Maternal Health Indicators Research Articles

Unveiling challenges of maternal health in India’s tribal mothers: Insights from a case series of maternal deaths

ABSTRACT Maternal mortality remains a significant public health concern globally, with disparities often evident among marginalized populations, including tribal communities. This case series delves into the complexities surrounding maternal mortality among tribal populations in India, shedding light on the multifaceted factors contributing to this persistent public health issue. Through verbal autopsy and retrospective review of medical records, a series of maternal deaths among tribal mothers were examined. Maternal deaths have been broadly divided into two categories Bottlenecks in quality antenatal services and missed opportunities.

The status of reproductive Health Indicators in Iran, Compared to the Sustainable Development Goals of the World Health Organization

Background and Objectives: Health indicators such maternal and child mortality rates are social indicators that are used to measure the development of each country. This study aims to investigate the status of maternal and child health indicators and total fertility rate in the last 10 years in Iran compared to the sustainable development goals (SDG) of the World Health Organization (WHO). Methods: This is a systematic review study. A search was first conducted to find studies related to the study objectives in Iran from 2012 to 2022 in online databases of SID, IranDoc, Web of Science, PubMed, Scopus and Google Scholar, using the keywords: Health, fertility, mothers, children. The results of the studies were compared with the SDG indicators of the WHO. Results: The initial search yielded 162 articles. After removing duplicates and screening the studies based on the inclusion criteria, finally 20 articles were selected for the review. The status of SDG indicators in Iran, except for neonatal mortality rate and low birth weight, was in accordance with the SDGs of the WHO until 2030. Conclusion: In the last ten years, the status of most SDG indicators in Iran has been favorable. However, the attention should be paid to the factors affecting neonatal mortality rate and low birth weight to reduce their rates and improve the country’s health status.

Maternal exercise during pregnancy is associated with reduced risk of asthma in the child: A prospective birth cohort study.

The means of primary prevention of asthma are limited. Maternal physical activity during pregnancy promotes fetal lung development and the newborn's lung function; thus, it could lower asthma risk and aid in asthma prevention. The objective of this study is to determine whether maternal physical activity during pregnancy is associated with asthma development in the child. The study population included 963 mother-infant pairs from the prospective Kuopio Birth Cohort study. Data on maternal physical activity during pregnancy, confounding factors, and children's asthma at 5 to 7 years of age were obtained from the Kuopio University Hospital birth registry and questionnaires. Maternal physical activity during pregnancy, when practiced three or more times per week, was associated with a reduced risk of asthma in the child, with an adjusted odds ratio of 0.54 (95% confidence interval 0.33-0.89; p= 0.02). The association was stable across a comprehensive set of adjustments, including length of gestation, mode of delivery, and maternal health indicators (e.g., asthma, smoking, pre-pregnancy body mass index and weight gain during pregnancy, infections, medication, healthy diet, stress), as well as various family environment variables. Maternal physical activity during pregnancy may be associated with marked protection of asthma in childhood and should be studied further as an applicable measure for asthma prevention. The study has been financially supported by grants from the Academy of Finland (no. 349427), the Emil Aaltonen Foundation, the Finnish Cultural Foundation, the Yrjö Jahnsson Foundation, the Juho Vainio Foundation (no. 202200461), the Kuopio Area Respiratory Foundation, and the Ida Montini Foundation.

The covid-19 pandemic and its effect on maternal health indicators in Latin American countries

Introduction: Maternal mortality constitutes one of the most important indicators of public health, and also reflects the response capacity of health systems to the healths needs of one of the most vulnerable groups, such a pregnant women. Objective: Conduct a bibliographic review of the maternal mortality indicators used by health management teams, before and during the COVID-19 pandemic in Latin American countries. Methodology: A bibliographic review was carried out by searching for scientific articles related to the topic. In addition, information was collected from epidemiological bulletins updated as of the review date. The PEO question was used (Population: pregnant women. Exposure: before and during the COVID-19 pandemic Result: maternal mortality in the context before and during the pandemic): What are the maternal mortality indicators before and during the COVID-19 pandemic? The search sources were PubMed, Scielo and Google Scholar. The key words were: "Maternal mortality" "Morbidity and mortality indicators" "COVID-19". Articles published from January 1, 2021 to May 30, 2023 were selected. Results: Of the 5670 articles found, 5654 articles were discarded because they did not meet our criteria for keyword combinations in the title or abstract. Of the 16 articles selected, 12 had research results. Of the total number of articles, there were 4 prospective articles and 8 retrospecitve articles, 4 were considered for conceptual theoretical aspects that are related to the objective of the study. Conclusion: an increase in the maternal mortality ratio was evident in the pre-pandemic period and during the pandemic compared to the figures from previous years, this was associated with the presence of comorbidities and maternal risk factors as well as the limited supply of health services, lack of intra-and extramural organization.

