Access To Maternal Health Care Research Articles

Demographics, Morbidity, and Mortality Between Nonpregnant and Pregnant Firearm Injury Victims [ID 2683667

INTRODUCTION: Despite ongoing national efforts to reduce maternal morbidity/mortality, literature on gunshot wounds (GSWs) is limited. We sought to compare demographics, injury severity scores (ISS), and mortality between pregnant and nonpregnant women with GSWs. METHODS: Retrospective review of demographics and injury severity in female GSW victims who presented to three Level 1 Trauma Centers between 2018 and 2020. Shapiro–Wilk tests, Wilcoxon-signed-ranks tests, and chi-squared tests were performed. A value of P<.05 was significant. RESULTS: We analyzed 575 nonpregnant and 27 pregnant women. Mean age (years) was 32 (30.77–33.33) for nonpregnant women and 27 (24.43–30.13) for pregnant women. For nonpregnant women, 283 (49.39%) were White, 249 (43.46%) Black, and 14 (2.44%) Asian. For pregnant women, 11 (40.74%) were White, 13 (48.15%) Black, and 1 (3.70%) Asian. 9 (23.81%) nonpregnant women and 135 (33.33%) pregnant women were Hispanic. Women publicly insured were 120 (21%) nonpregnant and 11 (41%) pregnant (P<.05). Within a year of shooting, 7% nonpregnant and 27% pregnant women had given birth (P<.05). For nonpregnant versus pregnant women, mean ISS were 11.86 (10.58–13.16) and 14.38 (7.03–21.67), and mortality was 258 (44.87%) and 11 (40.74%), respectively. CONCLUSION: Demographics, ISS, and mortality did not differ between pregnant and nonpregnant women. Although pregnant women were more likely to be insured, they had similar morbidity/mortality as nonpregnant women. There is a need to determine whether maternal health care access affects outcomes and evaluate methods of primary prevention.

Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa's Conditional Cash Transfer Program.

Maternal mortality, largely stemming from complications during pregnancy and childbirth, impacts poor expecting women with limited healthcare access in rural Pakistan. Conditional Cash Transfers (CCTs), commonly implemented in developing nations, are designed to improve the well-being of vulnerable populations by focusing on health and education. A CCT initiative named Chief Minister's Special Initiative for Mother and Child Health (CM-SIMCH) was launched in Khyber Pakhtunkhwa (KP), one of the less-developed provinces of Pakistan, to empower expecting women to access quality healthcare. This study investigates the factors influencing CM-SIMCH program participation and assesses its impact on the health of expecting women by analyzing health-seeking hospital visits in KP, Pakistan. The study utilizes the Propensity Score Matching (PSM) technique to analyze cross-sectional data obtained from 303 expecting women residing in the Nowshera district of KP. The PSM allows for a balanced comparison of participants who received the CM-SIMCH transfers with those who did not, assessing its impact on maternal healthcare access and outcomes. Empirical results show that factors such as education and family system positively influence the participation of expecting women in the CM-SIMCH program, whereas travel costs exert a negative effect. The intervention leads to a notable increase in hospital visits among these women, contributing to improved health outcomes in KP. This underscores the program's potential effectiveness in addressing maternal healthcare challenges and enhancing healthcare access for vulnerable women in less-developed areas. Therefore, empirical evidence supports the CM-SIMCH program's potential to promote maternal health and improve healthcare access in KP. The study recommends government intervention in health sector as a strategic imperative to empower women and enhance infant health.

Racism and access to maternal health care among garo indigenous women in Bangladesh: A qualitative descriptive study.

Racism as social determinant of health significantly affects Indigenous women's maternal healthcare access. This study uses Jones' 'Three Levels of Racism' theory and an intersectional lens to explore how racism shapes the experience of maternal health care access among Garo Indigenous women in Bangladesh. Semi-structured interviews were conducted with 24 women of diverse backgrounds and pregnancy statuses using snowball sampling. Thematic analysis, incorporating inductive and deductive approaches, was employed for data analysis. The findings reveal a significant deviation from Jones' theory regarding the level of internalized racism within the specific context of Garo Indigenous women's experiences. Jones' theory usually focuses on how racism is internalized due to institutional and personally-mediated factors. On the contrary, this study uncovers a unique theme: 'women agency.' This theme emerges as a robust response among the Garo Indigenous women to their encounters with institutional and personally-mediated racism, highlighting their cultural resistance and resilience. The findings suggest that the complex relationship between these two forms of racism contributes to the strengthening of agency among Garo Indigenous women. Their agency stems from avoiding hospitals that disrespect their culture, manifesting their cultural resistance practice against the encountered racism at the institutional and relational levels. To increase biomedical healthcare access among Garo Indigenous women, it is recommended to address racism through intercultural competency training with the 'cultural safety' 'cultural humility' approach. This approach would foster inclusivity and empowerment, recognizing the agency of Garo women in healthcare decisions. Additionally, it would facilitate constructive dialogues between clinicians and Garo Indigenous women, acknowledging the shared experiences of racism within the latter group.

