Maternal Health Outcomes Research Articles

Bibliometric Analysis of Risk Factors Contributing to Maternal Mortality: Trends and Research Directions

ABSTRACT Maternal mortality remains a significant global health challenge, with high maternal mortality rates in many parts of the world being a key indicator of disparities in maternal health care. While great efforts have been made to reduce these mortality rates, the various contributing risk factors remain a major focus of efforts. This study aimed to conduct a bibliometric analysis of the scientific literature addressing risk factors contributing to maternal mortality over the period 2017 to 2024. In this study, data was obtained from 50 relevant articles retrieved from Google Scholar using Publish or Perish software. The articles were filtered based on relevance and analyzed in depth. The data collected included information on publication year, country of origin, publisher, number of citations, and article type. To generate a comprehensive bibliometric map, VOSviewer was used with the parameters of occurrence of at least 4 and 19 terms, as well as network visualization, overlay, and density. The analysis showed that research on maternal mortality has consistently focused on various risk factors and aspects of maternal health, with a significant emphasis on factors related to pregnancy complications, postnatal care, and socioeconomic health conditions. Developed countries such as the United States are often the primary location of research, indicating a high concentration of studies in these countries. In addition, the research highlighted consistent attention to the importance of adequate health care and specific health issues faced by pregnant women. The analysis also revealed that key themes in the current literature include the management of postpartum hemorrhage, postpartum infections, and the influence of socio-economic factors on maternal health. This study provides valuable insights into current research directions and trends in maternal health and underscores the importance of continuing to identify and mitigate risk factors that contribute to maternal mortality. The findings are expected to guide the development of more effective interventions and health policy strategies that can reduce maternal mortality globally and improve maternal health outcomes worldwide. Keywords: Maternal Mortality, Risk Factors, Bibliometric Analysis, Healthcare Interventions, Research Trends

Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023.

Objectives. To assess the relationship between doula utilization and health outcomes of females enrolled in Medicaid-affiliated plans in the United States. Methods. In this retrospective, observational cohort study, we used Medicaid claims data from a national health insurer to compare health outcomes between females who used and who did not use a doula (2014-2023). We conducted propensity score matching using a 1:1 case‒control match, without replacement, and fit logistic regressions to analyze the relative risks for maternal health outcomes. Results. The study population included 722 matched pairs with and without a doula. Results indicate females with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth, and were 46% more likely to attend a postpartum checkup (all differences P < .05). Conclusions. Doula care is associated with improved health outcomes among Medicaid enrollees. Public Health Implications. Doulas have garnered increasing interest from policymakers as a strategy to address increasing trends in maternal morbidity and persistent health disparities. This study provides evidence from Medicaid enrollees across the United States that doula care can improve maternal health. (Am J Public Health. 2024;114(11):1275-1285. https://doi.org/10.2105/AJPH.2024.307805).

Male partners’ involvement in antenatal care and its associated factors in West-central Ethiopia

BackgroundMale partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners’ involvement in maternity care, particularly in developing countries.ObjectiveThis study aimed to assess male partners’ involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019.MethodsA community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant.ResultsIn this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20–29 years [AOR = 2.14, 95% CI = 1.04–4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02–4.07], [AOR = 3.02, 95% CI = 1.49–6.11] and [AOR = 4.03, 95% CI = 2.06–7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46–5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62–4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10–2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64–4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54–7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19–5.03] were associated with male partners involvement in antenatal care.ConclusionsMale partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners’ involvement in maternal healthcare services utilization.

Multidisciplinary management of severe hyperemesis gravidarum complicated by cannabinoid and opioid use: A case report on the complex interplay of hyperemesis gravidarum, opioids and treatment challenges

Hyperemesis gravidarum (HG) presents a significant management challenge in pregnancy due to its debilitating effects on maternal health and fetal outcomes. This case report details the presentation and management of a 34-year-old primigravida at 17 weeks and 4 days gestation with severe HG. The patient’s history includes significant gastrointestinal procedures, a prior child with lissencephaly, and continued opioid use during pregnancy. Her symptoms were refractory to conventional treatments and further complicated by cannabinoid use. A multidisciplinary approach involving gastroenterology, surgery, obstetrics, pharmacists, and dietitians was employed, resulting in significant improvement. This case highlights the importance of a comprehensive care strategy in managing refractory HG complicated by substance use.