Medical Demography and Access to Prenatal Care in the Foumbot Agricultural Production Basin (West Cameroon)

This article analyzes the dynamics of medical demography and access to prenatal care in the agricultural production basin of Foumbot, located in western Cameroon. This region, characterized by strong agricultural activity, presents particular challenges in terms of maternal and child health. Lack of adequate access to prenatal care is a major concern that can influence maternal and neonatal health indicators. In our work, we conducted a six-month study in the commune of Foumbot. We used a research methodology that included multidimensional analysis, drawing on data from field surveys of 140 randomly selected women in the villages of Baigom, Fosset, Foumbot 1, 2, 3, 4, 5, Maka, Momo and Njone. These data were analyzed using descriptive statistical techniques. This enabled us to highlight the variation in qualities of prenatal care according to environments and types of health facility. The results show a significant disparity in access to prenatal care according to different socio-economic and geographical factors. Only 70% of pregnant women made the minimum four visits required, 22% did not use prenatal care, while 8% had fewer than four visits. The study also reveals that the main obstacles are the remoteness of health centers, the costs associated with cares and cultural practices that can limit the use of available services. The impact of agricultural activity, which is often the main source of income and subsistence for local populations, exacerbates these challenges by reducing the time available for medical care and increasing economic constraints. In rural areas, the use of medicinal plants also predominates, at 30%. The maternal mortality rate rose from 20 to 25 deaths per 100,000 live births between 2020 and 2023. Life expectancy at birth is 56 years; the infant mortality rate is 54‰, and the adult literacy rate is 63%. This research sheds light on the challenges faced by rural populations in terms of prenatal cares, and proposes concrete avenues for strengthening the healthcare system in similar contexts. The results of this study could also serve as a reference for public health policies aimed at improving access to care in other rural areas of Africa.

Role of self-criticism in postpartum mental health: a network analysis

PurposeA significant percentage of women experience psychopathological symptoms during the postpartum period, which can impact not only their mental health and well-being but also the relationship between mother and baby. However, studies investigating how specific psychological factors, such as self-compassion and self-criticism, contribute to the development and maintenance of these symptoms are scarce.MethodsThis cross-sectional study aimed to examine the relationship among compassionate self-responding (CSR), uncompassionate self-responding (USR), maternal mental health indicators, mother-infant bonding, and the perceived impact of the COVID-19 pandemic. Data were collected online from 189 Brazilian women with infants aged 0 to 12 months. Participants completed measures of sociodemographic characteristics, Self-Compassion Scale (SCS), Edinburgh Postnatal Depression Scale (EPDS), Postpartum Specific Anxiety Scale (PSAS-BR-RSF-C), Postpartum Bonding Questionnaire (PBQ), and COVID-19–Impact on Quality of Life (COV19-QoL).ResultsThrough network analysis, our findings highlighted that postpartum depression played a central role in the structuring of variables in this system. Furthermore, USR, instead of CSR, emerged as the variable most strongly associated with levels of postpartum depression, which, in turn, was associated with mother-infant bonding.ConclusionMitigating levels of self-criticism in mothers may represent a pathway to prevent the development of postpartum depression, which, in turn, could impact the quality of the mother-infant relationship. Given the significance of the child’s early years for their emotional development, intervening early in maternal mental health may be a means to prevent mental disorders in the child as well.

Modeling the relationship between maternal health and infant behavioral characteristics based on machine learning.

This study investigates the impact of maternal health on infant development by developing a mathematical model that delineates the relationship between maternal health indicators and infant behavioral characteristics and sleep quality. The main contributions of this study are as follows: (1) The use of Spearman's correlation coefficient to conduct correlation analysis and explore the main factors that influence infant behavioral characteristics based on maternal indicators. (2) The development of a combined model using machine learning techniques, including random forest (RF) and multilayer perceptron (MLP) to establish the relationship between maternal health (physical and psychological health) and infant behavioral characteristics. The model is trained and validated by the real data respectively. (3) The use of the Fuzzy C-means (FCM) dynamic clustering model to classify infant sleep quality. An RF regression model is constructed to predict infant sleep quality using maternal indicators. This study is significant in gaining a deeper understanding of the relationship between maternal health indicators and infant development, and provides a basis for future intervention measures.