Geospatial Evaluation of Service Areas: Empowering Maternal Health for Ensuring Healthy Lives and Well-Being in the Wenchi Municipality of Ghana

This geospatial study in Wenchi Municipality sheds light on the intricate dynamics of maternal healthcare access. Leveraging Geographic Information System (GIS) mapping, network analysis, and Thiessen polygons, the service areas around nine health facilities were delineated, revealing a linear catchment and highlighting regions with maternal healthcare accessibility gaps. Of the 85 communities analyzed, only 34 enjoy easy access, emphasizing a critical need for targeted interventions. The vulnerability map, derived from Thiessen polygons, visually pinpoints areas at risk, fostering a nuanced understanding of localized disparities. Key recommendations include targeted infrastructure development, community engagement programs, and the integration of technology to enhance maternal healthcare accessibility. This study contributes valuable insights for evidence-based decision-making, emphasizing the importance of context-specific approaches in maternal healthcare planning. As maternal health disparities persist, this research provides a foundation for policymakers, healthcare practitioners, and local communities to collaborate in addressing the unique challenges faced by vulnerable populations, ensuring equitable maternal well-being across Wenchi Municipality.

Constraints to maternal healthcare access among pastoral communities in the Darussalam area of Mudug region, Somalia "a qualitative study".

While countries embrace efforts to achieve Sustainable Development Goals (SDG) goal 3.1 (to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and end preventable deaths of new-borns and children), an estimated 2.5 million pastoralists in Somalia are struggling to access maternal and child healthcare services. Institutional delivery and access to antenatal care remained to be a challenge in Somalia, where pastoralism is a common means of livelihood. The aim of this study is to explore the maternal health services available for settled pastoralists (transhumant) and their families who still practice nomadic pastoralism in the Mudug region of Somalia. A qualitative study, including 14 interviews and one FGD, was conducted in Darussalam village (a transhumant village along the border between Somalia and Ethiopia), Puntland State, from December 2022 to January 2023. The study participants were community members who support the maternal and child health clinic (MCH), village administration, and health providers. We found that the efficiency of the health facilities that serve for pastoralist women and children are hampered by staff-related, supply-related, patients-related and referral-related constraints. This study highlights that the absence of essential supplies, the unmet need for training among the staff as well as the absence of important facilities in the MCH such as ambulance and blood bags. Numerous strides could be made in the provision of affordable maternal healthcare to pastoralist communities in Darussalam areas of the Mudug region when organizations that support health care in Somalia and the Ministry of Health include pastoralists' healthcare in their priorities.

Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health.

Environmental factors are important causes that impair global pregnancy outcomes and are, importantly, responsible for maternal morbidity and mortality. However, apart from the direct reasons for maternal deaths, mainly obstetric and neonatal complications, such factors are ignored or given less importance. The recent surge in research on the impact of various environmental factors on pregnancy outcomes suggests the need for immediate attention to such factors and device-specific policies to counter the situation. Moreover, the recent coronavirus disease of 2019 (COVID-19) pandemic, global warming, and climate change showed a lack of preparedness to counter the impact of such events on maternal survival and safe and successful pregnancy outcomes. In the present review, we have emphasized the specific factors responsible for increased maternal and neonatal deaths and their association with specific environmental factors. Increased attention on maternal healthcare, preparedness to counter sudden environmental challenges and improvement of the conventional requirement for better maternal healthcare access and nutrition at a global level may improve the scenario.

Strengthening resilience of healthcare systems by focusing on perinatal and maternal healthcare access and quality.

Strengthening resilience of healthcare systems by focusing on perinatal and maternal healthcare access and quality.

Cultural norms and women’s health: Implications of the practice of menstrual restrictions in Nepal

We study the association between the ritual of menstrual restrictions and maternal healthcare access in Nepal as similar restrictions are also practised around the time of childbirth. These restrictions are based on the assumption that women are ritually impure during both menstruation and childbirth. Our outcomes of interest include the likelihood of giving birth at home and receiving no trained medical assistance at childbirth. We use a rich set of controls as well as assess the sensitivity of our results to alternative estimation methods. We find that women who face any menstrual restriction are also more likely to give birth at home and receive assistance only from untrained individuals during childbirth, which potentially increases the risk of maternal mortality. These findings indicate that menstrual restriction related rituals can have persistent negative implications on women’s physical health that is not just limited to the time of menstruation.

