesh between 2016 and 2020 and aimed to address these issues. Study results (N = 1,724) found higher maternal education levels were associated with use of MNCH services. After controlling for maternal education, service uptake was associated with male partner support level and perceived joint decision-making. The positive association between male support level and MNCH scale was robust to stratification by maternal education level, and by age group (i.e. adolescent vs. adult mothers). These findings suggest that one path for achieving optimal MNCH outcomes might be through structural-level interventions centred on women, combined with components targeting male partners or male heads of households.

Anaemia among Third-trimester Pregnant Women in a Community Hospital: A Descriptive Cross-sectional Study.

Anaemia has haemoglobin levels of less than 11/100 ml in the first and third trimesters and less than 10/100 ml in the second. Maternal anaemia is a global health issue that has a negative impact on neonatal outcomes. The prevalence is more common in developing nations like Nepal. Positive correlations have been found between third-trimester maternal haemoglobin and neonatal birth weight. Our study aimed to find out the prevalence of anaemia among third-trimester of pregnant women in a community hospital. This was a descriptive cross-sectional study conducted in the outpatient Department of Obstetrics and Gynecology from September 2020 to September 2021. Ethical approval was taken from the Nepal health research council (Registration number: 577/2020P). The haemoglobin level of 375 participants was recorded. Data were analyzed using Statistical package for social sciences (SPSS) version 22. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Out of a total of 375 pregnant females in the third trimester, 31 (8.27%) (5.48-11.06, 95% Confidence Interval) were anaemia. The prevalence of anaemia was lower as compared to other studies done in similar settings. anemia; maternal-child health services; prevalence.

Strategies for promoting male partner involvement in maternal, newborn and child health care in Kiambu County.

the 1994 International Conference on Population and Development (ICPD) recommended that men should share responsibility and be actively involved in sexual and reproductive health. The level of male partner involvement in Kenya remains low despite growing evidence showing its benefits in maternal and newborn health. This study sought to explore strategies for encouraging male partners to accompany their spouses to Maternal and Child Health (MCH) department. a qualitative exploratory study was used to gather the views of nurse-midwives and invited men on mechanisms to encourage men to accompany their spouses to MCH clinic. Three and two focused group discussions (FGDs) composed of six to eight participants from nurse-midwives and men were conducted respectively. The FGDs were audio recorded and lasted 60-90 minutes. Content analysis was used to generate themes using MAXQDA 2022 software. seven categories emerged as strategies that can encourage male partner participation in the Maternal Neonatal and Child Health (MNCH) services: creating community awareness and sensitization, engaging men in the MCH department, reducing waiting time, provision of health services that address male health needs, inviting male partners to the MCH clinic, encouraging MCH staff to be receptive to couples and re-scheduling of MCH working days as well as extension of hours. evidence-based strategies that adopts multi-level interventions with greater focus on community sensitization and re-organization of the MCH services are important in encouraging men accompany their spouses to clinic and actively participate in the MNCH.

Indicator Selection for Quality Measurement in Maternal Neonatal and Child Health Services: Application of Random Forest Classifier

Indicator Selection for Quality Measurement in Maternal Neonatal and Child Health Services: Application of Random Forest Classifier

Contributors and associated risk factors of neonatal mortality in a tertiary care hospital in the sub-Himalayan region of West Bengal

