Maternal Health Behaviors Research Articles

Association Between Breastfeeding and Child Stunting in Mexico.

Background:Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting.Objective:To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico.Methods:Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors.Findings:Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models.Conclusions:According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Differences in levels of stress, social support, health behaviours, and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic, and based on phases of pandemic restrictions, in Ireland

BackgroundThe COVID-19 pandemic and related restrictions can adversely impact antenatal maternal well-being and health behaviours. AimTo examine antenatal stress and stress-reduction strategies, social support, and health behaviours between women pregnant before and during the pandemic in Ireland. Methods210 pregnant women were recruited online and in the antenatal department of a tertiary maternity hospital before the pandemic, and 235 women recruited online during the pandemic. Only women resident in Ireland were included in this study. Women completed measures of stress, social support, health-behaviours, and self-reported stress-reduction strategies. Differences in outcomes were examined between women pregnant before and during the pandemic, and between Phase 2 and Phase 3 of the Irish Government COVID-19 restrictions. FindingsWomen pregnant during the pandemic reported lower perceived social support, including support from a significant other, friends and family, than women pregnant before the pandemic. There were no significant differences in stress in health behaviours but women reported higher stress and less physical activity during the pandemic. Women reported a range of comparable stress-reduction strategies before and during the pandemic. No differences were observed between phases of pandemic-related restrictions for any outcome. DiscussionOur findings highlight negative impacts of the pandemic on social support, stress, and physical activity, which can have implications for maternal and child health. Lack of differences between restriction phases suggests on-going negative effects for antenatal well-being and behaviours. ConclusionDevelopment of supports for pregnant women during the pandemic should include social-support and stress-reduction components.

Maternal Health-Care Access and Utilization in Sidoluhur, Lawang

The geographical conditions influence infrastructure development, such as public health services. The utilization of facilities depends on the socio-economic characteristic of the community itself. Accessing and utilizing health services would maternal mortality. This study aims to describe the maternal health behavior and to assess the correlation between access and utilization with regards to socio-economics maternal characteristics. This research used a quantitative method and samples 75 women of childbearing age. This study uses cross-sectional primary data, and analysis was performed using descriptive and inferential statistics nonparametric. Correlation analysis was performed using the Kendal Tau correlation to determine the relationship of independent variables to the dependent variable. The influence of independent variables on dependent variables measure using logistic regression. The results of this study were 31% of respondents still carrying out traditional births through an attendant called ”dukun”. Public health service availability is sufficient, although not everyone can access easily. While in traditional services, traditional birth attendants come to patients so they preferred this method because it’s effortless. Access to health services and access to information simultaneously give a 72.2% impact towards maternal behavior of ante-natal care.&#x0D; Keywords: socio-economics characteristic, maternal healthcare utilization, maternal delivery

Food Security and Race/Ethnicity Matter when Conceptualizing Breastfeeding Within a Social Justice Framework

Abstract Objectives To examine the effects of food insecurity and race/ethnicity on breastfeeding within a social justice framework among children aged 0 to 35 months in the US. Methods Secondary data analysis of 3345 children from 4 waves of the 2007–2014 National Health and Nutrition Examination Survey (NHANES), using survey commands, and computing tests of proportions, logistic and generalized ordered logistic models to examine bivariate and multivariable associations. Results The prevalence of breastfeeding initiation, any breastfeeding for ≥3 months and any breastfeeding for ≥6 months was lower in non-Hispanic Black children when compared to all other races/ethnicities (i.e., Mexican-American, other Hispanics, non-Hispanic White, and others). Controlling for race/ethnicity, children living in food insecure households were less likely to receive any breastfeeding for ≥3 or ≥6 months. When compared to non-Hispanic White children and controlling for food insecurity, Mexican-Americans, other Hispanics and non-Hispanic Black counterparts were less likely to receive any breastfeeding for ≥3 or ≥6 months. The interaction between food insecurity and race/ethnicity on breastfeeding was statistically significant, and the largest effect of food insecurity on breastfeeding was observed among non-Hispanic Black children. Conclusions According to our results and theoretically grounded on social justice perspectives, efforts need to be aimed towards supporting non-Hispanic Black women particularly living in food insecure households, pre- and postnatally, to increase breastfeeding initiation and continuation rates. By focusing strategies that continuously support positive maternal health behaviors such as breastfeeding, wider goals may be achieved such as narrowing the health gap that has been consistently reported in this racial/ethnic group. Funding Sources No funding was received for this research.