Which communication technology is effective for promoting reproductive health? Television, radio, and mobile phones in sub-Saharan Africa.

The use of radio and television as means to spread reproductive health awareness in Sub-Saharan Africa has been extensive, and its impacts significant. More recently, other means of communication, such as mobile phones, have received the attention of researchers and policy makers as health communication tools. However, evidence on which of the two types of communication (i.e. passive communication from TV/radio, or active communication through phones) is more effective in fostering better reproductive health choices is sparse. This study aims to identify the potential influence of TV or radio ownership as opposed to cell phone ownership on contraceptive use and access to maternal healthcare. Cross-sectional, individual analysis from eleven high-maternal mortality Sub-Saharan African countries is conducted. A total of 78,000 women in union are included in the analysis. Results indicate that ownership of TV or radio is more weakly correlated to better outcomes than mobile phone ownership is. Results are stronger for lower educated women and robust across all levels of wealth. Interestingly, the study also finds that decision-making power is a relevant mediator of cell phone ownership on contraceptive use, but not on maternal healthcare access. A key takeaway from the study is that, while the role of television and radio appears to have diminished in recent years, mobile phones have become a key tool for empowerment and behavioural change among Sub-Saharan African women. Health communication policies should be designed to take into account the now prominent role of mobile phones in affecting health behaviours.

Towards achievement of Sustainable Development Goal 3: multilevel analyses of demographic and health survey data on health insurance coverage and maternal healthcare utilisation in sub-Saharan Africa.

Improving maternal health and achieving universal health coverage (UHC) are important expectations in the global Sustainable Development Goals (SDGs) agenda. While health insurance has been shown as effective in the utilisation of maternal healthcare, there is a paucity of literature on this relationship in sub-Saharan Africa (SSA). We examined the relationship between health insurance coverage and maternal healthcare utilisation using demographic and health survey data. This was a cross-sectional study of 195 651 women aged 15-49 y from 28 countries in SSA. We adopted bivariable and multivariable analyses comprising χ2 test and multilevel binary logistic regression in analysing the data. The prevalence of maternal healthcare utilisation was 58, 70.6 and 40.7% for antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC), respectively. The prevalence of health insurance coverage was 6.4%. Women covered by health insurance were more likely to utilise ANC (adjusted OR [aOR]=1.48, 95% CI 1.41 to 1.54), SBA (aOR=1.37, 95% CI 1.30 to 1.45) and PNC (aOR=1.42, 95% CI 1.37 to 1.48). Health insurance coverage was an important predictor of maternal healthcare utilisation in our study. To accelerate progress towards the achievement of SDG 3 targets related to the reduction of maternal mortality and achievement of UHC, countries should adopt interventions to increase maternal insurance coverage, which may lead to higher maternal healthcare access and utilisation during pregnancy.

Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities

BackgroundDisparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs. AimThe aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities. MethodsThis intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components. FindingsAn increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably. ConclusionsInterventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Challenging categorical thinking: A mixed methods approach to explaining health inequalities

“Categorical thinking” in social science research has been widely criticised by feminist scholars for conceptualising social categories as natural, de-contextualised, and internally homogeneous. This paper develops and applies a mixed-methods approach to the study of health inequalities, using social categories meaningfully in order to challenge categorical thinking. The approach is demonstrated through a case study of socio-economic (SES) inequalities in maternal healthcare access in Zambia.This paper's approach responds to the research agenda set by intersectional social epidemiologists by considering potential heterogeneity within categories, but also by exploring the context-specific meaning of categories, examining explanations at multiple levels, and interpreting results according to mutually constitutive social processes.The study finds that meso-level institutions, “health service environments”, explain a large share of SES inequalities in maternal healthcare access. Women's work, marital status, and levels of “autonomy” have heterogeneous implications for healthcare access across SES categories. Disadvantaged categories and their reproductive behaviours are stigmatised as 'backwards', in contrast to advantaged categories and their behaviours, which are associated with 'modernity’ and 'development’. Challenging categorical thinking has important implications for social justice and health, by rejecting framings of a specific category as problematic or non-compliant, highlighting the possibility of change, and emphasising the political and structural nature of progress.

Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: A pooled analysis of nine East African countries.

In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia. This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia. According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women's residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia. This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.

Paternal Jail Incarceration and Birth Outcomes: Evidence from New York City, 2010-2016.

