Maternal Health Policy Research Articles

HUMANIZED PRENATAL CARE

Humanized prenatal care is a concept that aims to ensure that pregnant women receive respectful and personalized care, promoting an emotionally supportive and welcoming environment during pregnancy. This approach aims not only to ensure the physical health of the mother and fetus, but also to improve the psychological and emotional well-being of women during pregnancy, which can have a positive impact on maternal and fetal outcomes. Studies have shown that a humanized approach is a determining factor in reducing complications during pregnancy and childbirth, as well as strengthening the bond between mother and baby. This summary seeks to analyze the influence of humanized care during prenatal care on maternal and fetal outcomes, discussing the importance of welcoming and personalized practices for increasing the quality of care. It also examines how humanized care can have a positive impact on both the physical and emotional health of pregnant women, promoting more favorable outcomes for mother and baby. This study used a qualitative methodology based on a literature review, focusing on humanization practices in prenatal care, exploring their impact on maternal and fetal health and public policy guidelines in Brazil. Humanized prenatal care involves practices such as respect for the autonomy of the pregnant woman, active listening, inclusion of the family in the process and psychological support, as well as comprehensive care for the woman’s physical health. Research shows that pregnant women who receive this type of care have lower rates of anxiety and depression, factors that are associated with obstetric complications and negative outcomes. In addition, humanized care contributes to pregnant women’s adherence to prenatal appointments and tests, reducing the risks of premature births, low birth weight and neonatal mortality. Care that respects a woman’s individuality also facilitates the control of conditions such as hypertension and gestational diabetes, promoting a safer pregnancy. Humanized prenatal care therefore plays a crucial role in maternal and fetal outcomes, promoting a healthier pregnancy and reducing the risks associated with labour and birth. In addition to improving the physical health of the mother and fetus, humanized care strengthens the emotional health of the pregnant woman and facilitates the mother-baby bond, factors that are essential for the healthy development of the newborn. The implementation of humanized practices in health services is therefore a fundamental strategy for improving the quality of prenatal care and promoting better outcomes for mothers and babies.

Financial Incentives for Improving Maternal Health: A Review of Ethical Considerations

Abstract Maternal health is considered a key global priority by the World Health Organization, and several strategies are used to promote it. Especially in lower- and lower-middle-income countries, one widely used strategy employs financial incentives to motivate pregnant women to access available healthcare. While such interventions have been extensively empirically evaluated, their normative aspects appear to have received less attention. To address this gap, we systematically searched and reviewed normative and qualitative literature to map and analyze the ethical considerations of using financial incentives to promote maternal health. Twenty-three articles (four normative and 19 qualitative) were included in the review. We grouped ethical considerations under six categories, namely the program structure, promoting institutional births, of the ethical significance of cash, justifying conditionalities for maternal health, effects on individuals’ decision-making and the experiences of vulnerable groups. While incentives could be used for beneficent goals, we show how they may emphasize global rather than local solutions, impose unfamiliar sociocultural values, unfairly expect behavior change and disempower individuals and groups. We argue that future maternal health policy, especially those targeting vulnerable groups and minorities, would benefit from taking these normative considerations into account.

Study of the Association Between Socioeconomic Determinants and Pregnancy Follow-Up Indicators of Mothers of Low-Birth-Weight Infants: Insights for Achieving Sustainable Development Goals

Aims: This study investigates the association between socioeconomic determinants and pregnancy follow-up among 200 mothers of low-birth-weight newborns. By identifying factors influencing maternal care and birth outcomes, the study contributes to achieving Sustainable Development Goals (SDG) 3, 8, and 10, focusing on improving maternal and child health, reducing socioeconomic disparities, and ensuring equitable healthcare access. Methods: A prospective descriptive study was conducted over 12 months (June 2020–July 2021) at the neonatology and nutrition reference center of Rabat Children's Hospital. The study recruited 206 mother-child pairs, focusing on those with low-birth-weight infants. Results: Among the 200 mothers, 92% followed their pregnancies. Distribution of prenatal consultations was as follows: 0.54% had one visit, 5.98% two visits, 33.7% three, 41.85% four, and 17.93% more than four. Analysis revealed significant associations between pregnancy follow-up and socioeconomic factors. Maternal age (p < 0.001), education level (p < 0.001), and place of residence significantly influenced pregnancy monitoring, with urban mothers more likely to receive follow-up care. Single mothers had a 100% non-tracking rate, while married mothers predominantly monitored their pregnancies. Conclusions: This study demonstrates the strong influence of sociodemographic factors on antenatal care use, aligning with findings from other contexts. It contributes new insights into the specific characteristics of our study population and has practical implications for shaping maternal and child health policies, addressing the unique needs of diverse sub-populations. Achieving SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), and SDG 10 (Reduced Inequalities) requires targeted interventions that improve equitable access to quality maternal care.