Mobile Phone-Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review.

BackgroundChronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions.ObjectiveThis study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes.MethodsThis systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation.ResultsOf the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis.ConclusionsIn high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain.

Predictors of Insufficient Preconception Multivitamin Use: An IMPLICIT Network Study.

Adequate maternal nutrition before pregnancy is important to reduce the risk of poor birth outcomes. However, patients report suboptimal intake of multivitamins with folic acid (MVIs). We conducted a quality improvement study to identify predictors of insufficient multivitamin use in women of childbearing age at five University of Pittsburgh Medical Center (UPMC) family health centers that implemented the IMPLICIT interconception care (ICC) model of maternal health screenings during well-child visits (WCVs). We derived this analysis from a retrospective chart review of patient-reported demographic information and physician documented maternal behaviors of 758 women who accompanied their children to 2,706 total well-child visits. Insufficient multivitamin use was defined as having one or more visits where the mother reported that she was not taking multivitamins. Insufficient multivitamin use at these health centers was associated with younger age (OR 0.96, 95% CI 0.92, 0.98), less than high school education (OR 3.3, 95% CI 1.56-6.80), public insurance (OR 1.56, 95% CI 1.05-2.34), and increased number of well-child visits attended (OR 1.46, 95% CI 1.31-1.61). Among women who received screening, younger, low-income, and less educated women are likely to benefit from targeted interventions to improve multivitamin use during the interconception period. Findings also suggest that WCVs are a viable access point to assess and address multivitamin use and other desired maternal health behaviors.

Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

BackgroundChamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors.MethodsWe prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October–December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.ResultsCompared to controls (n = 115), a significantly higher proportion of Chamas participants (n = 211) delivered in a health facility (84.4% vs. 50.4%, p < 0.001), attended at least four ANC visits (64.0% vs. 37.4%, p < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12–9.64, p < 0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls.ConclusionsChamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.Trial registrationClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017).

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo.

Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas. We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five. Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2weeks. Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors. ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

The feasibility of ‘Mind the Bump’: A mindfulness based maternal behaviour change intervention

Backgroundand purpose: Women's health behaviours during pregnancy can affect their children's lifetime outcomes. Inactivity, poor diet, alcohol, and smoking during pregnancy are linked to maternal stress and distress. Mindfulness-based interventions can improve health behaviours and mental health. The purpose of the study was to develop and evaluate the feasibility of a mindfulness-based maternal behaviour change intervention. Materials and methods: The eight-week ‘Mind the Bump’ intervention integrated mindfulness training with behaviour change techniques. It aimed to improve mindfulness, mental health, and adherence to UK maternal health behaviour guidance. Acceptability, practicability, effectiveness/cost-effectiveness, affordability, safety/side-effects, and equity were evaluated from baseline to post-course and follow-up. Results: Mindfulness, positive affect, and wellbeing improved. Stress, negative affect, depression, anxiety, and adherence to guidance did not improve. The intervention was practicable and safe, but the other implementability criteria were not satisfied. Conclusion: The intervention was not fully feasible; recommendations to address its limitations are discussed.