Predictive Utility of Biochemical Markers for the Diagnosis and Prognosis of Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy with an increasing prevalence worldwide. Early prediction of GDM and its associated adverse outcomes is crucial for timely intervention and improved maternal and fetal health. The objective of this review is to provide a comprehensive summary of contemporary evidence on biomarkers, focusing on their potential to predict the development of GDM and serve as predictors of maternal, fetal, and neonatal outcomes in women with GDM. A literature search was conducted in the PubMed database using relevant terms. Original research articles published in English between 1 January 2015, and 30 June 2024, were included. A two-stage screening process was employed to identify studies on biomarkers for GDM diagnosis and prognosis and to evaluate the evidence for each biomarker's diagnostic performance and its potential prognostic correlation with GDM. Various biochemical markers, including adipokines, inflammatory markers, insulin resistance markers, glycemic markers, lipid profile markers, placenta-derived markers, and other related markers, have shown promise in identifying women at risk of developing GDM and predicting adverse pregnancy outcomes. Several promising markers with high predictive performance were identified. However, no single biomarker has demonstrated sufficient accuracy to replace the current diagnostic criteria for GDM. The complexity of multiple pathways in GDM pathogenesis highlights the need for a multi-marker approach to improve risk stratification and guide personalized management strategies. While significant progress has been made in GDM biomarker research, further studies are required to refine and validate these markers for clinical use and to develop a comprehensive, evidence-based approach to GDM prediction and management that can improve maternal and child health outcomes.

Exploring determinants of early marriage among women in Bangladesh: A multilevel analysis.

Early marriage, defined as marriage under the age of 18, is widely recognized as a human rights violation with deleterious consequences on women's health and well-being. It persists as a significant global public health issue, predominantly being practiced in South Asian countries. In Countries like Bangladesh, this practice contributes to an increase in early pregnancies among women of reproductive age, further exacerbating adverse maternal and child health outcomes. While certain predictors of early marriage are recognized, additional investigation is warranted due to diverse socio-economic and demographic circumstances. This study, therefore, aimed to identify the prevalence and determinants of early marriage among women in Bangladesh. This study included a total weighted sample of 18,228 married women aged 18 to 49 years, extracted from the most recent nationally representative Bangladesh Demography and Health Survey (2017-18). We estimated the survey weighted pooled prevalence of early marriage among women and stratified by their different characteristics. We used multilevel mixed-effect binary logistic regression model and estimated the odds ratios (ORs) with their 95% confidence intervals (CIs) to identify the individual-, household-, and community-level factors associated with early marriage practice. All analyses were performed by Stata software version 18. Overall, 74.27% [95% CI: 73.15, 75.35] women got married before reaching the age of 18 years. Early marriage was more prevalent in Rajshahi (82.69%), Rangpur (81.35%), and Khulna division (79.32%). Women with higher education (OR = 0.10, 95% CI: 0.08, 0.12), husband's higher education (OR = 0.57, 95% CI: 0.48, 0.67), and non-Muslim women (OR = 0.46, 95% CI: 0.40, 0.52) were associated with a lower likelihood of experiencing early marriage. Compared to those household heads aged ≤35 years, the likelihood of early marriage among women was lower for those household heads aged 36-55 years (OR = 0.84, 95% CI: 0.76, 0.93) and >55 years (OR = 0.78, 95% CI: 0.69-0.88). Women aged 18-24 years (OR = 1.24, 95% CI: 1.10, 1.40), husbands with agricultural occupation (OR = 1.22, 95% CI:1.06, 1.41), middle wealth index level (OR = 1.14, 95% CI: 1.02, 1.28), family size five or more (OR = 1.21, 95% CI: 1.11, 1.31), and rural residence (OR = 1.17, 95% CI: 1.04, 1.30) were more likely to experience early marriage. This study underscores the alarming prevalence of early marriage among women in Bangladesh, with three-fourths experiencing early marriage, particularly in specific regions. Notably, women education and older household heads were significantly associated with a reduced likelihood of early marriage. Our findings suggest that culturally sensitive interventions should focus on empowering older household heads, alongside initiatives to increase awareness among younger household heads, and enhance education, particularly in rural and impoverished households. These efforts could potentially alter socio-cultural practices and reduce early marriage in Bangladesh.