Maternal Health Indicators Across States and UTs of India

The present contribution makes the 21st part of the Social Change Indicators series. We have considered specific social and economic issues in the preceding editions, which included vulnerable households across social classes, poverty, migration, living conditions, social protection, displacement of labour, old-age health and morbidity conditions, women’s time use patterns, intimate partner violence, household assets/indebtedness, and aspects of higher education. In this part, we provide a comparison of maternal health indicators across major states and UTs of India.

Risk Factors in Pregnant Women as Predictors of Postpartumhaemorrhage: A Systematic Review Aligned with SDG Goals

Objective: The objective of this study is to examine the risk factors affecting mothers that serve as predictors of postpartum haemorrhage, with the aim of identifying key predictors to improve clinical outcomes and reduce maternal mortality, aligning with the Sustainable Development Goals (SDGs). Theoretical Framework: In this topic, the main concepts and theories that underpin the research are presented. The framework includes understanding the pathophysiology of postpartum haemorrhage, maternal health indicators, and predictive analytics models. The Sustainable Development Goals (SDGs) for reducing Maternal Mortality Ratio (MMR) provide a solid basis for understanding the context of the investigation. Method: The methodology adopted for this research comprises a systematic review of the literature. A comprehensive search was conducted in PubMed, SpringerLink, ScienceDirect, Neliti, and Research Gate using the keywords "risk factor as predictor for postpartum haemorrhage." The search yielded 3587 articles, which were screened based on inclusion criteria: published between 2014 and 2024, original articles, full-text accessible, in English or Indonesian, and relevant to risk factors predicting postpartum haemorrhage. This process narrowed the selection to 805 articles. Further screening based on exclusion criteria, such as discrepancies in research titles, article inaccessibility, and duplication, resulted in six articles. These align with the PICOS framework: Population (women giving birth with or without comorbidities), Intervention (risk factors for postpartum haemorrhage), Outcome (predictors of postpartum haemorrhage), and Study (observational studies like cohorts, case controls, and cross-sectional studies). Results and Discussion: The results obtained revealed 33 risk factors that could be used as predictors of postpartum haemorrhage. In the discussion section, these results are contextualized in light of the theoretical framework, highlighting the implications and relationships identified. Possible discrepancies and limitations of the study are also considered in this section, including variations in study design and population characteristics. Research Implications: The practical and theoretical implications of this research are discussed, providing insights into how the results can be applied or influence practices in the field of maternal health. These implications could encompass clinical practice guidelines, development of predictive tools, and policy-making aimed at reducing MMR in line with SDGs Originality/Value: This study contributes to the literature by highlighting the originality of the research through the identification of multiple risk factors as clinical predictors of postpartum haemorrhage. The relevance and value of this research are evidenced by the potential to develop scoring systems, nomograms, and XGBoost classification models, which may significantly impact maternal healthcare practices and outcomes.

A Comparison of The Various Maternal Health Indicators and Its Association To Infant Mortality Rate in the BIMARU States Built on The NFHS-4 and NFHS-5 Data

Aim: The present research aims to compare the maternal health indicators and its association to infant mortality rate in the BIMARU states built on the NFHS-4 and NFHS-5 Data. It also presents an uphill or downhill growth pattern in the BIMARU states. Material Method: The methodology that was applied to do the research work was a narrative, descriptive. The NFHS 4&5 fact sheets for the BIMARU states namely Bihar, Rajasthan, Madhya Pradesh and Uttar Pradesh were used. From the last NFHS-4 and the recent NFHS-5 data, a comparison was done for the BIMARU states for the various maternal health indicators. Result and Discussion: The various tables display the various health indicators. Conclusion: There has been a consistent improvement made by the BIMARU states in the field of maternal health indicators as per NFHS-5 compared to NFHS-4 data. The comparative result shows a decrease of Infant Mortality Rate in the BIMARU states. However, there is still a vast scope for improvement in the health parameters of the pregnant women all the BIMARU states. However, Uttar Pradesh needs major efforts to improve their NMR and IMR data.