Health Behavior Prediction Model Based on Health Literacy among Mothers with Obesity Children

INTRODUCTION: Mothers have an important role in childhood obesity. The role of the mother is influenced by self-care, self-efficacy, child health status, and health information obtained by mothers who form health literacy in the prevention of obesity in children.&#x0D; AIM: The aim of this study was to determine the health behavior prediction model based on health literacy among mothers with obesity children.&#x0D; METHODS: This study used a cross-sectional study design. The study sample was all mothers who had school children aged 7–15 years in Jakarta Province, Indonesia, in 2018, with a sample of 301 people. The sampling technique used proportional random sampling. Data were collected by health literacy questionnaire, self-care, self-efficacy, health status, health information, and maternal health behavior in the prevention of childhood obesity that has been validated. Data were analyzed using the structural equation model using Stata version 14.2 (Stata Corporation) software.&#x0D; RESULTS: The results of this study found that determinant variables associated with obese children’s behavior prevention in mothers were health literacy, self-care, self-efficacy, health status, and health information (p &lt; 0.05). The model of maternal health behavior to prevent childhood obesity based on health literacy, health information, and health status explained 40% of maternal health behavior variances. In addition, health information, self-care, self-efficacy, and health status associated with health literacy described 34%.&#x0D; CONCLUSION: This study confirmed maternal health behavior based on health literacy to prevent childhood obesity. These results will help health professionals promoting effective childhood obesity prevention among mothers.

Exploring the Gender-Specific Impact of Educational Film on Maternal and Child Health Knowledge and Behavior: A Qualitative Study in Serenje District, Zambia.

Educational film is a communication tool that helps to present complex information simply and clearly, keeping audiences interested for longer and helping to reinforce important learning. Medical Aid Films produces educational films targeted at communities and health workers, with a focus on maternal and child health (MCH) content. Pilot work suggests that film screenings have attracted male as well as female viewers and have started to increase male involvement in MCH care. We explored stakeholder perspectives and gender-specific responses to educational films screened in a rural district of Serenje, Zambia. A qualitative study using focus group discussions and in-depth interviews with men and women who had viewed the films at least once, and key informant interviews with health workers who helped deliver the film screenings. Thematic framework analysis was used to derive themes and subthemes, and illustrative quotes are used to substantiate interpretation of the findings. Men's and women's perspectives are clustered around the influence of the films on knowledge and behavior in relation to MCH topics and male involvement and overall community responses to the films. The three themes summarizing key informant perspectives relate to their impressions of the influence of the films on male involvement in MCH and their views on using film to deliver heath information. Educational films have the potential to improve women's and men's knowledge and awareness of MCH topics, including healthy nutrition and welfare of women during pregnancy, the need to seek skilled care during pregnancy and for childbirth, and the importance of male involvement in supporting the care of women and children. Before widespread implementation, decisions must be made about whether and how to integrate the films with community health education programs, the needs, values, and preferences of men and women and how to present and deliver the film content in a way that maximizes participation of men and women in MCH but does not undermine women's rights, autonomy, or safety.

Women's Land Rights and Maternal Healthcare in Southwestern Uganda: Exploring the Implications of Women's Decision-Making Regarding Sale and Use of Land on Access to Maternal Healthcare.

Most traditional land tenure practices among developing economies are opposed to protecting and promoting women's land ownership rights. In Uganda, land tenure practices are largely customary and patriarchal in nature, in most communities women's land tenure security is dependent on marriage. This paper builds a body of evidence on how gender biased land tenure negatively affects maternal healthcare decision-making for family planning, antenatal care services and skilled care during childbirth. A cross-sectional mixed methodology was used to collect household survey data. Qualitative data from individual and focus group interviews were analysed using thematic content analysis. Land was found to be an important household factor that shapes women's maternal healthcare decision-making, not only through land ownership, but also through land's role as a source of identity, gendered land use decision-making patterns, and the allocation of resources that accrue from work on land. Most of the land-owning households are headed by men. More women than men expressed insecurity of tenure, despite the household's land ownership status. Land use decision-making, including its sale was significantly associated with maternal healthcare decision- making. Feeling secure on land was significantly associated with maternal healthcare decisions for planned pregnancy and use of antenatal care. Land purchasing was found to significantly determine place and skill level of providers for childbirth. In conclusion, women involvement in land purchasing decisions demonstrates more control and agency in the number of children. Women's land insecurity undermines their prospects for positive maternal health behaviours.

Adverse birth outcomes and the risk of dental caries at age 3years.

