Utilization Of Maternal Health Care Services Research Articles

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa

BackgroundPrevious studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa.MethodsWe utilized data from 29 sub-Saharan African countries’ Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval.ResultsYoung women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors.ConclusionOur study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.

Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries.

BackgroundIntimate partner violence (IPV) adversely affects women’s reproductive health outcomes but to what extent women’s justification of IPV affects maternal health care service utilization is unexplored.MethodsThe secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women’s justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT).ResultsA total of 26,029 women aged 15–49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94).ConclusionsWomen’s justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women’s condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women’s utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12905-022-01780-4.

Trends and determinants in the utilization of maternal healthcare services in West Bengal, India: Findings from the 3rd and 4th round National Family and Health Survey

BackgroundProper utilization of recommended healthcare services during the pregnancy is considered as critically important for better pregnancy outcomes, as well as a good health status of the mother. ObjectiveThe aim of the current study was to trace the trend in progress, and what are factors associated with the attendance at four Antenatal Care (ANC) visits, receive full ANC and institutional delivery in the study area. Research design/settingThe study has used a cross-sectional secondary data of the 3rd and 4th round National Family and Health Survey (NFHS) for India conducted in 2005-06 and 2015-2016 respectively. For West Bengal, a total of 6794 in 2005-06 and 17,668 in 2015-2016 ever-married women aged 15-49 who had experienced at least one live birth in the past five years preceding the survey were covered in this study. To analyze the data, the chi-square test was performed as it allows researcher to assess the association between outcome variables and independent variables. The univariate descriptive and multivariate statistical tools have been applied to analyse the data in this study. ResultsOur study indicated that the progress rate in attending at least four antenatal care visits, institutional delivery considerably good, but a noticeable gap exists across the different socio-economic groups. The coverage of full ANC services has remained very poor and unchanged over the decade. It was concluded that the wealth status of the households significant predictor of the attendance at least four ANC visits, full ANC and Institutional delivery in West Bengal. Other statistically significant socio-economic and demographic factors include level of women education, age of women, exposure to mass media, place of residence, and number of parities of birth. ConclusionThe present study suggests that the increasing strength in the coverage of all maternal healthcare services could be a significant focus during the program implementation in West Bengal. For strengthening and ascertaining the universal coverage of maternal healthcare services, there is an urgent need to reduce socioeconomic inequity in uses of the recommended maternal healthcare services. Moreover, our study found that the socio-economic and demographic factors play a significant role in utilization of maternal healthcare services. Thus the promotion of women education, empowerment and autonomy, and the frequent social marketing of government schemes and programs on maternal healthcare through the various types of mass media should be the unique future steps for achieving the universal coverage of maternal service in West Bengal.

Multilevel analysis of continuation of maternal healthcare services utilization and its associated factors in Ethiopia: A cross-sectional study.

Continuum of care (CoC) has been recognized as a crucial strategy for minimizing maternal, neonatal, and child mortality. CoC promotes integrated Maternal Neonatal and Child Health (MNCH) services by linking together three aspects of maternal health care antenatal care, skilled birth attendance, and postnatal care. The study aimed to assess continuation of maternal healthcare services utilization and its associated factors among reproductive age women at pregnancy, delivery and postnatal stages in Ethiopia. Cross-sectional study design conducted using Ethiopian 2016 Demographic and Health Survey data. All women with the most recent live birth in the last five years preceding the 2016 survey were the study population. The sample size was 7590, 2415, and 1342 at service entry (ANC use), COC at a delivery level, and CoC at Postpartum level respectively. COC was measured at three levels of maternal health care (during pregnancy, delivery, and postpartum). The CoC is constructed from four or more antenatal care visits (ANC4+), skilled birth attendance (SBA), and postnatal care (PNC). About 9.1% of women received all components of CoC. Educational attainment, wealth quintile, and media exposure were associated with four or more antenatal care visits and COC at the delivery level. Perception of getting money for healthcare, having blood pressure measured and urine sample taken during ANC was associated with continuity of care at the delivery level and continuity of care at a postpartum level. Birth order, residence, and region were common factors associated with each outcome of interest. The proportion of women who received all ANC4+, SBA, and PNC across the CoC was low in Ethiopia. Effort needed to increase CoC at each stage. The study shows that focusing on place of residence and regional state variation is necessary to improve CoC at each level. Thus, contextualizing the strategies and further research are critical.

Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: A cross-sectional study in Nigeria

ObjectivesThe aim of this study was to assess and determine associations between maternal health literacy (MHL) levels, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers. Study designCross-sectional descriptive study. MethodsIn total, 185 newly delivered mothers were selected from two health facilities using a purposive sampling technique. Data were collected using an adapted structured questionnaire. Analyses of data were performed using frequency, percentage, mean, standard deviation, Kruskal-Wallis test and logistic regression. The level of significance was set at 0.05 (p < 0.05). ResultsMore than one-third of participants (41.6%) had inadequate MHL. Utilisation of maternal healthcare services was moderate; only 55.7% of participants were registered for antenatal care at ≤14 weeks of pregnancy and 59.5% received three doses of tetanus vaccine, however, the majority of participants (85.9%) attended antenatal care with skilled birth attendants. Almost half of participants (49.2%) had poor pregnancy outcomes. A significant association was found between MHL and utilisation of maternal healthcare services (p < 0.05). MHL was also significantly associated with certain sociodemographic characteristics of participants (i.e. age, educational level, occupation and income). ConclusionsMore than one-third of participants had inadequate MHL, utilisation of maternal healthcare services was moderate and approximately half of study participants had poor pregnancy outcomes. Health workers should provide training sessions for pregnant women to improve MHL.

Locus of Control and Self-Esteem as Predictors of Maternal and Child Healthcare Services Utilization in Nigeria.

This study investigated the influence of locus of control and self-esteem on the utilization of maternal and child healthcare services in Nigeria. Specifically, it explored the differences in utilization of antenatal care, skilled birth care, postnatal care, and child vaccination by women having internal and external locus of control and women having high and low self-esteem. It also examined the association between utilization of maternal and child healthcare on other sociodemographic characteristics. We collected information on non-cognitive traits of 1,411 randomly selected women along with information on utilization of various indicators of maternal and child healthcare services. We estimated logistic regression models for various components of maternal and child healthcare services utilization and found that women's internal locus of control was a significant predictor of utilization of antenatal care, skilled birth care and completion of child vaccination. We also found that having a high self-esteem was a significant predictor of utilization of antenatal care, postnatal care and completion of child vaccination after adjusting for other control variables. By improving our understanding of non-cognitive traits as possible barriers to maternal and child healthcare utilization, our findings offer important insights for enhancing participants' engagement in intervention programs that are initiated to improve maternal and child health outcomes in lower-middle-income countries.

Determinants of maternal healthcare service utilisation among Indonesian mothers: A population-based study.

Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother's age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husband's occupational status, the number of children, and access to the healthcare facility. Next, factors that drive mothers' delivery at the healthcare facility were the mother's education level, husband's educational level, and residential area. The use of postnatal care was determined by the mother's occupational status, husband's educational level, number of children, wealth index, access to the healthcare facility, and residential area. Conclusions:The utilisation of each maternal healthcare service was determined by various socio-structural and intermediary determinants, but the mother's age and household wealth index were emerged as the typical determinants of all maternal healthcare services. Providing maternal healthcare services that are adjusted and tuned with these socio determinant factors may ensure that mothers can adequately utilise each service.

