Maternal Health Care Practices Research Articles

Comparison of Hemopoietic Biochemical Parameters in the First, Second, and Third Trimester of Pregnant Females Attending a Tertiary Care Hospital of Western Rajasthan.

Pregnant women constitute a high-risk group for nutrient deficiency anemia which may be associated with detrimental effects on maternal and infant health. This study aimed to assess and compare hematological and biochemical changes across trimesters in pregnant women, considering parameters such as hemoglobin, serum iron, unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), ferritin, vitamin B12, and folic acid. The research sought to identify mean value differences, correlations, and potential implications for maternal healthcare practices. A hospital-based prospective observational study was conducted, involving 60 primigravida women with singleton pregnancies. The subjects were assessed during the first, second, and third trimesters. Biochemical parameters were assessed using standard methods, and statistical analysis was performed to identify significance and correlations. The study revealed a significant decline in hemoglobin, serum iron, ferritin, vitamin B12, and folic acid as pregnancy advanced. Hemoglobin levels decreased from 11.40 g/dl (first trimester) to 10.43 g/dl (third trimester). Serum iron exhibited a decline from 109.73 µg/dl (first trimester) to 94.03 µg/dl (third trimester). Serum ferritin decreased from 24.93 ng/ml (first trimester) to 18.21 ng/ml (third trimester). Vitamin B12 levels dropped from 255.92 pg/ml (first trimester) to 92.13 pg/ml (third trimester). Folic acid levels decreased from 13.82 ng/ml (first trimester) to 11.77 ng/ml (third trimester). UIBC and TIBC concentrations increased progressively across trimesters. Statistical evaluations confirmed the significance of these trends. The coefficient of correlation indicated positive relationships between hemoglobinand serum iron, ferritin, folic acid, and vitamin B12.Positive correlation between serum iron and ferritin, vitamin B12, and negative with folic acid. Serum ferritin negatively correlated with vitamin B12 and folic acid. Serum folic acid and vitamin B12 are positively correlated. The findings emphasize the dynamic nature of hematological and biochemical changes during pregnancy. The observed trends have profound implications for maternal healthcare practices, urging targeted interventions, early monitoring, and supportive supplementation. Recognizing these variations contributes to the optimization of health outcomes for both mother and child.

Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Women.

Despite persistent racial disparities in maternal health in the USA, there is limited qualitative research on women's experiences of discrimination during pregnancy and childbirth that focuses on similarities and differences across multiple racial groups. Eleven focus groups with Asian American and Pacific Islander (AAPI), Black, Latina, and Middle Eastern women (N = 52) in the USA were conducted to discuss the extent to which racism and discrimination impact pregnancy and birthing experiences. Participants across groups talked about the role of unequal power dynamics, discrimination, and vulnerability in patient-provider relationships. Black participants noted the influence of prior mistreatment by providers in their healthcare decisions. Latinas expressed fears of differential care because of immigration status. Middle Eastern women stated that the Muslim ban bolstered stereotypes. Vietnamese participants discussed how the effect of racism on mothers' mental health could impact their children, while Black and Latina participants expressed constant racism-related stress for themselves and their children. Participants recalled better treatment with White partners and suggested a gradient of treatment based on skin complexion. Participants across groups expressed the value of racial diversity in healthcare providers and pregnancy/birthing-related support but warned that racial concordance alone may not prevent racism and emphasized the need to go beyond "band-aid solutions." Women's discussions of pregnancy and birthing revealed common and distinct experiences that varied by race, skin complexion, language, immigration status, and political context. These findings highlight the importance of qualitative research for informing maternal healthcare practices that reduce racial inequities.

Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study.

Background and AimsEssential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices.MethodsThe study used a cross‐sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast‐feeding), χ 2 test and t‐test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design.ResultsOnly about 24% (95% confidence interval [CI]: 22.95%–25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice.ConclusionThe study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.