Since birth outcome is associated with maternal and newborn health, it can be a predictor of the future health of the child. To investigate the association between adverse birth outcomes and dental caries. The present registry-based cohort study included all children born in 2000-2003, residing in Stockholm County, Sweden and who received a dental examination at the age of 3years (n=74748). National registries supplied data on socioeconomic conditions, maternal health, maternal health behavior, and birth outcomes. Forward stepwise binary logistic regression was performed to determine predictors of caries experience in the 3-year-olds. Of the subjects, 6.0% had caries experience (decayed, extracted, and filled teeth [deft]≥1), 5.6% were born preterm (<37weeks); 2.2% were born small (SGA) and 3.7% large (LGA) for gestational age. Of the studied adverse birth outcomes, only SGA was significantly associated with caries experience at 3years of age, and only for mothers who had refrained from smoking during pregnancy. SGA is associated with caries experience in 3-year-old children; however, this relationship occurs only in mothers who did not smoke during pregnancy.

The 3G Multigenerational Cohort of Nova Scotian women and their mothers and offspring.

The negative impact of exposures such as maternal obesity, excessive gestational weight gain, and hypertension in pregnancy on the health of the next generation has been well studied. Evidence from animal studies suggests that the effects of in utero exposures may persist into the second generation, but the epidemiological literature on the influence of pregnancy-related exposures across three generations in humans is sparse. This cohort was established to investigate associations between antenatal and perinatal exposures and health outcomes in women and their offspring. The cohort includes women who were born and subsequently had their own pregnancies in the Canadian province of Nova Scotia from 1980 onward. Intergenerational linkage of data in the Nova Scotia Atlee Perinatal Database was used to establish a population-based dynamic retrospective cohort. The cohort has prospectively collected information on sociodemographics, maternal health and health behaviours, pregnancy health and complications, and obstetrical and neonatal outcomes for two generations of women and their offspring. As of October 2018, the 3G cohort included 14978 grandmothers (born 1939-1986), 16766 mothers or cohort women (born 1981-2003), and 28638 children (born 1996-2018). The cohort women were generally younger than Nova Scotian women born after 1980, and as a result, characteristics associated with pregnancy at a younger age were more frequently seen in the cohort women; sampling weights will be created to account for this design effect. The cohort will be updated annually to capture future deliveries to women who are already in the cohort and women who become eligible for inclusion when they deliver their first child. The 3G Multigenerational Cohort is a population-based cohort of women and their mothers and offspring, spanning a time period of 38years, and provides the opportunity to study inter- and transgenerational associations across the maternal line.

Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh?

BackgroundIn Sunamganj there are fewer than four skilled providers per 10,000 population and just 27% of births are assisted by a skilled attendant. We evaluate a private community skilled birth attendant (P-CSBA) model, developed through the GSK-CARE Frontline Health Worker Programme, designed to address this gap and report on changes in service utilization and health outcomes from baseline to three years post-baseline.MethodsThis analysis presents the results of a pre-post cross sectional design. A baseline survey (n = 1800) was conducted using a multistage cluster sampling approach. Three years post-baseline a second cross-sectional survey (n = 1755) was conducted across the same project area. To describe demographic characteristics of the study participants descriptive statistical techniques were used as appropriate. Logistic and multiple logistic regression, controlling for a comprehensive set of covariates, were used to assess odds ratios for key maternal health behaviors and outcomes.ResultsBirth planning and the use of key maternal health services improved from baseline to follow-up. There was a dramatic increase in the proportion of respondents reporting skilled attendance at birth (aOR: 2.18, p = .001). Women also reported significantly fewer complications during the prenatal (aOR: .30, p<.001), labor and delivery (aOR: 0.41, p<.0001) and postnatal periods (aOR: 0.32, p<.0001).ConclusionPrivate-sector approaches, when coupled with robust efforts to strengthen and collaborate with the public sector, can work successfully to deliver services in underserved communities. The success of this model lends credence to the growing appreciation that reaching our development targets will require governments to work in partnership with private sector actors and highlights the potential of private-public partnerships as we drive towards universal health coverage.