Maternal Mortality in the Governorate of Tunis between 2017 and 2023: evolution of Maternal Mortality Ratio and the main causes of death

Background Maternal mortality is the main indicator of maternal health worldwide. The aims of your study were to determine the Maternal Mortality Ratio (MMR) in the governorate of Tunis and to identify the main causes of maternal death. Methods We included all maternal deaths between January 2017 and December 2023, reported to the Tunis Regional Health Directorate. The data collected included the MMR per 100000 live birth, sociodemographic characteristics, causes of death, circumstances of death, autopsy findings, and preventability. Results Sixty one maternal deaths were recorded. The average of MMR was 46, 88 per 100000 live births. Two peaks in the MMR were noted in 2017 and 2020. The average age of the patients was 34, 1 years (±5.1). We noted that 43, 75 % of the patients were not residents of the governorate of Tunis. The postpartum period was the most critical. In fact, 83, 33 % of maternal deaths occurred postpartum. Hemorrhage was the main etiology in 20.8% of cases. The second cause was COVID- 19complicationsin 16, 6% of cases. Conclusion This study of maternal mortality in Tunis opens the debate on the effectiveness of maternal health policies in Tunisia and the areas for improvement.

Why “free maternal healthcare” is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power

BackgroundGhana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana’s free maternal healthcare policy.MethodsCross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes.ResultsWe found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues – delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors – mothers’ lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare.ConclusionsUrgent measures are required to address the structural and administrative issues confronting Ghana’s free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.

What is the Status of the Scientific Association of Midwifery in Iran based on the Criteria of the International Confederation of Midwives?

Introduction: Scientific midwifery associations can play a leading role in improving maternal health policies and practices. This study aimed to evaluate the Iran Scientific Association of Midwifery (ISAM) using a translated valid version of the Member Association Capacity Assessment tool (MACAT) and also to explain the needs and propose the related strategies and actions to improve ISAM capacities. Methods: This was a mixed sequential (Quantitative-Qualitative) explanatory research in 2022. The study was performed in three phases based on the study's objectives. In the first phase, the MACAT of the International Confederation of Midwives (ICM) was translated into Persian. Then, the validity of MACAT was assessed by 10 experts. After the validity approval of the Persian version of the MACAT, in the second phase, which was a descriptive study, the capacity of ISAM was assessed by two trained evaluators using MACAT. In the third phase of the study, with a qualitative research and using a focused group discussion and six in-depth individual interviews with 14 key informants, the demonstrated challenges in the first phase of the study and the related suggestions for the problem solutions were discussed. The data from the qualitative phase of the study were analyzed using directed Qualitative content analysis. Lincoln and Guba’s criteria were used to confirm the trustworthiness of the data. Then the needs were explained, and the strategies and actions were suggested to improve ISAM capacities in the seven dimensions of MACAT, including governance, management, financial resources, functions, communication, collaboration, and visibility. Results: In the first phase of the study, the MACAT was translated into Persian, and its validity assessment showed S-CVI= 0.91 and I-CVI= 0.89. CVR scores of all items were also above 0.62 and so acceptable. In the second phase of the study, the document review and the observations showed 88 out of 96 items scored 1 (91 percent) while 8 items scored zero. In the third phase of the study, 83 codes in the 6 dimensions were categorized from directed content analysis. Then, 53 actions were proposed for seven main strategies for improving the governance, enhancing the management practices and leadership methods, increasing functions, increasing collaboration, partnership, and networks, and expanding visibility and increasing sustainability to improve ISAM capabilities. Conclusion: The Scientific Midwifery Association obtained 91 percent of the scores. The most important challenges of the ISAM were (1) low advocacy, (2) a shortage of human and financial resources and sponsors, and (3) low contribution in policy and decision-making in midwifery affairs. The most necessary actions for the ISAM capacity improvement were suggested to be (1) considering more independence in a culturally and politically-based context governance, (2) paying attention to infrastructure improvement, and (3) defining the mechanisms in communication with the other midwifery-related sectors, other NGOs, and potential sponsors; (4) the ISAM involvement in making macro policies and midwifery affairs, and (5) using the ISAM capacity for participating in mega health projects for fundraising.