Explore the Role of Homoeopathy in Maternal Health Care Practices in UP and India

On 13th December 1986, the famous actor of Indian cinema Mrs. Smita Patil died of child birth complications technically known as puerperal sepsis (HT, 13th Dec, 1986). 36 years later, in 2022, Dr. Archana of Dausa, Rajasthan died by suicide as she was arrested after a pregnant woman died of Post Partum Haemorrhage (PPH) in her private hospital (TNN. March 30th 2022). This clearly reflects the challenge that maternal health throws at the health fraternity. A woman’s struggle in the stage of pregnancy is full of turbulents. The struggle of mothers continues in India even today and that too in the state of UP even on a large scale. The current Maternal Mortality Ratio in India is 103 per 10000 live births & for the state of UP, it is 167 (SRS, 2019). Similarly, the Maternal Mortality Rate of India is 6.5 per 100,000 pregnant women in the age group of 15-49 years where as in UP, it is 14.7 per 100,000 pregnant women in the age group of 15-49 years. The high Maternal Mortality both in India and UP stand as a testimony to this fact as reducing this indicator is a priority. The target of achieving the SDG target of 70 per one lakh live births is a long way. The current article focuses on the initiatives of the role of homoeopathy in public health system to address maternal mortality. Basically, there are three approaches to reduce maternal mortality. These are addressing the three crucial delays related to the maternal mortality. The article focuses exclusively on these approaches while relating to homoeopathy. There are three objectives of the article. The first is to find out the current status of Homoeopathy in the maternal health practices, the second is to find out the details of the current & past implementation strategies in the homoeopathic context and the third is to find out the link between Homoeopathy & maternal health practices. The study uses secondary data. The gap that the article worked on is to explore a link between Homoeopathy & maternal health & its modalities. It deciphers whether there is a functional link currently or not & suggests future strategies based on the functionality of the link. It will be a step in the right direction to fulfill the plans to achieve the maternal health target of SDG by 2030 especially for maternal mortality related goals. For the benefit of the readers, the article includes its expected outcome, relevance to society & policy making through the context of the identified issues & the research gap. Through all these sections, the current article puts an effort to fulfill the three cited objectives of the current study related to incorporation of homoeopathy in maternal care.

Impact of Supportive Information-Based Guidelines in Gaining the Recommended Gestational Weight among Low-risk Women: A Quasi-Experiment

Better adherence to dietary guidelines during pregnancy is supposed to result in healthier perinatal outcomes. We aimed to examine the impact of supportive information-based guidelines in gaining the recommended gestational weight among low-risk pregnant women in Egypt. The main objectives were to; 1) modify pregnant women's lifestyle behavior to achieve optimal weight gain in pregnancy, 2) add evidence to the utilization of the ACOG & WHO dietary pregnancy guidelines in the antenatal care, and 3) establish clear antenatal routine care strategy for gaining an optimal gestational weight among low-risk pregnant women. The analysis included 60 first trimester primiparous pregnant women with normal pre-pregnancy weight with a BMI between 18.5 and 24.9 kg/m2. The total sample was divided into the intervention and control groups. The intervention group received an educational session; the content mainly included supportive information based on WHO dietary pregnancy guidelines and the American College of Obstetricians and Gynecologists, followed by text messages twice a week during the second and third trimesters antenatal follow-up of gestational weight. At the same time, women in the control group received standard outpatient antenatal follow-up. This study’s findings shed light on gained gestational weight in the second and third trimesters, with observable differences between both groups related to the second-trimester weight gain. Our study adds to the existing body of knowledge and fills an important gap by investigating the implementation of international guidelines in Egypt's maternal health care practice. In addition, we innovatively used a simple and cost-effective method, namely supportive information, to enhance weight gain management during pregnancy. Further studies are needed to validate the effectiveness of adopting the guidelines as a part of antenatal follow-up.

The large-scale community-based programme 'Suchana' improved maternal healthcare practices in north-eastern Bangladesh: Findings from a cluster randomized pre-post study.

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh.

Factors Influencing Male Participation in Maternal Health Care among Married Couples in Nepal: A Population-based Cross-sectional Study

Background The male involvement in maternal health care is essential to reduce obstetric complications. However, there is little known about factors contributing to male participation in maternal health in Nepal. Objective To assess predisposing, enabling and reinforcing factors contributing male participation in maternal health care in Nepal. Method A population based cross-sectional study was conducted among 374 married couples. Ethical approval was obtained from Institutional Review Board of Kathmandu Medical College Teaching Hospital. The data was collected, using modified Safe Motherhood and Partnership Family Approach Model. Multivariable logistic regression was applied to account associated paternal factors. Concentration curve and concentration index were computed to measure equity gap between lowest and highest quintiles. Result While four out of ten husbands reported high level of their involvement in maternal health care practices, wives reported relatively less involvement of their husbands. Logistic regression showed that husband having low family income, knows about immunization, contact with family planning providers were more likely to participate. In contrary, according to wives, husbands' who have ever been to health facility, discuss family planning with others, contact with family planning providers and who knows about exclusive breast feeding were less likely to participate. The study also showed that socio-economic factors play a significant role. Conclusion Male involvement in maternal health care practices is low. Predisposing, enabling and reinforcing factors play a significant role; however, some contradictions among husbands' and wives' perspectives provide strong evidence on significance of communication within partners on maternal health care issues.

