Maternal Health Care Utilization Research Articles

Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching.

Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.

Benefits of Investing on Mother and Child Healthcare in Tanzania

Purpose: Maternal and child healthcare play crucial role in reducing global mortality rates, with a significant impact on the overall burden of disease. The Sustainable Development Goal 3 aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030. Sub-Saharan Africa, including Tanzania, carries a high burden of mortality rates and experiences a significant share of maternal and child deaths, exacerbating the global figures. The average prevalence of below 5 years mortality in SSA between 2010 and 2018 was 4.10% according to Ahinkorah (2021). Recognizing the severity of this issue, the government of Tanzania through the Development Agenda 2025, Draft health policy 2020 and the current Health Sector strategic plan 2021-2026 plans to reduce infant and maternal mortality rates through mother and child healthcare investment. The Health Sector Strategic Plan focuses on strengthening the health systems in the country and aims to sustain the achievements made in enhancing the health of reproductive, maternal, newborn, children, and adolescent populations. This study sought to assess the benefits of investing on mother and child healthcare in Tanzania. The study was guided by the investment commodity theory developed by the economist John Maynard Keynes in 1936. The study evaluated the current status of mother and child health indicators, the benefits of investing in mother and child health on overall health outcomes and identified the existing gaps and challenges in the provision, access and utilization of mother and child healthcare services in Tanzania.
 Methodology: The study was a desktop review-based study which relied on existing published information, data, and literature.
 Findings: The study found out that there have been improvements in certain areas of mother and child health indicators but maternal and child mortality rates remain high. Health interventions such as vaccination programs, improved access to healthcare services, and the use of maternal and child health insurance cards showed positive effects on reducing child mortality, improving child health outcomes, and enhancing maternal healthcare utilization. The significant gaps and challenges in the provision, access, and utilization of mother and child healthcare services include disparities in access to healthcare services based on factors such as education level and wealth status, inadequate healthcare infrastructure, long distances to health facilities, sociocultural barriers, and financial constraints.
 Unique contribution to theory, practice and policy: The study recommends strengthening of healthcare infrastructure, enhancing access to maternal and child healthcare services, especially for vulnerable populations, promoting health education and raising awareness about maternal and child healthcare practices, addressing the shortage of skilled healthcare professionals, improving data collection and use and monitoring of maternal and child health indicators, addressing socio-cultural barriers that hinder access and utilization of healthcare services and increasing investment in mother and child health care programs through allocate adequate resources.

Completion of the Continuum of Maternity Care in the Emerging Regions of Ethiopia: Analysis of the 2019 Demographic and Health Survey.

Maternal mortality in Ethiopia was estimated to be 267 per 100,000 live births in 2020. A significant number of maternal deaths occur in the emerging regions of the country: Afar, Somali, Gambela, and Benishangul-Gumuz. Achieving the Sustainable Development Goal (SDG) target requires a dramatic increase in maternal healthcare utilisation during pregnancy, childbirth, and the postpartum period. Yet, there is a paucity of evidence on the continuum of maternity care utilisation in Ethiopia, particularly in the emerging regions. Therefore, this study aimed to assess completion and factors associated with the continuum of maternity care in the emerging regions of Ethiopia. This study used the 2019 Ethiopian Demographic and Health Survey data (n = 1431). Bivariable and multivariable logistic regression analyses were carried out to identify factors associated with the completion of the continuum of maternity care. An adjustment was made to the survey design (weight, stratification, and clustering). 9.5% (95% Confidence Interval (CI): 7.0-13.0) of women completed the continuum of maternity care (four or more antenatal care, institutional delivery, and postnatal care within 24 h). Living in Somali (adjusted Odds Ratio (aOR): 0.23, 95%CI: 0.07-0.78) and Benishangul-Gumuz (aOR 3.41, 95%CI: 1.65-7.04) regions, having a secondary and higher educational level (aOR 2.12, 95%CI: 1.13-4.00), and being in the richest wealth quintile (aOR 4.55, 95%CI: 2.04-10.15) were factors associated with completion of the continuum of maternity care. Although nearly half of the women had one antenatal care, fewer than 10% completed the continuum of maternity care. This indicates that women in these regions are not getting the maximum health benefits from maternal healthcare services, and this might contribute to the high maternal death in the regions. Moreover, the completion of the continuum of maternity care was skewed toward women who are more educated (secondary or higher education) and in the richest quintile.