Women with disabilities' use of maternal care services in sub-Saharan Africa.

Quality maternal health care is central to the Sustainable Development Goals efforts to reduce maternal mortality, yet there remain limited quantitative data on maternal care inequities for women with disabilities in sub-Saharan Africa. This study aims to understand the differences in maternal care providers for women with and without disabilities. We used Multiple Indicator Cluster Surveys from 13 sub-Saharan African countries conducted between 2017-2020. We used logistic and multinomial logistic regression to examine the relationship between disability (Washington Group definition) and antenatal care attendance and the type of care provider for antenatal care, skilled birth attendance, and postnatal and postpartum checks. All analyses were adjusted for age, wealth, country, and location. The sample included 10 021 women, including 306 (3.1%) women with disabilities. There were small absolute and no relative differences in antenatal care attendance, qualified antenatal care provider, postnatal, and postpartum checks, for disabled and women without disabilities. Women with disabilities had some evidence of higher odds of having a doctor at their birth compared to women without disabilities (aOR = 1.52, 95% CI: 0.99-2.33). This study shows small absolute and no relative differences between women with and without disabilities for antenatal access and provider types for maternal care, though these findings are limited by a small sample and no data on care quality, acceptability, or outcomes. More research on care quality and outcomes is needed. This study is the first quantitative, multi-country study in sub-Saharan Africa to examine maternal care seeking patterns, demonstrating important data on maternal health indicators for women with disabilities.

Evaluating the Prevalence of Maternal Health Indicators on Infant Mortality Rates in Florida.

Background The infant mortality rate is defined as the number of infant deaths for every 1000 live births. In 2020, the infant mortality rate was 5.8% in the state of Florida, compared to 7.0% in 2000. Although infant mortality rates have declined in the state of Florida, disparities influencing these rates exist across varying Florida counties, with the widest differences being compared between the healthiest versus unhealthiest counties in Florida.Many factors can contribute to high infant mortality rates in certain counties, including income inequality, access to and quality of healthcare, race/ethnicity, obesity, and disadvantaged socioeconomic status (SES). Methods This study utilized data from Florida Health Charts on infant mortality rates in the state of Florida and the Pregnancy and Young Child Profiles in 10 counties to examine how certain risk factors impact infant mortality outcomes in the state of Florida. These 10 counties consistoffive healthiest andfive unhealthiest counties, as determined by the 2022 County Health Rankings data. T-tests were used to evaluate the relationship between county health status and several county health indicators. Results The average infant mortality rate from 2011 to 2020 differed significantly among healthy and unhealthy counties (p-value=0.0000). Median household income, individuals below the poverty level, and those aged zero to 17 years old were found to differ significantly by county health status (p-values 0.0000, 0.001, and 0.009, respectively). However, mothers having no high school education, births with first-trimester care, births with adequate care, and births with late or no prenatal care were not statistically significant. Conclusion Our study suggests that counties more likely to have fewer resources than other counties, such as those considered unhealthy, are more impacted by a higher infant mortality rate. The unhealthy counties in this study were found to have lower average median household income, higher rates of no high school education among mothers, and less prenatal care in comparison to healthy counties.

The best healthcare (commodity) available (for purchase): provider-induced demand for obstetric ultrasonography among ethnic minority women in rural northern Vietnam