Background: Lack of revision of knowledge on the magnitude of problem, cause and factors associated with neonatal mortality hampering early interventions and thus preventing reduction of neonatal mortality rate in India. Neonatal mortality statistics are sensitive indicators of the utility, convenience and effectiveness of maternal child health service in the community. This study was done to see the mortality pattern of neonates and contributing factors at the special newborn care unit (SNCU) and neonatal intensive care unit (NICU) of a rural tertiary care hospital so that special attention to those cause and factors can lead to favourable outcomes.Methods: This was a cross sectional retrospective study done in the SNCU and NICU of rural tertiary care centre of West Bengal for a period of three years with neonates admitted before 28 days of life. Data were collected in pre-designed proforma by analysing the case sheets from the records section of the hospital. Results were analysed by descriptive analytical method.Results: Total 13738 babies were admitted in the study period (7143 inborn and 6595 outborn). Majority of the inborns (86.8%) and outborns (68.4%) were discharged during that period while 9.4% inborns and 19.5% outborns were expired and only those expired cases were included in this study. HIE/moderate-severe birth asphyxia (41.2%) was the major contributor of death in inborns but in outborns the most common contributor of death was sepsis/pneumonia/meningitis (34.8%). Prematurity and low birth weight were the most common associated risk factors in both the groups.Conclusions: This study delineating the mortality patterns and associated risk factors of neonates in a rural tertiary care hospital of West Bengal which is unique in its kind. Outcome analysis showed that neonatal mortality rate for outborn babies was higher than in relevant recent studies.

Socio-cultural and Gender Impacts on Resilience Access to and Utilization of Contraceptives Service during Covid-19 Pandemic by Women of Reproductive Age in Oyo State, Nigeria

Cultural and gender factors are a major obstacles to informed discussions about sexual and reproductive health issues, particularly regarding contraception. This paper presents the findings of a cross-sectional quantitative study exploring socio-cultural and gender impacts on resilience access to and utilization of contraceptives service during the Covid-19 Pandemic by women of reproductive age in Oyo state, Nigeria. A purposive sampling technique was used to select 471 users of Maternal New-borne and Child Health (MNCH) services such as postnatal and family planning that responded to 43 structured questionnaires that included socio-demographical characteristics, access, and utilization, socio-cultural and gender factors amidst Covid-19 pandemics. Of the 471 respondents, the mean age of respondents was 29.63± 3.29years, with (34.2%) within the 26-30 years age group. The findings show that of the total respondents, 59.4% required permission/consent to use contraceptive services, of which 96.1% mentioned spouses must give consent/approval for them to visit health facilities for contraceptive use. On the way that their spouses do influence, 43.5% mentioned cost, choice of methods 41.6%, and timing by 14.4%. On the respondents’ concerns/issues as a result of poor access to contraceptive information/services; 10.8% expressed unplanned pregnancy, fighting with spouses (11.3%), and poor mutual sexual relationships by 12.3% and experienced side effects by just 1.1%, while the rest 64.5% expressed no concerns/issues. Other societal influences mentioned included friends/relations, in-laws, clergy, and social class/group. The socio-cultural and gender effect included strict caution/disapproval by spouses (7.0%), carefree attitudes in society (4.0%), and fear of Covid-19 infection by 19.7%. Chi-square analysis for gender and socio-cultural revealed p=0.008 and p=0.002 on access and utilization of contraceptive services. The study therefore provides insight to the socio-cultural and gender impacts on women’s s health decision-making. This is important for public health programme designs, even in the face of any pandemic like Covid-19, towards resilience access and service utilization of contraceptive services. Keywords: Access and utilization, Contraceptives, Covid-19, Gender, Socio-cultural.

The impact of social determinants of health of Australian Indigenous women on access and engagement in maternal child health services.