The roles of social networks and social support on breastfeeding practices in Nigeria

Background: The global prevalence of early breastfeeding initiation, exclusive breastfeeding, and avoidance of prelacteal feeding has remained below the recommendations by the World Health Organization. Nigeria has the lowest rates of exclusive breastfeeding and the highest rates of prelacteal feeding in sub-Saharan Africa. It has been shown that social support is positively associated with healthy breastfeeding practices. Materials and Methods: This study used data from the household interviews of the Pilot Study on the Quality of Care in Antenatal Care and Patterns of Maternal Health Behavior in Nigeria, a cross-sectional survey of women (n = 455) in Nigeria to investigate the association between social support and breastfeeding practices among women. We conducted multivariable logistic regression analyses to explore the association between sources and types of social supports and breastfeeding in Nigeria. Results: We found that supports from mothers and fathers were associated with a higher prevalence of early breastfeeding initiation (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.03–3.53; P = 0.039) and avoidance of prelacteal feeding (OR = 2.20; 95% CI = 1.08–4.49; P = 0.030), respectively. On the other hand, supports from neighbors (OR = 0.40; 95% CI = 0.24–0.64; P < 0.001) and mothers-in-law (OR = 0.46; 95% CI = 0.22–0.96; P = 0.039) were negatively associated with early breastfeeding initiation. Other sources of support were not significantly associated with either breastfeeding initiation or prelacteal feeding. Also, high levels of physical support from all network members were associated with a higher likelihood of avoiding prelacteal feeding (OR = 2.94; 95% = CI 1.65–5.22; P < 0.001). In contrast, high levels of emotional support from all network members were associated with a higher risk of prelacteal feeding (OR = 0.61; 95% CI = 0.37–0.98; P = 0.045). Conclusion: Our findings suggest that there are significant dual roles of social support from older generations on breastfeeding. Physical support during the postpartum periods may discourage prelacteal feeding in Nigeria.

Connecting mothers to care: Effectiveness and scale-up of an mHealth program in Timor-Leste.

BackgroundHealth Alliance International (HAI) with the Ministry of Health (MoH) of Timor-Leste and Catalpa International implemented a mobile phone-based mHealth program in 2013 known as Liga Inan (“Connecting Mothers”). Liga Inan was designed as a sustainable and scalable effort that would support MoH efforts to improve maternal and newborn health care-seeking and home practices. Key aims were to use mobile phone technology to improve communication between pregnant women and their MoH health providers and to increase optimal maternal health behaviors. MoH health staff registered pregnant women into Liga Inan at their first antenatal care (ANC) visit and followed them through pregnancy, delivery and six months postpartum. A web-based platform sent text messages twice weekly to promote safe pregnancy/delivery and facilitated phone communication between pregnant women and their MoH care providers.MethodsFor the program’s final evaluation, baseline (2012) and final (2015) surveys interviewed women in one intervention district and one adjacent control district who had given birth in the preceding two years. Primary outcomes were receiving four or more ANC visits, using skilled birth attendants, delivery in health facilities, and timely postnatal care.ResultsMultivariate analysis compared endline maternal health behaviors for women in the intervention district compared to baseline and to women in the control district. Controlling for other factors, women in the intervention district had nearly twice the odds of having a skilled birth attendant and a facility delivery, nearly five times the odds of receiving a postpartum care visit within two days of delivery, and over five times the odds of having their newborn’s health checked within two days of birth. There was no significant association between Liga Inan exposure and receipt of four or more ANC visits.ConclusionsLiga Inan was associated with substantial increases in MoH health provider-assisted and facility-based births and timely postnatal care in Timor-Leste. These positive results led the MoH to incorporate Liga Inan into the national maternal and child health program. To date the program has expanded to cover all 13 districts in the country, with gradual assumption of management and financial responsibility by the MoH under way.