Effects of an mHealth voice message service (mMitra) on maternal health knowledge and practices of low-income women in India: findings from a pseudo-randomized controlled trial

BackgroundMobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited.MethodsA pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care.ResultsTwo thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05–2.4, p = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07–2.75, p = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38–2.33, p = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49–4.35, p = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54–0.88, p = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23–0.91, p = 0.027). Both groups’ knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards.ConclusionsThis study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings.Trial registrationThe mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111).

Maternal Health Care Practices and Factors Associated with Service Delivery at Sub-health Post in Dadeldhura District of Nepal

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Pregnant Women's experiences of Birth Preparedness and Complication Readiness in Ghana

Background & aim: Most of the maternal mortalities are preventable when safe maternal healthcare practices adhere to antenatal care. Lack of birth and emergency preparedness is one of several factors contributing to maternal mortalities. Adequate birth preparedness (BP), as well as emergency, and complication readiness (CR) planning can determine the survival rate of a pregnant woman and her unborn neonate. The present study aimed to describe the experiences of pregnant women at Jachie Health Center regarding BP and CR. Methods: In this qualitative study, a phenomenological approach was used for data collection. In-depth interviewing was conducted with a total of 15 pregnant women from Jachie Health Center. The interviews were digitally recorded, transcribed verbatim, reviewed several times, and thematic analysis was performed. NVivo software (version 11) was utilized to manage the data and help with thematic analysis. Results: The pregnant women practiced preparations towards the place of delivery, support person, layette, and warning signs of pregnancy. The majority of the cases were not aware of obligatory preparations in terms of transportation and the need for emergency compatible blood donor prior to delivery. Most of the respondents were not sufficiently prepared for delivery due to poverty and low educational status. Conclusion: The role of community members could include the instruction of pregnant women to attend antenatal clinic to receive education regarding birth preparedness and complications readiness. The district health directorate and public health nurses should train community leaders for the benefits of birth preparedness and complications readiness.

“Lost births,” service delivery, and human resources to health

PurposeThe purpose of this paper is to advocate for improved service delivery of maternal-newborn care in northern Indigenous communities. This is done through critical examination of the loss of pregnancy and birthing knowledge and practice in these communities, from both a historical and contemporary lens. Supporting the return of traditional midwifery practices to the communities is the recommended solution.Design/methodology/approachThe paper is a general review of the available literature regarding Indigenous birthing practices, historical and contemporary Canadian maternal health service provision, and midwifery.FindingsCurrent maternal health care practice in these northern communities is not resolving service delivery and human resource inadequacies, highlighting the need for a community-based and midwifery-driven primary health care approach. Potential recommendations include implementing a comprehensive birthing initiative, innovative midwifery training, and promotion and support of the role of the community midwife.Originality/value“Lost births” is a largely unrecognized issue in Canadian public health literature. The value of this paper lies in its potential to stimulate discourse and advocacy.

Evaluation of Maternal Health Service Indicators in Urban Slum of Bangladesh.

BackgroundA continuous influx of poor people to urban slums poses a challenge to Bangladesh’s health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the ‘MANOSHI’ programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area.MethodsThis cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15–49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data.ResultsThe activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; p<0.000) and PNC (48% vs. 39%; p<0.01) coverage in the intervention slums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services from medically trained providers (MTPs). The poorest had a lower likelihood of receiving services from MTPs during delivery complications.ConclusionThe MANOSHI programme service coverage for delivery care and PNC-checkup for women who prefer home delivery needs to be improved. For sustainable improvement of maternal health outcomes in urban slums, the programme needs to facilitate access to services for poor and illiterate women.