Digital Tele-Counseling for Sustainable Maternal Health Services in Indonesia Focus on Telelactation

Breastfeeding is essential for infant health and development, yet Indonesia faces challenges in meeting global breastfeeding targets. This review examines the potential of tele-counseling (telelactation) as a solution to improve breastfeeding support in the digital era, focusing on overcoming geographical and service delivery barriers. A systematic literature search covering PubMed, Scopus, Google Scholar, and local Indonesian journals identified 25 articles from 2019 to 2023, with 14 unique studies meeting inclusion criteria. Findings indicate that telelactation primarily utilizes WhatsApp groups, Androidbased apps, and online counseling sessions, resulting in improved breastfeeding techniques, increased exclusive breastfeeding rates, and enhanced maternal knowledge. However, privacy concerns and technological barriers persist, though these are addressed through specialized training and ongoing support for healthcare providers. Telecounseling demonstrates promise in supporting breastfeeding in Indonesia, though further research is needed to address geographical limitations and assess longterm impacts. Integrating telecounseling into national breastfeeding policies could significantly advance maternal and child health outcomes in Indonesia.

Maternal education and antenatal attendance in Georgia: A cohort study

Abstract Background Antenatal care (ANC) and maternal education are important determinants for maternal and newborn health outcomes. Understanding the impact of maternal education on ANC is crucial. Purpose To examine the association between maternal education and ANC attendance. Methods A retrospective cohort study utilized nationwide electronic medical birth registry data (2020-2022) in Georgia. the study includes pregnant women and their newborns. A randomized sample was selected, and extracted variables included maternal age, parity, body mass index, education, year of delivery, gestational age, infant sex, Apgar score, birth weight, delivery type, and newborn status. Statistical analysis via IBM SPSS v23 involved chi-square, t-tests, and logistic regression. Results The sample size contains 4976 mothers after excluding cases with missing data (n = 25). The mean maternal age was 30.5 years (SD = 5.4), with a mean BMI of 28.0(SD = 4.8), and the mean gestational week was 38.4(SD = 2.0), with a mean birth weight of 3263.0 (SD = 568.0) grams. Highly educated women had more than 3 times higher odds (OR = 3.636,95%CI:2.575-5.134) of having at least one ANC visit compared to those with Unknown education. primiparous women had significantly higher odds of having at least one ANC visit compared to Multiparous women, OR = 1.519, (95%CI:1.081-2.135). The chi-square test showed significant difference between ANC visits and the number of liveborn/stillborn (χ² = 53.026, p &amp;lt; .001). Moreover, there was a significant association between birth weight categories and ANC visits (χ² = 167.095, p &amp;lt; .001). Conclusions Our study emphasizes the role of education in improving access to ANC among women with low education levels. We can increase ANC visits and improve maternal and newborn health outcomes by focusing educational efforts on pregnant women. Additionally, focusing on high-risk populations, and using tailored interventions can further improve ANC attendance along with maternal and neonatal health. Key messages • Boosting ANC access and improving maternal and neonatal health by tailored community programs. • Conservative communities and underrepresented communities require additional resources to promote tailored healthcare. and extra effort in education about ANC.