Despite Vietnam's overall progress on maternal health indicators, marginalized ethnic minorities in remote areas face lower access to antenatal care and higher maternal mortality rates relative to the Kinh (majority ethnic group). Last year, we conducted fieldwork for 2 qualitative research projects that aimed to address maternal health inequities among pregnant ethnic minority women in rural Northern Vietnam. Although not the focus of our research, the use of ultrasonography services at for-profit private clinics was ubiquitous in participants' healthcare-seeking accounts. Ultrasound scans from for-profit clinics were a major component of ethnic minority women's antenatal care: many purchased 8 to 10 scans during pregnancy at $6.15 US dollars per scan, despite their limited agricultural income of $120 to $205 per month. Women were unaware of how many scans were recommended and their medically indicated scheduling, but purchased frequent scans to assuage pregnancy anxieties and access what they experienced as the highest-quality antenatal service. In tandem, for-profit ultrasonography providers offered broader opening hours, immediate results, and rich technological scans, which seemed to deliver poor families the most tangible "value" for their hard-earned money. Previous literature documented the concerning overuse of ultrasonography among Kinh women in urban Vietnam: What are the implications of this trend extending to affect rural-dwelling ethnic minority women who face lower education, economic marginalization, and a 4-fold higher maternal mortality rate? Our findings raise concerns related to safety, financial vulnerability and provider-induced demand, and broader health policy questions regarding healthcare commodities in low-resource settings. Critically, there is no evidence of the effect of obstetrical ultrasound on reducing maternal mortality in low- and middle-income countries, and its excess use could burden available resources and detract from evidence-based services. Our findings suggest that health system gaps are driving poor women toward frequent purchases of a single insufficient maternal health commodity: this will not improve their pregnancy outcomes or health equity for marginalized ethnic minorities. We argue that addressing this overuse of ultrasonography due to provider-induced demand requires a multipronged response that meets women's growing expectations. Our findings highlight the need for investment in health education, health promotion, and reliable high-quality public maternal healthcare for ethnic minority communities in Vietnam.

Contributing factors for reduction in maternal mortality ratio in India

Maternal mortality ratio (MMR) estimates have been studied over time for understanding its variation across the country. However, it is never sufficient without accounting for presence of variability across in terms of space, time, maternal and system level factors. The study endeavours to estimate and quantify the effect of exposures encompassing all maternal health indicators and system level indicators along with space–time effects influencing MMR in India. Using the most recent level of possible -factors of MMR, maternal health indicators from the National Family Health Survey (NFHS: 2019–21) and system level indicators from government reports a heatmap compared the relative performance of all 19 SRS states. Facet plots with a regression line was utilised for studying patterns of MMR for different states in one frame. Using Bayesian Spatio-temporal random effects, evidence for different MMR patterns and quantification of spatial risks among individual states was produced using estimates of MMR from SRS reports (2014–2020). India has witnessed a decline in MMR, and for the majority of the states, this drop is linear. Few states exhibit cyclical trend such as increasing trends for Haryana and West Bengal which was evident from the two analytical models i.e., facet plots and Bayesian spatio- temporal model. Period of major transition in MMR levels which was common to all states is identified as 2009–2013. Bihar and Assam have estimated posterior probabilities for spatial risk that are relatively greater than other SRS states and are classified as hot spots. More than the individual level factors, health system factors account for a greater reduction in MMR. For more robust findings district level reliable estimates are required. As evident from our study the two most strong health system influencers for reducing MMR in India are Institutional delivery and Skilled birth attendance.

The paradox of growing technical capacities with low global governance: a review of Voluntary National Reviews’ SDG health-related indicators

BackgroundThis study delves into the States’ accountability for health-related Sustainable Development Goal (SDG) indicators from 2016 to 2020. An analysis of Voluntary National Reviews (VNR) is employed as an instrument to scrutinize the alignment of States’ indicators with the global indicator framework, shedding light on global health governance within the context of the 2030 Agenda and States’ strategic prioritization. A curation of 60 health-related indicators from 195 VNRs, produced during the aforementioned period, is organized into thematic groups.ResultsOur results highlight a concerning discrepancy in the reporting frequency of various health-related themes. The findings reveal a paradoxical coexistence characterized by the concurrent strengthening and diminution of the global health governance articulated in the Agenda’s global health governance. This manifests in the increased utilization and consistency of health-related indicators over the study years, coupled with an emphasis on infectious diseases and child and maternal health indicators. Conversely, a discernible governance decline is evidenced by the inadequate representation of health-related indicators in VNRs, notably within the domains of universal health coverage and health system indicators. Furthermore, High-Income States exhibit diminished accountability.ConclusionsThe VNRs unveil a paradox wherein burgeoning technical capacity coexists with governance deficits, a phenomenon attributable to both statistical capabilities and political preferences. The prevalent use of proxy indicators in VNRs oversimplifies the presentation of official indicators, thereby compromising the aspirational goal of pioneering statistical innovations for measuring intricate issues in the SDGs. In light of our conceptualization of the 2030 Agenda’s global health as a regime complex governance, we advocate for comprehensive investigations into each health regime cluster. This approach aims to unravel disputes, discern patterns, and elucidate States’ preferences concerning specific thematic areas. Functioning as an accountability mechanism for the Agenda’s governance, VNRs underscore States’ adaptability and short-term learning capabilities, offering valuable insights for identifying harmful goal prioritization. The discretionary nature of indicator selection by States in the VNRs, enabled by the Agenda’s proposition of a contextual adaptation of the SDGs and a blind eye to the guideline’s request to review all SDG indicators, highlights a critical flaw in the VNR as an accountability mechanism.