Determinants of maternal healthcare service utilisation among Indonesian mothers: A population-based study

Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother’s age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husband’s occupational status, the number of children, and access to the healthcare facility. Next, factors that drive mothers’ delivery at the healthcare facility were the mother’s education level, husband’s educational level, and residential area. The use of postnatal care was determined by the mother’s occupational status, husband’s educational level, number of children, wealth index, access to the healthcare facility, and residential area. Conclusions: The utilisation of each maternal healthcare service was determined by various socio-structural and intermediary determinants, but the mother’s age and household wealth index were emerged as the typical determinants of all maternal healthcare services. Providing maternal healthcare services that are adjusted and tuned with these socio determinant factors may ensure that mothers can adequately utilise each service.

Covid-19 Related Factors Associated with Antenatal Care in Rural Bangladesh: A qualitative study

Objective: Available literature reveals that usage of Maternal Health Care Services (MHCSs), including antenatal care (ANC), has been decreased significantly in the developing countries due to Corona Virus Disease (COVID-19) pandemic. However, the COVID-19 related factors on the MHCSs utilization in Bangladeshi women are yet to be examined. Therefore, this study examines the effect of COVID-19 on the use of ANC services among rural communities in Bangladesh.Method: A community-based qualitative study was conducted from May 01, 2021, to July 20, 2021, among selected pregnant women residing in eight villages of the Kushtia District, Bangladesh. A total of ten focus group discussions (FGDs) was conducted. Open Code 4.0 software was used to transcribe, translate, and analyze the data thematically. Results: Findings suggest that the measures taken by the government against the COVID-19 pandemic have significantly decreased the optimum usage of ANC services. The need to shift the role of the health workforces a vital factor that has a negative effect on women's attitude towards seeking MHCSs. Anxiety, dirty and poor environment of the health facilities, low quality of care, stigma, and risk minimization strategy are among other factors that refrained the pregnant women from seeking ANC services. Conclusion: Undoubtedly, the COVID-19 related factors have decreased the possible usage of ANC services among rural communities in Bangladesh. Additional necessary health workforces are needed to recruit urgently. A special wing for pregnant women in each health facility may be opened as a one-stop service center for the COVID-19 period. The policymakers should take necessary actions to reduce anxiety among pregnant women and motivate them to use MHCSs for safe motherhood.

Facilitators and Barriers to the Utilisation of Maternal Healthcare Services in Empowered Action Group States, India

The use of adequate reproductive healthcare services is critical to mothers and newborn babies. This study aimed to examine the facilitators and barriers to maternal healthcare utilisation in the Empowered Action Group (EAG) states. Data were drawn from the fourth round of the National Family Health Survey, 2015–16 ( n = 103,984). In this study, full antenatal care (ANC), delivery assistance by the skilled birth attendant (SBA) and postnatal care (PNC) within 2 days of delivery were taken as indicators of maternity care. Overall, approximately 13% of women received full ANC, 69.4% were delivered by SBA and 57.7% had PNC within 2 days of delivery. The findings of this study reveal that urban residence, higher education, wealthier economic status, exposure to mass media and contraceptive use are the facilitators of maternal healthcare utilisation. On the contrary, low levels of education, poverty, marriage during childhood, having a large number of children, belonging to socioeconomically backward castes, having difficulties related to healthcare-seeking and unwanted pregnancies are some of the major barriers to the use of maternity care. This study suggests that policymakers and public health practitioners should design proper healthcare policies and programs to provide quality reproductive healthcare services, particularly among socio-economically vulnerable women.

Socio-economic determinants of maternal health care utilization in Kailahun District, Sierra Leone, 2020