Maternal health in conflict-affected settings: a case study from a frozen conflict zone

Abstract Background Reproductive, maternal, newborn and child health are negatively impacted in conflict-affected settings, and may be acutely affected in frozen conflicts due to fragile health systems and uncertain geopolitical contexts. To better understand maternal health in a frozen conflict zone, we examined maternal health outcomes in Nagorno-Karabakh during a ceasefire period prior to the forced displacement of the entire population. Methods Multistage cluster sampling was used to sample 1023 households in Nagorno-Karabakh during the summer of 2022. From each household, one woman, age 18 to 49, participated in an interviewer-administered survey. Maternal health outcomes were assessed among all married women who had ever given birth. Women with at least one child under 5 years were also asked about their most recent pregnancy. Results Among all married women, 85.5% had ever given birth, 19.0% ever had a miscarriage, and 2.8% ever had a stillbirth. Of the 299 women with at least one child under 5, 97.7% received antenatal care, of which 90.4% had at least 4 visits. Over half experienced toxicosis (51.8%), 16.4% high blood pressure, 13.0% anemia, and 6.4% hemorrhage during their most recent pregnancy. The most common delivery complications were uterine scarring (19.7%), breached birth (7.0%), prolonged labor (6.4%) and hemorrhage (5.7%). Age was found to be a significant factor, with the odds of toxicosis (p = 0.039) and breached birth (p = 0.009) decreasing, yet the odds of miscarriage (p = 0.001) and hypertension (p = 0.007) increasing with age. Conclusions Almost all women reported adequate antenatal care with birth outcomes comparable to global statistics, demonstrating the ability of Nagorno-Karabakh to provide sufficient maternal healthcare while in a frozen conflict. Fortifying and ensuring access to maternal and reproductive healthcare, particularly antenatal care, is vital for ensuring the health and wellbeing of women and children in conflict-affected settings. Key messages • Women in Nagorno-Karabakh received antenatal care and experienced birth outcomes similar to global rates, demonstrating the value of access to reproductive healthcare in conflict-affected settings. • Future studies should examine the impact of forced displacement on the women of Nagorno-Karabakh to better understand the effect of conflict on reproductive and maternal health.

Exploring racial inequalities in maternal mental health outcomes

Abstract Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.

Anemia in pregnancy and adverse maternal health outcomes - birth-registry based study from Georgia

Abstract Anemia in pregnancy is an important public health challenge; however, it has not been thoroughly studied in Georgia. We assessed the prevalence of anemia during pregnancy across Georgia and the association between anemia in the third trimester of pregnancy and adverse maternal outcomes. We used data from the Georgian Birth Registry and included pregnant women who delivered between January 1, 2019, and August 31, 2022 (n = 158,668). The prevalence of anemia (hemoglobin (Hb) &amp;lt; 110 g/L) at any time during pregnancy was calculated per region. Women in the third trimester were classified into three groups, based on their lowest measured Hb value: no (Hb ≥ 110 g/L, reference group); mild (Hb 100-109 g/L); and moderate to severe anemia (Hb &amp;lt; 99 g/L). Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated for the associations between anemia status and post-delivery intensive care unit (ICU) admission and preterm delivery. The prevalence of anemia occurring at least once during pregnancy was 40.6%, with large regional differences in anemia prevalence (25.1%-47.0%). Of 105,811 pregnant women with Hb measurements in the third trimester, 71.0% had no anemia; 20.9%, mild anemia; and 8.1%, moderate or severe anemia. The odds of post-delivery ICU admission did not increase linearly with decreasing Hb value (P for trend .13), and the relationship was inverse for preterm delivery (P for trend .01). Key messages • A considerable proportion of pregnant women in Georgia have anemia during pregnancy, and the prevalence and quality of reporting differ across regions. • To accelerate national progress toward the SDGs and mitigate the consequences of anemia, equal countrywide access to high-quality ANC programs and complete registration of Hb values should be ensured.

It takes a village: A pilot cross-randomized trial to enhance pregnancy care and support in northern Ghana.