To explore the impact of social determinants of health and health outcomes of Australian Indigenous women on their access and engagement in maternal child health services. A qualitative study, guided by the methodological principles of narrative inquiry integrated with the Indigenous philosophy 'Dadirri', and thematic analysis of the data. Interviews of 35 Aboriginal mothers with children aged birth to 5 years in December 2021, to explore factors that influence their access and engagement in maternal child health services. Enabling factors that influence access and engagement of Indigenous women in maternal child health services include service models or interventions that are culturally sensitive and effective. Models that recognize the social determinants of health and well-being, are timely, appropriate, culturally strong, flexible, holistic and effective community-based services that support continuity of care and communication and encourage earlier identification of risk and further assessment, intervention, referral and support from the antenatal period to the child's fifth birthday (the first 2000 days), also support access and engagement. Barriers to access and engagement include an ineffective service model built on mistrust and poor communication from cultural differences between client and provider, a lack of continuity of care between services, limited flexibility of service delivery to suit individual needs and a healthcare model that does not recognize the importance of the social determinants of health and well-being. Nurses' understanding of Indigenous culture, and the impact of the social determinants of health and health outcomes on the well-being of Indigenous women, is critical to improve their access and engagement in maternal child health services. The findings of this research support the benefit of models or interventions that recognize the interactions and effects of the social determinants of health and health outcomes of Indigenous women and their healthcare access. Data from Indigenous mothers residing in the Glenelg Shire with at least one child aged birth to 5 years were collected through face-to-face, in-depth semi-structured discussion ('yarning') at the Dhauwurd Wurrung Elderly and Community Health Service and the Winda-Mara Aboriginal Corporation Aboriginal and Community Controlled Health Organizations (ACCHO's) in December 2021, co-facilitated by key staff from the ACCHO's. To ensure cultural safety and an Indigenous lens to the research, consultation with traditional owners residing in the Glenelg Shire was sourced to assist with the development of the research guide and to develop interview questions. A panel of experts was then consulted to clarify the relevance and clarity of each question/discussion prompt on the indicative interview schedule and establish face validity. The panel of experts comprised of the research project team, an experienced Maternal and Child Health (MCH) nurse researcher and key representatives from the Victorian Aboriginal Community Controlled Health Organization (VACCHO) and the ACCHO sites. A small number of the target group, independent of the research, piloted the questions. Any valid suggestions from the expert panel and pilot testing were incorporated into the interview schedule design and clarifications were made to the questions/prompts where appropriate. Following full approval of the research, the Chief Executive Officers (CEO's) of the two ACCHO's were provided with an overview of the project and timeframes, and an Indigenous employee within each ACCHO was appointed by the CEO as a 'site coordinator' to act as the chief point of contact with the project team and assist with recruitment of discussion participants. Women who met the inclusion criteria were then invited to participate in the research. To ensure procedural and interpretative rigour, and to gain a deeper, comprehensive insight and understanding of First Nation women's access and engagement in MCH Services, the ACCHO Site Coordinators, key staff from VACCHO and an Indigenous academic consultant with research experience interviewing Indigenous mothers in 'the first 1000 days' of their child's life, also participated in the analysis of the data.

Motivation and Facilities to the Compliance of Independent Midwife Practices in Recording Reporting on Maternal Child Health Services in Wonosobo

Independent Practice Midwives are obliged to systematically record midwifery care and other services provided, the Wonosobo Health Office and the professional organization of the Indonesian Midwifery Association have not yet made a mutual agreement on the report form in which PMB is required to report records of Maternal and Child Health services to Puskesmas every year. month. Purpose this study was to determine the relationship between motivation and facilities on PMB compliance. Type of research is a quantitative with a cross sectional research design. Subjects was 210 PMB with a significance level of 1%, so the samples taken were 160. Sample was determined randomly using a lottery system. The data were taken using a questionnaire that had been tested for validity and reliability. Data analysis consisted of Chi Square statistical test and logistic regression analysis. The results show that there is a significant positive relationship between motivation and compliance, the value of continuity correction is 57,325 p-value = 0.0000 (p<0.05). There is a significant positive relationship between facilities and compliance with the value of continuity correction 50.897 p-value = 0.0000 (p<0.05). The motivation and facilities variables simultaneously have a significant effect on the compliance variable because the omnibus test significance value is 0.000 (p<0.01) with the coefficient of determination R square. It is explained that the motivation and facilities variables in the study are able to contribute to the compliance variable of 0.668 (66.8 %), sequentially the most influential variable on Compliance is the Motivation variable with a wald value of 29,827 followed by the Facility variable with a wald value of 26,719.