Effects of health behaviour change intervention through women's self-help groups on maternal and newborn health practices and related inequalities in rural india: A quasi-experimental study

BackgroundDespite the health system efforts, health disparities exist across sub-populations in India. We assessed the effects of health behaviour change interventions through women's self-help groups (SHGs) on maternal and newborn health (MNH) behaviours and socio-economic inequalities. MethodsWe did a quasi-experimental study of a large-scale SHG program in Uttar Pradesh, India, where 120 geographic blocks received, and 83 blocks did not receive health intervention. Data comes from two cross-sectional surveys with 4,615 recently delivered women in 2015, and 4,250 women in 2017. The intervention included MNH discussions in SHG meetings and community outreach activities. The outcomes included antenatal, natal and postnatal care, contraceptive use, cord care, skin-to-skin care, and breastfeeding practices. Effects were assessed using multilevel mixed-effects regression adjusted difference-in-differences (DID) analysis adjusting for geographic clustering and potential covariates, for all, most-marginalised and least-marginalised women. Concentration indices examined the socio-economic inequality in health practices over time. FindingsThe net improvements (5–11 percentage points [pp]) in correct MNH practices were significant in the intervention areas. The improvements over time were higher among the most-marginalised than least-marginalised for antenatal check-ups (DID: 20pp, p<0•001 versus DID: 6pp, p = 0•093), consumption of iron folic acid tablets for 100 days (DID: 7pp, p = 0•036 versus DID: -1pp, p = 0•671), current use of contraception (DID: 12pp, p = 0•046 versus DID: 10pp, p = 0•021), cord care (DID: 12pp, p = 0•051 versus DID: 7pp, p = 0•210), and timely initiation of breastfeeding (DID: 29pp, p = 0•001 versus DID: 1pp, p = 0•933). Lorenz curves and concentration indices indicated reduction in rich-poor gap in health practices over time in the intervention areas. InterpretationDisparities in MNH behaviours declined with the efforts by SHGs through behaviour change communication intervention.

Fertility intentions and maternal health behaviour during and after pregnancy

This study examines associations between fertility intentions and maternal health behaviours during and after pregnancy among a nationally representative sample of 3,442 women from India. Two waves of data (2005, 2012) from the India Human Development Survey were analyzed to investigate the influence of unwanted births on women’s use of antenatal care, timely postnatal care, and the delivery setting using binary and ordered logistic regression, partial proportional odds models, and propensity score weighting. Fifty-eight per cent of sample births were unwanted. Regression results show that, net of maternal and household characteristics, women with unwanted births were less likely to obtain any antenatal care and had fewer antenatal tests performed. Unwantedness was also associated with a lower likelihood of delivering in an institutional setting and of obtaining timely postnatal care. The relationships between unwantedness and antenatal care, postnatal care, and delivery setting were robust to models accounting for propensity weighting.

Maternal sociodemographic and health behaviours associated with adiposity in infants as measured by air displacement plethysmography

BackgroundIdentifying modifiable factors associated with body fat in infancy may improve health outcomes. Few studies have examined factors associated with percentage body fat calculated using air displacement plethysmography, a gold standard technique. AimsTo investigate maternal sociodemographic and health behaviour characteristics associated with percentage body fat in offspring at birth. Study designObservational cross-sectional study in which the body composition of term infants was measured by air displacement plethysmography during the hospital stay after birth. SubjectsOne-hundred-and-ninety-six women and their term (37–42 weeks) infants. Outcome measuresAssociations between infant body composition and maternal sociodemographic and health characteristics. ResultsOne-hundred-and-ninety-six women (41.8% primiparous) participated. Mean percentage body fat among infants (51.5% female) was 10.3 ± 3.7. Percentage body fat was significantly (p < 0.001) higher in infants born to women with an obese or overweight body mass index (BMI), when compared to infants born to women with a healthy BMI (12.1 ± 4.0, 11.1 ± 3.1, and 9.2 ± 3.7, respectively). A significant positive correlation (r = 0.294) was observed, with the percentage body fat of infants born to women with an overweight or obese BMI being 17.1% and 23.9% higher, respectively, than that of infants born to women with a healthy weight BMI. Percentage body fat was lower in infants born to primiparous women (p = 0.011) and women of low social class (p = 0.003). ConclusionsInfants born to women with an overweight or obese pre-pregnancy BMI had significantly higher mean percentage body fat when compared to infants born to women with a healthy pre-pregnancy BMI. Research into approaches that promote a healthy BMI in advance of pregnancy is warranted.