Maternal mortality remains a challenge in Ghana, where 263 women per 100 000 live births die during pregnancy or childbirth. Barriers to reaching the recommended antenatal care (ANC) include poor access to quality health care, cultural factors, and lack of support for pregnant women. We piloted two cross-randomized interventions: durbars, or local community meetings that incorporated education about ANC and supporting pregnant women, and an enhanced ANC model that added phone calls and a home visit to standard care. The study took place in 30 villages in the Upper East Region of Ghana between August 2021 and November 2022. We tracked 277 women during pregnancy, with 120 women randomly assigned to the enhanced ANC intervention and 142 women living in villages randomized to the durbar intervention. Women who were randomized to the enhanced ANC intervention were 13.2 percentage points (pp) (95% confidence interval (CI) = 0.1, 24.3) more likely to have average or above average knowledge of pregnancy danger signs, 22.1 pp (95% CI = 9.1, 36.5) more likely to have a birth plan, 28.2 pp (95% CI = 13.0, 42.4) more likely to prepare the plan with their partners, and 16.4 pp (95% CI = 0.9, 29.3) more likely to pay for delivery with funds set aside in birth plan. They were also 35 pp (95% CI = 16.1, 48.1) more likely to make blood donor arrangements than control women who made birth plans. We found no impact of the durbar intervention on study outcomes. Evidence from this pilot suggests that interventions that increase interactions between health providers and pregnant women outside of the health facility may substantially improve women's experience during pregnancy and maternal health outcomes. Providing structured ways for men to get engaged in ANC increased their involvement. Although we found no evidence the community meetings improved study outcomes, larger studies with repeated meetings and community-wide surveys are needed to make causal conclusions. American Economic Association RCT Registry: 10360; ISCRNT: ISRCTN95961119.

Spatial Heterogeneity and association between the survey-based Women’s Empowerment Index (SWPER) and unmet need for birth spacing in sub-Saharan Africa

BackgroundUnmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women’s sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA).MethodsWe used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs).ResultsThe hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy. ConclusionUnmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.

The Influence of Prenatal Vitamin use and Community Health Programs on Reducing Teratogenic Medication Exposure and Improving Perinatal Nutrition among African American Adolescents with Limited Access to Healthcare

This review paper examines the critical influence of prenatal vitamin use and community health programs on reducing teratogenic medication exposure and improving perinatal nutrition among African American adolescents with limited access to healthcare. African American adolescents face disproportionate barriers to healthcare access, including socioeconomic challenges and systemic healthcare inequities, which contribute to heightened risks of teratogenic exposure and poor prenatal nutrition. The paper explores the role of prenatal vitamins such as folic acid, iron, and calcium in preventing congenital disabilities and enhancing maternal health. It also highlights the impact of community-based health programs and education initiatives that aim to bridge healthcare gaps for vulnerable populations. By focusing on adolescent pregnancy in African American communities, this review identifies key challenges such as limited healthcare access, inadequate educational resources, and socio-economic constraints. Furthermore, the paper assesses the effectiveness of current health interventions and policies, offering recommendations for improving healthcare access and expanding community programs. The review underscores the necessity for long-term research to address gaps in the intersection of race, adolescent health, and prenatal care, ultimately aiming to inform policy and program development that promotes equitable maternal and fetal health outcomes.

Malaria Infection in relation to parasitological indices, blood group and anaemia in pregnant women attending two health facilities in Adamawa State, Nigeria

Decline of maternal immunity and susceptibility to malaria had posed a detrimental effect on the maternal health and foetal outcomes. A cross-sectional study was carried out in two different secondary health facilities at General Hospital Ganye and Cottage Hospital Toungo with the aim of determining the malaria burden in relation to parasite species, parasite density, blood group and anaemia in pregnant women who booked for antenatal care as first timer irrespective of their gestational stage. A total of 471 randomly selected pregnant women who consented to the study were enrolled for the study. Blood samples were collected from each of the consented pregnant women. Thick and thin blood smear were prepared using Giemsa and examined microscopically to detect malaria parasite and infecting species, respectively. The overall prevalence of malaria was 22.9% (n=108). Plasmodium falciparum and P. malariae were the two malaria species encountered with a prevalence of 78.7% and 19.4%, respectively. Mixed infection had a 1.9% prevalence. Parasite density was recorded as low (67.6%), moderate (11.1%) and severe (21.3%) with a statistical significance (P=0.000). Prevalence of malaria in relation to blood group showed that pregnant women with blood group O (51.9%) had the highest burden of malaria infection and blood group AB (6.5%) had the least, although there was no statistical significance. Non-anaemic pregnant women recorded the highest infection prevalence (37.0%). This study revealed that malaria infection is significantly associated with the infecting parasite species and parasite density. It was discovered that P. falciparum was the most predominant species in the region during the period of this research.