BackgroundAscertaining the key determinants of maternal healthcare service utilization and their relative importance is critical to priority setting in policy development. Sierra Leone has one of the world’s highest maternal death ratios in the context of a weak health system. The objectives of this study were to determine; the level of utilization of Antenatal Care (ANC), Skilled Delivery Attendants (SDA), Postnatal Care (PNC) services, and factors that influence the utilization of these services.MethodsWe conducted a community-based cross-sectional study involving 554 women of reproductive age (15–49 years) who had at least one delivery in the last 3 years and lived in the Kailahun District, Sierra Leone from November 2019 to October 2020. Data were analysed using analysed using bivariate, multivariate and multinomial logistic regression models.ResultsThe median age of respondents was 25 years (Q1 = 17 years, Q3 = 30 years). Eighty-nine percent (89%) had 4 or more ANC visits. Only 35.9% of women were delivered by SDA. Women residing in urban areas had over six-fold increased odds of utilizing SDA as compared to women residing in rural areas (AOR = 6.20, 95% CI = 3.61–10.63). Women whose husbands had a primary level of education had 2.38 times increased odds of utilizing SDA than women whose husbands had no education (AOR = 2.38, 95% CI = 1.30–4.35). Women that walked longer distances (30–60 min) to seek healthcare had 2.98 times increased odds of utilizing SBA than those that walked shorter distances (< 30 min) (AOR = 2.98, 95% CI = 1.67–5.33). Women who had a secondary/vocational level of education had 2.35 times increased odds of utilizing the standard PNC category as compared to those with no education (OR = 2.35, 95% CI = 1.19–4.63).ConclusionThe majority of women had 4 or more ANC visits yet the use of skilled birth attendants was low. Urban residence and education were significantly associated with the use of the standard PNC category. To improve the utilization of maternal health care services, national healthcare policies should target the advancement of education, train skilled Maternal Healthcare (MHC) attendants, rural infrastructure, and the empowerment of women.

Urban rural differentials in spatial distribution of pregnant women's choice of delivery place by district in Punjab - Results from Pakistan Social and Living Standards Measurements Survey 2014-15.

Madam, home deliveries are fraught with higher risks of maternal and neonatal complications, but in many developing countries childbearing women choose to deliver at home.1-3 Utilization of public or private maternal healthcare services is predicated on availability of, access to, and cost concerns. Public sector healthcare facilities are designed to essentially provide free services.1-3 In this study, percent of delivery sites utilization, disaggregated by urban and rural residency status in each district of the Punjab province were mapped using Geographic information Systems. The spatial distribution of delivery site percentages, disaggregated by three places of either home delivery, delivery at government facilities (hospital, Rural Health Center, and Basic Health Units), and delivery at private hospitals or clinics was done to highlight the urban and rural distribution, including the differences between urban and rural percentages. &#x0D; Continues...

Intention to use maternal health services and associated factors among women who gave birth at home in rural Sehala Seyemit district: a community-based cross-sectional study

BackgroundLow maternal healthcare service utilization contributes to poor maternal and newborn health outcomes in rural Ethiopia. 'Motivational factors influence women's intention to perform a specific health behavior, and the intention of subsequent home delivery and related risks that may contribute to women's death is less known. Therefore, this study aimed to assess the intention of maternal health service utilization among women who gave birth at home in the rural Sehala Seyemit district.MethodsA community-based cross-sectional study was conducted from September 1st to October 15th, 2020, among 653 women. A two-stage sampling technique was used to select the study participants. First, a semi-structured, pretested, and interviewer-administered questionnaire were used. The mean of the sum score was also used to categorize the intention as intended and not intended. Second, multivariable logistic regression analysis was computed to identify factors associated with women's intention to use maternal health services. Adjusted odds ratio (AOR) with a 95% confidence interval at a p-value of ≤ 0.05 were used to declare statistical association.ResultsOf the women who gave birth at home the intention to use maternal health service was 62.3% (95% CI; 59, 66). Women’s age of > 30 years (AOR = 6.04; 95%CI: 2.34, 15.60), short time to reach health facility (AOR = 2.52; 95% CI: 1.57, 4.10), media exposure (AOR = 2.10; 95% CI: 1.16, 3.65), history of obstetric danger signs (AOR = 4.60; 95% CI: 2.33, 9.10), positive subjective norms (AOR = 11.20; 95% CI; 6.77, 18.50) and last delivery assisted by traditional birth attendants (AOR = 0.15; 95% CI: 0.06, 0.33) were factors associated with women’s intention to use maternal health services.ConclusionIn this study, maternal health service utilization intention is still unsatisfactory compared to the national target plan. Maternal age, media exposure, obstetric danger signs, distance to a health facility, positive subjective norms, and delivery assistant at delivery were predictors of women's intention to use maternal healthcare services. Improving women's awareness of maternal healthcare services and developing strategies to increase women's access to mass media, skilled birth attendants, and transportation for rural women may enhance their intention to use maternal healthcare services.