Maternal Health Care Practices among Mothers of a Selected Slum in Dhaka City

Background: Bangladesh is a small South Asian country which became independent in 1971 after a bloody war. Rapid urbanisation in Bangladesh (26% of the 147.1 million inhabitants live in urban areas) is fuelling a growth in urban poverty, particularly in the urban slums where the quality of life is extremely poor. The average population density in slums was reported in 2005 as 831 persons per acre or 205,415 people per square kilometre.1 Early commencement of antenatal care by pregnant women as well as regular visits has the potential to affect maternal and foetal outcome.Objective: To assess the status of ANC service used by the pregnant mothers and their socio-demographic characteristics.Materials and Methods: A community-based cross-sectional study was conducted at Moghbazar slum area in Dhaka district of Bangladesh, during January to June 2014. A total of 161 slum dwellers were enrolled in the study. Information regarding education, occupation, monthly family income, antenatal care was gathered using a pretested structured questionnnare and data were analysed.Results: The majority respondents had knowledge about antenatal care and of them 89 (55.2%) completed ?3 visits. Forty five (47.8%) pregnant women received ANC from government hospitals. Nearly 72% mothers received ANC service from doctors and 16.9% received from family welfare visitors (FWV). Half of mothers were satisfied with the overall care provided to them. About 86.2% mothers said that they had to wait for more than two hours for check-ups. More than 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy.Conclusion: This study reveals that antenatal care provided was not up to the mark of standard care and measures should be taken to improve it.J Enam Med Col 2015; 5(3): 166-169

Assessing gaps in Infant and Young Child Feeding (IYCF) practices and capacity building of functionaries and beneficiaries of Integrated Child Development Services (ICDS) for improved outcomes

Knowledge, Attitude and Practices (KAP) of Anganwadi workers (AWW) i.e. ICDS functionaries and mothers regarding maternal health care practices during pregnancy and IYCF practices were assessed. The AWWs were well aware about the objectives of the ICDS program. Knowledge scores of functionaries regarding maternal health care and IYCF at baseline were good. Most AWWs had little information on the importance of the Nutrition Health Education (NHE) service and how it should be implemented. Knowledge scores of mothers regarding IYCF were sub optimal. Utilisation of antenatal care by mothers was good with 90% of mothers receiving more than three checkups. Utilisation of food supplements and attending sessions by mothers at the Anganwadi (ICDS centre) was sub-optimal at baseline. There was lack of convergence between ICDS and health sector. Appropriate interventions led to improved counseling and delivery of nutrition, health services by ICDS functionaries and adoption of optimal IYCF practices by mothers. Key Words: Infant and Young Child Feeding (IYCF); Antenatal Check up; Counseling; Integrated Child Development Services (ICDS) Program

Factors associated with use of antenatal care services in a rural area of Bangladesh

Antenatal care (ANC) includes care during pregnancy, should begin from the early stages of pregnancy. ANC al-lows management of pregnancy, detection and treatment of complications, and promotion of better maternal and child health. This study assessed the factors relating to maternal healthcare practices in rural Bangladesh and exam-ined the association between use of antenatal care services and socio-demographic variables of rural women. A community based cross-sectional study was conducted in Madhupur upazila of Tangail district. Postnatal mothers who visited the Expanded Programme on Immunization (EPI) centers constituted as sampling frame and selected. The sample size was determined based available information on the Bangladesh Demographic and Health Survey (BDHS) 2007. In total 360 randomly selected postnatal mothers were interviewed using structured questionnaire for collecting information on demographic characteristics, knowledge on ANC and practices. The mean (±SD) age of the respondents was 24(±4.4) years. Most (95.6%) of them were housewives. Twenty-two percent of the respon-dents were from the poorest socioeconomic class. Mothers who had one living child had the highest percentage of adequate ANC use compared to those who had two or more living children. Access to mass media (newspapers and TV) had a positive significant (p&lt;0.001) effect on the use of ANC services. The results of logistic regression analy-sis showed that, after adjusting other factors, respondents who had secondary-level education were 4.5 times more likely to use ANC adequately compared to those who had no education. The findings suggested that education of the mothers is an important determinant of ANC visits during pregnancy. Therefore, information, education and communication on ANC must be intensified in order to reach the rural mothers. DOI: http://dx.doi.org/10.3329/seajph.v2i2.15956 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 61-66

Survey Questions for the Measurement of Induced Abortion

Underreporting of induced abortion in survey research is a ubiquitous problem. The use of an indirect interview technique in which questions were asked about abortion in the context of unwanted pregnancy was described earlier as holding promise for increasing the response rate. This report reviews the mixed results from multicountry studies that used indirect technique. Exploratory qualitative studies are needed to identify a setting-specific context for discussing abortion. Because the subject of induced abortion is inherently sensitive, survey measurement of this practice is less precise than that of other, less controversial maternal health-care practices. This lack of precision should not deter the pursuit of the study of this critically important public-health-care concern.