Pattern of Family Planning in Bani-Talib village in Assiut, Egypt-cross Sectional Study

Family planning programs have emerged as one of the most successful public health interventions of the 20th century, significantly improving maternal and child health outcomes. This study aims to evaluate the prevalence and patterns of contraceptive use in Bani-Talib village, Assiut governorate, and to identify barriers to family planning method utilization. Conducted as part of a baseline survey by the Ministry of Health and Population in 2010, this cross-sectional study included all married women aged 15-49 in the village. Data were collected through structured questionnaires addressing demographic information and contraceptive practices. Ethical approval was obtained, and data were analyzed using SPSS. The mean age of participants was 30.38 years, with an illiteracy rate of 63.8% and only 4.6% employed. The prevalence of contraceptive use was 46%, with 36.9% never having used any method. The most commonly used contraceptive method was the intrauterine device (IUD) at 40.4%, followed by injectables (32%) and oral contraceptive pills (22.1%). Major barriers to contraceptive use included newly married status (34.9%), cost (24.8%), and concerns about infertility (20.2%). The findings revealed no significant differences in contraceptive use related to education, employment status, or number of children, but age was significantly associated with usage patterns. The results highlight the need for targeted interventions to address barriers to contraceptive use and increase awareness of family planning among men. Future studies should further explore family planning utilization patterns in urban versus rural settings in Egypt. Enhanced training for healthcare providers is also recommended to improve family planning service delivery in rural communities.

The maternal and infant health consequences of restricted access to abortion in the United States

Since the recent US Supreme Court decision in Dobbs v. Jackson Women's Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference-in-differences techniques across outcomes from restricted-use microdata on the universe of US births. I find that TRAP laws lead to 11–16 % increased rates of hypertensive disorders of pregnancy. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion.

Turkish adaptation of the antenatal risk questionnaire-revised: study of validity and reliability

ObjectiveThis study sought to translate the Antenatal Risk Questionnaire-Revised (ANRQ-R) into Turkish and evaluate its psychometric properties for assessing psychosocial vulnerabilities among Turkish-speaking pregnant women.MethodsThe ANRQ-R was translated into Turkish following standard linguistic adaptation procedures. Psychometric properties were then examined using a cross-sectional study design, involving 156 pregnant women recruited from antenatal clinics in Turkey. Participants completed the Turkish ANRQ-R and the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses, including intraclass correlation coefficients (ICC) for test-retest reliability, Pearson correlation analysis for item-total test correlations, and Receiver Operating Characteristic (ROC) analysis for diagnostic accuracy, were conducted.ResultsThe ANRQ-R Turkish version showed high test-retest reliability with an ICC of 0.888 for the total score. Moderate to good ICCs were obtained for individual Likert-type items (0.572–0.849). Criterion-related validity was established via moderate correlations with the EPDS and its anxiety subscale EPDS-3 A (r = 0.537 and r = 0.431, respectively). ROC analysis demonstrated good discriminatory power (Area Under the Curve = 0.75) with an optimal cut-off score of 17, yielding 78% sensitivity and 65% specificity for identifying potential depression cases.ConclusionsThis study provides preliminary evidence of the overall reliability of the Turkish version of the ANRQ-R as a measure of psychosocial risk among Turkish-speaking women during pregnancy. Despite some limitations in item-level internal consistency indicators, integration of the ANRQ-R into routine antenatal care could enhance early identification and intervention strategies, potentially improving maternal health outcomes. Future research should aim to further validate the scale across diverse populations and settings, using a diagnostic tool as the reference standard.

Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence

IntroductionMobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.MethodsA qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.ResultsThe current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.ConclusionmHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.Trial registrationPROSPERO: CRD42023461425.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.