Predictors of utilization of facility-based ante-natal care and delivery services in a Nigerian Rural Community.

With maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth. The objective of this study was to assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria. This was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25. Binary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219-1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305-1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616-13.962). The predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.

Factors associated with poor maternal health care services utilization in Eswatini: A secondary analysis of a nationally representative household survey

BackgroundThis study investigated the prevalence and factors associated with poor maternal health care services utilization (MHCSU) i.e., having < 4 antenatal care (ANC) visits, not delivering at a health facility, and not receiving institutional postnatal care (PNC). MethodsWe conducted a secondary analysis of data from the 2014 Eswatini Multiple Cluster Indicator Survey, a cross-sectional, nationally representative household survey. Participants were childbearing women (15–49 years) who had a live birth in the past two years preceding the survey. Multivariable logistic regression analyses were performed for each outcome variable. ResultsThe prevalence of poor MHCSU was 22.1% (202/903) for ANC, 10.4% (102/899) for institutional delivery or intrapartum care (IPC), and 26.9% (123/598) for PNC. Being younger, having a low education level, being never married, having no access to mass media, being a household head of low education, coming from a household of poor/middle wealth index, being a primipara, having an unintended pregnancy, and having a longer length of stay in the postpartum ward were significantly associated with poor MHCSU. ConclusionMidwives should pay special attention to women who present with the factors associated with poor MHCSU identified in this study, as early as the first booking for ANC to intervene early.

National and subnational variations in gender relations and the utilization of maternal healthcare services in Nigeria.

Introductionpoor maternal health outcomes remain a major public health issue in Nigeria. These have been shown to be affected by the low level of utilization of maternal healthcare services. This study investigates the levels of gender relations (GR) among Nigerian women and how these influence their utilization of maternal healthcare services. The relations are conceptualized as feminine (FGR), masculine (MGR) and egalitarian.Methodsdata on household decision-making, antenatal care (ANC) visits, health facility delivery, and associated sociodemographic variables, were extracted from the 2018 Nigeria Demographic and Health Survey for 29,992 parous women aged 15-49 for a cross-sectional study. Associations were investigated using Chi-Square and regression analyses.Resultswomen with FGR constituted 5.7% of the population at the national level, while subnational variations ranged from 1.8% in the North-East to 12.8% in the South-South regions. The prevalence rates of the recommended minimum ANC visits (RMANC) and health facility delivery were 42.1% and 30.0% at the national level and were lowest in the northern regions. At both the unadjusted and adjusted levels, FGR was not significantly associated with RMANC and health facility delivery at the national level and in all the regions except the South-West. MGR was however significantly associated with increased odds of RMANC (OR: 2.235, CI: 2.043-2.444) and health facility delivery (OR: 2.571, CI: 2.369-2.791) at national level. Significant subnational variations in the association between gender relations and the utilization of maternal healthcare services were also recorded.Conclusionsub-national variations in GR and their varying impacts on the utilization of maternal healthcare services in Nigeria suggest that gender-related policies to improve maternal health outcomes should be location-specific, rather than general. As FGR did not affect maternal healthcare services utilization, educating men on the benefits of supporting their wives to scale-up utilization is recommended.

Continuum of maternal healthcare services utilization and its associated factors in Ethiopia: A systematic review and meta-analysis.