Correction: The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization

Correction: The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization

Trends and factors associated with immediate postnatal care utilisation in Ethiopia: analysis of the demographic and health surveys, 2011-2019

Background Globally, most maternal deaths occur during the first twenty-four hours after childbirth. Although different interventions have been implemented to improve maternal health care utilisation in Ethiopia, including immediate postnatal care, information regarding the change in immediate postnatal care utilisation over time is lacking. This study aimed to examine the trends of immediate postnatal care utilisation from the year 2011 to 2019 and to identify factors associated with immediate postnatal care utilisation using nationwide demographic and health survey data. Methods The study was conducted using secondary data from Ethiopia Demographic and Health Survey (EDHS) in 2011 (n=4268), 2016 (n=4081), and 2019 (n=2159). The trend analysis was conducted using data from the three surveys, however, only the latest survey data were used for the analysis of factors associated with immediate postnatal care utilisation. Bivariable and multivariable logistic regression analysis was carried out to identify factors associated with immediate postnatal care utilisation. Odds ratio (OR) with a 95% confidence level (CI) was computed and adjustment was made to the survey design (i.e., weight, stratification, and clustering). Results The percentage of women who received immediate postnatal check increased from 6.4% (95% CI=5.1-8.0) in 2011 to 16.3% (95% CI=14.3-19.0) in 2016 to 33.4 % (95% CI=28.6-39.0) in 2019. Moreover, health facility births and the percentage of women who had four or more antenatal care visits increased in this period. Having less than four (adjusted OR (aOR)=3.33; 95% CI=1.77-6.24) and greater than and equal to four antenatal care visits (aOR=7.19; 95% CI=3.80-13.56), and caesarean delivery (aOR=4.39; 95% CI=2.28-8.46) were factors positively associated with immediate postnatal care utilisation. On the other hand, giving birth at a health facility (aOR=0.04; 95% CI=0.02-0.07) was negatively associated with immediate postnatal care utilisation. Conclusions The study showed consistent improvements in immediate postnatal care utilisation between 2011 and 2019. Despite the progress, the coverage remains low in Ethiopia, only reaching one-third of those who need it. More tailored and context-specific efforts across the continuum of maternal health care services are needed to improve the utilisation and quality of postnatal care.

Socioeconomic inequalities in maternal healthcare utilization: An analysis of the interaction between wealth status and education, a population-based surveys in Tanzania.

Limited scientific, evidence has so far described the interactions between socioeconomic factors and the gap of inequalities in maternal healthcare utilization. This study assessed the interaction between wealth status and education to identify women with greater disadvantage. This analysis used secondary data from the three most recent rounds (2004, 2010, and 2016) of the Tanzania Demographic Health Survey (TDHS). Maternal healthcare utilization was assessed based on six services (outcomes) which are i) booking during the first trimester (bANC), ii) at least four antenatal visits (ANC4+), iii) adequate antenatal care (aANC), iv) facility-based delivery (FBD), v) skilled birth attendance (SBA), vi) cesarean section delivery (CSD). The concentration curve and the concentration index were used to measure socioeconomic inequality in maternal healthcare utilization outcomes. The interaction coefficients suggest that each unit increase in the wealth status is significantly associated with higher odds of utilizing all maternal healthcare services for women with primary and secondary or higher education compared to those with no education (booking during the first trimester [AOR = 1.30; 95% CI: 1.08-1.57], at least four antenatal visits [AOR = 1.16; 95% CI: 1.01-1.33], facility-based delivery [AOR = 1.29; 95% CI: 1.12-1.48], skilled birth attendance [AOR = 1.31; 95% CI: 1.15-1.49]). The highest wealth-related inequality in bANC (EI: 0.166), at least four antenatal visits (EI: 0.259), FBD (EI: 0.323) and skilled birth attendance (EI: 0.328) (P < 0.05) was observed among women with primary and secondary or higher education. These findings provide strong evidence that there is an interaction effect between education attainment and wealth status in socioeconomic inequalities of maternal health services utilization. Therefore, any approach which will address both women's education and wealth status might be the first step to reducing socioeconomic inequalities in maternal health services utilization in Tanzania.

Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women

ObjectivesThe continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic interrupted the provision and use of...

A qualitative investigation into pregnancy experiences and maternal healthcare utilisation among adolescent mothers in Nigeria

BackgroundAdolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria.MethodsThe study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software.ResultsThe findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers.ConclusionsInterventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive.

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991-2015: An Ecological Systems Theory Perspective.

Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991-2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009-2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals.

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers

BackgroundIt is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda.MethodsA qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software.ResultsThe main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care.ConclusionsDespite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Maternal Health Care Utilization Behavior, Local Wisdom, and Associated Factors Among Women in Urban and Rural Areas, Indonesia.

Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia's maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women's deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women's attitudes toward seeking health services. The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of >0.05. Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96). Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.

Socioeconomic Inequalities in Maternal Health Care Utilization and Delivery Channels in Nigeria

Inequalities in maternal health care services prevent women of reproductive ages from accessing required care. The existence of equitable distribution channels can substantially diminish these discrepancies. This study examines the inequalities in maternal health care utilization outcomes and the socioeconomic factors that contribute to these inequalities and identifies the delivery channels that can effectively reduce disparities in utilization. The paper employed 2013 and 2018 data from the Nigeria Demographic and Health Surveys. The utilization variables are; at least four antenatal care visits, deliveries by skilled birth attendants, delivery in a health facility, and postnatal care attendance. The degree of socioeconomic disparities in maternal outcomes was evaluated using the Erreygers concentration indices and the slope index of inequality. The decomposition analysis was performed using a TPM model to determine the contribution of various socioeconomic factors to inequality in the utilization outcomes. Findings reveal that disparities in the country's utilization of maternal health care services are prevalent. The community-based health delivery channel is the least inequitable. It can work effectively in mitigating socioeconomic disparities in maternal care uptake. The significant contributors to inequalities in the indicators of maternal healthcare utilization are education and wealth indices.

Is there a link between the autonomy of women and maternal healthcare utilization in Nigeria? A cross-sectional survey

BackgroundDespite legislation and intervention programmes, the rates of maternal and child mortality in Nigeria remain high. Sustainable development goals on mother and child mortality would be a mirage if this continues. The study investigated the autonomy of women (women’s decision-making autonomy) and the use of maternal health-care services in Nigeria.MethodsSecondary data obtained from the Nigeria Demographic and Health Survey, 2018 were used in this investigation. Women who indicated they gave birth in the five-year before the surveys were considered in the study. The association between autonomy of women and maternal health-care utilization was studied using binary logistic regression models.ResultsIn total, about one-fifth of the women (19.6%) indicated they had at least eight ANC visits for their most recent birth. Overall, 40.5% of the women gave birth in a health institution, and 20.1% went for postnatal checkups. The use of health-care services was significantly related to the autonomy of women. Women’s and husbands/partners’ educational levels, residency and ethnicity were socio-demographic characteristics that influenced women’s healthcare service consumption.ConclusionsFor most recent childbirth, most women did not utilise the health-care services in Nigeria. To enhance the autonomy of women and, as a result, maternal health-care services use in Nigeria, effective interventions, policies, and programmes are required.

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

What Explains the Rural − Urban Inequalities in Maternal Health Services Utilization in Tanzania? A Fairlie Decomposition Analysis

Introduction: Maternal mortality remains a public health issue in developing countries, with rural areas having higher rates as compared to the urban areas. Since effective utilization of maternal health-care services has the potential to reduce maternal mortality, this study measures the factors contributing to the existing rural − urban differences in the utilization of maternal healthcare services in Tanzania. Methods: We used Tanzania Demographic and Health Survey 2015/2016 data. Multi-stage stratified sampling was used to select the study participants and we estimated a Fairlie decomposition to understand the factors that contribute to inequality in maternal health-care services utilization between the rural and urban areas in Tanzania using Stata 17. Results: The study findings revealed a considerably wide rural-urban disparity in the utilization of maternal health-care services. As the findings indicated, household wealth status is the major factor for that disparity. Other factors are women's exposure to the media, women's working status, and distance from the homesteads to the health facilities. Conclusion: Therefore, any policy geared toward bridging the gap between the rural and urban areas in the utilization of maternal health-care services should focus on empowering women in terms of household economic status, media exposure, and employment.

Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature.

This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.

A study on utilization of maternal and infant health services in rural area of district Kanpur Nagar

Background: There is a pressing need to identify and address the grass root determinants of maternal health care utilization to steer the health services toward achieving the ambitious SDG target of reducing the global MMR to &lt;70 per 100 000 births by 2030. Objective of current study was to assess the utilization of health services provided to mothers and infants. Methods: The present cross-sectional study was conducted by the department of community medicine GSVM Medical College Kanpur using multistage random sampling technique including women having children less than 1 years of age and Infant (less than one year) born to these eligible women in rural blocks of district Kanpur Nagar for evaluation mother and infant care services from February 2021 to September 2022. Results: 94.17% participants had at least one antenatal visit, 85.06% of delivery were take place at CHC, 83.80% post natal care provided by doctor, 30.76% infant were treated properly for Acute respiratory symptom 21.31% infant received ORT and Zinc for treatment of diarrhea. Similar results were found as per NFHS-5 in rural Uttar Pradesh in previous published research work. Conclusions: Utilization of health care services require more improvement for infant disease treatment.

Factors Associated with Maternal Health Services Utilization Among Lao Adolescents: A Nationwide Retrospective Cross-sectional Study

Addressing the social determinants of health that affect adolescent pregnancy is paramount to eliminating disparities and achieving health equity toward reducing the maternal mortality rate. The Lao People’s Democratic Republic has a high adolescent childbearing rate, which can negatively impact maternal and child health. We conducted a retrospective cross-sectional study that used data from the pooled Lao Social Indicator Survey II of 2017 to clarify the social contextual factors associated with the utilization of adolescent antenatal care and facility deliveries. We analyzed data from 663 adolescents aged 10-19 years at delivery and extracted the factors associated with maternal healthcare utilization based on social determinants. Those factors were area and region of residence, educational status, marital status, the ethnolinguistic group of the household head, and economic strata. A multiple logistic regression analysis was performed to determine the factors associated with those factors. The results showed that social factors strongly associated with the use of antenatal care were higher educational status and higher economic strata. On the other hand, the social factors associated with facility delivery were being in an ethnic majority and having a higher economic status. Thus, it is essential to establish interventions targeting those factors, such as lower educational status, lower socioeconomic status, and being from an ethnic minority, to increase adolescents' antenatal care visits and facility deliveries. This study’s results can be used to inform nurses and midwives in their efforts to eliminate socioeconomic disparities. This can be done by enhancing the provision of antenatal care consultations and facility deliveries in Lao, thus helping to achieve better health for adolescent mothers, their infants, and their families.

Patterns of Health Services Utilization During Pregnancy, Delivery, and Postpartum Period: Evidence from Pakistan Maternal Mortality Survey

Utilization of health services is a multidimensional behavioural phenomenon, particularly when it comes to pregnancy and delivery concerns. The importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, delivery and postnatal care. However, uptake of maternal health care services is very low even in the areas where they are extensively available. The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in Pakistan. Data is taken from Pakistan Maternal Mortality Survey (PMMS) 2019. Logistic regression was performed and adjusted odd ratios were calculated by using three dependent variables – Ideal Antenatal Care (IANC), birth assisted by Skilled Birth Attendant (SBA), and Postnatal Care (PNC). Impact of biological and socio-demographic variables were computed, and findings revealed that with the increase in age, education and household wealth, women are more likely to have better opportunities to use ANC, SBA and PNC. The focus of policy considerations should be on the provision of high-quality services as well as on educating women about the value of receiving such services during pregnancy and the postpartum period through education and awareness campaigns. Moreover, skilled staff and voluntary health workers can be recruited to make future agendas in reducing maternal mortality and morbidity more successful.

Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews

BackgroundInequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs.MethodsWe searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization’s (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107).ResultsIn a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed.ConclusionThe generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.