Global maternal mortality projections by urban/rural location and education level: a simulation-based analysis

Maternal mortality remains a challenge in global health, with well-known disparities across countries. However, less is known about disparities in maternal health by subgroups within countries. The aim of this study is to estimate maternal health indicators for subgroups of women within each country. In this simulation-based analysis, we used the empirically calibrated Global Maternal Health (GMatH) microsimulation model to estimate a range of maternal health indicators by subgroup (urban/rural location and level of education) for 200 countries/territories from 1990 to 2050. Education levels were defined as low (less than primary), middle (less than secondary), and high (completed secondary or higher). The model simulates the reproductive lifecycle of each woman, accounting for individual-level factors such as family planning preferences, biological factors (e.g., anemia), and history of maternal complications, and how these factors vary by subgroup. We also estimated the impact of scaling up women's education on projected maternal health outcomes compared to clinical and health system-focused interventions. We find large subgroup differences in maternal health outcomes, with an estimated global maternal mortality ratio (MMR) in 2022 of 292 (95% UI 250-341) for rural women and 100 (95% UI 84-116) for urban women, and 536 (95% UI 450-594), 143 (95% UI 117-174), and 85 (95% UI 67-108) for low, middle, and high education levels, respectively. Ensuring all women complete secondary school is associated with a large impact on the projected global MMR in 2030 (97 [95% UI 76-120]) compared to current trends (167 [95% UI 142-188]), with especially large improvements in countries such as Afghanistan, Chad, Madagascar, Niger, and Yemen. Substantial subgroup disparities present a challenge for global maternal health and health equity. Outcomes are especially poor for rural women with low education, highlighting the need to ensure that policy interventions adequately address barriers to care in rural areas, and the importance of investing in social determinants of health, such as women's education, in addition to health system interventions to improve maternal health for all women. John D. and Catherine T. MacArthur Foundation, 10-97002-000-INP.

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis

BackgroundLimited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).MethodsRoutine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.ResultsOverall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.ConclusionsUnlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.

Accountability for maternal and newborn health: Why measuring and monitoring broader social, political, and health system determinants matters.

This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, "Improving Maternal Health Measurement to Support Efforts toward Ending Preventable Maternal Mortality". These papers were aimed at validating ten of the Ending Preventable Maternal Mortality initiative indicators that capture information on distal causes of maternal mortality. These ten indicators were selected through an inclusive consultative process, and the research designs adhere to global recommendations on conducting indicator validation studies. The findings of these papers are timely and relevant given growing recognition of the role of macro-level social, political, and economic factors in maternal and newborn survival. The four key lessons include: 1) Strengthen efforts to capture maternal and newborn health policies to enable global progress assessments while reducing multiple requests to countries for similar data; 2) Monitor indicator "bundles" to understand degree of policy implementation, inconsistencies between laws and practices, and responsiveness of policies to individual and community needs; 3) Promote regular monitoring of a holistic set of human resource metrics to understand how to effectively strengthen the maternal and newborn health workforce; and 4) Develop and disseminate clear guidance for countries on how to assess health system as well as broader social and political determinants of maternal and newborn health. These lessons are consistent with the Kirkland principles of focus, relevance, innovation, equity, global leadership, and country ownership. They stress the value of indicator sets to understand complex phenomenon related to maternal and newborn health, including small groupings of complementary indicators for measuring policy implementation and health workforce issues. They also stress the fundamental ethos that maternal and newborn health indicators should only be tracked if they can drive actions at global, regional, national, or sub-national levels that improve lives.

Challenges in reducing maternal and neonatal mortality in Niger: an in-depth case study

IntroductionRecent modelled estimates suggest that Niger made progress in maternal mortality since 2000. However, neonatal mortality has not declined since 2012 and maternal mortality estimates were based on limited data....

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

BackgroundLow- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries.MethodsThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies.ResultsA total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment.ConclusionThe introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries’ progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status.Trial registrationThis study was registered with Prospero (CRD42021285776).