The continuum of care throughout pregnancy, childbirth, and postnatal period is one of the vital strategies for improving maternal and neonatal health and preventing maternal and neonatal mortalities and morbidities. The level and determinants of the complete continuum of care for maternal health services reported by different studies were extremely varied in Ethiopia. Therefore, this meta-analysis aimed to estimate the overall prevalence of a complete continuum of maternal health care services utilization and its associated factors in Ethiopia. Databases such as PubMed/MEDLINE, Science Direct, DOJA, African journals online, Cochrane library, Google scholar, web of science, and Ethiopian universities’ institutional repository were used to search for relevant studies. A total of seven studies with 4854 study participants were involved in this study. Data were extracted by two reviewers and exported to STATA Version 11 for analysis. The I2 statistics and Egger’s test were used to assess heterogeneity and publication bias, respectively. The random-effects random effects model was used to estimate the level of complete continuum of care for maternal health services. The pooled prevalence of complete continuum of maternal healthcare services utilization was 25.51%. Employed mothers (OR = 3.16, 95%CI = 1.82, 5.47), first antenatal ante natal care visit before 16 weeks (OR = 7.53, 95% CI = 2.94, 19.29), birth preparedness and complication readiness plan (OR = 1.95, 95% CI = 1.12, 3.41), secondary and above educational status (OR = 2.97, 95% CI = 2.00, 4.41), planned pregnancy (OR = 6.86, 95% CI = 3.47, 13.58) and autonomy (OR = 3.73, 95% CI = 2.24–6.23) were significantly associated with continuum of maternal healthcare services utilization. In conclusion, the national level of complete continuum of maternal healthcare service utilization was low in Ethiopia. Being employed mothers, first ante natal care visit before 16 weeks, birth preparedness and complication readiness plan, secondary and above educational status, autonomy, and planned pregnancy were the major determinants of continuum of maternal healthcare services utilization.

An observational study on maternal mortality and maternal near miss in a selected facility of West Bengal.

An observational study was performed at Purba Medinipur District Hospital, West Bengal, from April 1, 2018, to December 31, 2020, with an aim to find out the magnitude of maternal mortality and near miss cases and to assess the utilization of available maternal health care services by the deceased women and near miss cases. Result showed 4.5% women developed potentially life-threatening condition (PLTC) of which 21% women developed LTC. Maternal Near Miss (MNM) ratio was 9.46/1000 live birth and the MNM-to-Maternal Mortality ratio was 8.3:1 and the leading causes of MNM and maternal death were hemorrhage, pregnancy induced hypertension/eclampsia. The utilization of maternal health-care services revealed that there is a scope to increase the service delivery. Study finding indicates that health-care programs need to enhance the existing efforts to improve timely health seeking behavior of women.

Factors Associated with Health Facility Delivery in the 12th District of Kandahar City, Kandahar, Afghanistan: A community-Based Cross-Sectional Study.

Background:Maternal mortality and morbidity are increasing public health concerns in Afghanistan. Even more worrying is maternal death due to causes that can be prevented through maternal healthcare services utilization during pregnancy and delivery.Objectives:We sought to investigate the magnitude of women giving birth in a health facility and its associated factors in the 12th district of Kandahar city, Kandahar province, Afghanistan.Materials and Methods:A community-based cross-sectional study of women who gave birth in the last 2 years in the 12th district of Kandahar city was conducted in early 2021. We used a systematic random sampling method to enroll 850 women. We collected data on sociodemographics, reproductive characteristics, and delivery practices of respondents. Factors associated with health facility delivery were identified using a multivariable logistic regression model.Results:The proportion of women who gave birth at health facilities was 71.8% (confidence interval [CI]; 68.61%–74.77%). In this study, health facility delivery was associated with husbands’ education (adjusted odds ratio [AOR] = 3.07, 95% CI: 1.50–6.31), antenatal care (ANC) services utilization (AOR = 17.84, 95% CI: 11.86–26.8), and history of complications in previous births (AOR = 3.65, 95% CI: 2.32–5.74).Conclusion:In this study, the utilization of a health facility for delivery was slightly lower than reported on the national level. Our study found potential factors such as ANC visits, husbands’ education, and history of complications in previous births, for which interventions aimed at enhancing the proportion of health facility deliveries.