To examine population-level associations between paternal jail incarceration during pregnancy and infant birth outcomes using objective measures of health and incarceration. We use multivariate logistic regression models and linked records on all births and jail incarcerations in New York City between 2010 and 2016. 0.8% of live births were exposed to paternal incarceration during pregnancy or at the time of birth. After accounting for parental sociodemographic characteristics, maternal health behaviors, and maternal health care access, paternal incarceration during pregnancy remains associated with late preterm birth (OR = 1.34, 95% CI = 1.21, 1.48), low birthweight (OR = 1.39, 95% CI = 1.27, 1.53), small sizefor gestational age (OR = 1.35, 95% CI = 1.17, 1.57), and NICU admission (OR = 1.14, 95% CI = 1.05, 1.24). We found strong positive baseline associations (p < 0.001) between paternal jail incarceration during pregnancy with probabilities of all adverse outcomes examined. These associations did not appear to be driven purely by duration or frequency of paternal incarceration. These associations were partially explained by parental characteristics, maternal health behavior, and health care. These results indicate the need to consider paternal incarceration as a potential stressor and source of trauma for pregnant women and infants.

Trends and antecedents of inequalities in maternal healthcare coverage in four African countries

AbstractUsing data between 2003 and 2016, this paper assesses the degree and evolution of socio‐economic inequalities in maternal health outcomes in four African countries. The study measures the trends of socio‐economic inequalities in maternal healthcare and assesses the sources of socio‐economic inequalities in maternal health through a decomposition approach. We find cross‐country differences in the evolution of maternal healthcare inequalities. Rwanda and Uganda witnessed a decline in pro‐rich inequalities, whereas changes in Ethiopia and Kenya have been mixed. Further, the study finds significant contributions of personal characteristics of the woman to inequalities in maternal healthcare access.

Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh

ABSTRACT Objectives Bangladesh has achieved notable success in improving maternal health by increasing women’s access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities’ perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities’ perspectives on challenges and opportunities for improving MHC service access in the CHT. Design This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. Results Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. Conclusion Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.

National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility.

In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor.

Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso

IntroductionMost of the literature on terrorist attacks’ health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist...

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

Mapping maternal healthcare access in selected West African Countries

Background: The Sustainable Development Goal (SDG) three emphasizes the need to improve maternal and new-born health and reduce the global maternal mortality rate to less than 70 per 100 000 live births by 2030. Achieving the SDG goal 3.1 target will require evidence-based data on the distribution of maternal health outcomes and their linkage to healthcare access. Data and Methods: This study used WorldPop data derived from an integration of satellite, census and household survey. Exploratory spatial analysis techniques were used to examine and visualize the spatial distribution of women of reproductive age (15-19 and 40- 44), live births and pregnancies at the subnational level in three “poor resource” West African countries: Mali, Guinea and Liberia. Buffer analysis was used to quantify the number of pregnancies within user-defined distances of a health facility. Findings: Results showed wide variations in the distribution of maternal health outcomes across the countries of interest and districts of each of the countries. There was also clustering of maternal health outcomes and health facilities at the urban capital cities of Bamako, Conakry, and Greater Monrovia. A considerable number of pregnancies in most districts of northern Mali, northern and forest regions of Guinea and counties in south-eastern Liberia were not within 50km distance of a health facility, indicating inadequate access to maternal healthcare. Conclusion: To bridge the gap in inequity in healthcare access, and improve maternal and newborn health in the study countries, there is need for equitable distribution of health resources and infrastructure within and across the disadvantaged districts. Background: The Sustainable Development Goal (SDG) three emphasizes the need to improve maternal and new-born health and reduce the global maternal mortality rate to less than 70 per 100 000 live births by 2030. Achieving the SDG goal 3.1 target will require evidence-based data on the distribution of maternal health outcomes and their linkage to healthcare access. Data and Methods: This study used WorldPop data derived from an integration of satellite, census and household survey. Exploratory spatial analysis techniques were used to examine and visualize the spatial distribution of women of reproductive age (15-19 and 40- 44), live births and pregnancies at the subnational level in three “poor resource” West African countries: Mali, Guinea and Liberia. Buffer analysis was used to quantify the number of pregnancies within user-defined distances of a health facility. Findings: Results showed wide variations in the distribution of maternal health outcomes across the countries of interest and districts of each of the countries. There was also clustering of maternal health outcomes and health facilities at the urban capital cities of Bamako, Conakry, and Greater Monrovia. A considerable number of pregnancies in most districts of northern Mali, northern and forest regions of Guinea and counties in south-eastern Liberia were not within 50km distance of a health facility, indicating inadequate access to maternal healthcare. Conclusion: To bridge the gap in inequity in healthcare access, and improve maternal and newborn health in the study countries, there is need for equitable distribution of health resources and infrastructure within and across the disadvantaged districts.