Discontinued Maternal Health Care Utilization in Bhojpur District, Nepal

Why all pregnant women did not receive all care at antenatal period; those who did not even utilize any ANC visit may also prefer to utilize facility-based delivery or postnatal care related queries are rarely available in several rounds of NDHS data set. A study conducted in Tarai region of Nepal, analysis of Nepal demographic and health surveys of several rounds, Annual Health Report 2077/78 published by the Department of health services, Ministry of health and population were taken into study. A qualitative study designed in 2014-15 from the women of reproductive health having children of 2-23 months were asked their discontinuation, if any. Maternal health service utilization through national and the district level data were analysed to study about the discontinuation in utilization.Several factors are identified as the cause for discontinuation in the Tarai region of Nepal. Data revealed by department of health services for the fiscal year 2077-78 show discontinued maternal health service utilization (MHSU) in Bhojpur district. The NDHS 2022 report still found some level of discontinuation in national level. Therefore, urgent need of qualitative study is a most for Bhojpur district which has low level of utilization. In the new administrative set-up according to constitution of Nepal, effective functional policy adopted by municipal region may solve several issues of maternal health. Hilly regions could have different response than Tarai region of Nepal. Therefore, local bodies of hilly regions should bring maternal health policy and program to achieve continuum of maternal health care which will ultimately help Nepal to achieve SDG related goal and target.

5 - Maternal Healthcare and Health Policy Planning in Tanzania, 1961–1970s

5 - Maternal Healthcare and Health Policy Planning in Tanzania, 1961–1970s

Ethno-racial inequalities on adverse birth and neonatal outcomes: a nationwide, retrospective cohort study of 21 million Brazilian newborns

Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil. We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers' schooling, with White women with 8 or more years of education as the reference group and by year. 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations. A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies. Bill & Melinda Gates Foundation and Wellcome Trust.

Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana

BackgroundGhana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments. MethodsCross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models. ResultsThe median OOP payments for maternal healthcare was GH₵866.5(US$109.3). The median non-medical OOP cost (GH₵479[US$ 59.9]) was higher than the median medical OOP cost (GH₵296.5[US$ 37.1]). The median OOP cost was higher for delivery (GH₵454[US$56.8]) compared to ANC (GH₵356.5[US$44.5]) and PNC (GH₵21.5[US$2.6]). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs<1; p-values<0.05) with lower probabilities of incurring catastrophic OOP expenditure. Tertiary education was associated (AORs> 1; p-values<0.05) with a higher probability of incurring catastrophic OOP payments. ConclusionOOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana’s free maternal healthcare policy to include non-medical supplies within its benefit package.

Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews.

Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77.

Maternal and Child Health Policy Innovation Program (HRSA)

Maternal and Child Health Policy Innovation Program (HRSA)

Psychometric properties of the experiences of maternity care scale among Iranian women

BackgroundAssessing women’s perceptions of the care they receive is crucial for evaluating the quality of maternity care. Women’s perceptions are influenced by the care received during pregnancy, labour and birth, and the postpartum period, each of which with unique conditions, expectations, and requirements. In England, three Experience of Maternity Care (EMC) scales – Pregnancy, Labour and Birth, and Postnatal – have been developed to assess women’s experiences from pregnancy through the postpartum period. This study aimed to validate these scales within the Iranian context.MethodsA methodological cross-sectional study was conducted from December 2022 to August 2023 at selected health centers in Tabriz, Iran. A panel of 16 experts assessed the qualitative and quantitative content validity of the scales and 10 women assessed the face validity. A total of 540 eligible women, 1–6 months postpartum, participated in the study, with data from 216 women being used for exploratory factor analysis (EFA) and 324 women for confirmatory factor analysis (CFA) and other analyses. The Childbirth Experience Questionnaire-2 was employed to assess the convergent validity of the Labour and Birth Scale, whereas women’s age was used to assess the divergent validity of the scales. Test-retest reliability and internal consistency were also examined.ResultsAll items obtained an impact score above 1.5, with Content Validity Ratio and Content Validity Index exceeding 0.8. EFA demonstrated an excellent fit with the data (all Kaiser-Meyer-Olkin measures > 0.80, and all Bartlett’s p < 0.001). The Pregnancy Scale exhibited a five-factor structure, the Labour and Birth Scale a two-factor structure, and the Postnatal Scale a three-factor structure, explaining 66%, 57%, and 62% of the cumulative variance, respectively, for each scale. CFA indicated an acceptable fit with RMSEA ≤ 0.08, CFI ≥ 0.92, and NNFI ≥ 0.90. A significant correlation was observed between the Labour and Birth scale and the Childbirth Experience Questionnaire-2 (r = 0.82, P < 0.001). No significant correlation was found between the scales and women’s age. All three scales demonstrated good internal consistency (all Cronbach’s alpha values > 0.9) and test-retest reliability (all interclass correlation coefficient values > 0.8).ConclusionsThe Persian versions of all three EMC scales exhibit robust psychometric properties for evaluating maternity care experiences among urban Iranian women. These scales can be utilized to assess the quality of current care, investigate the impact of different care models in various studies, and contribute to maternal health promotion programs and policies.

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.

Prioritization of maternal and newborn health policies and their implementation in the eastern conflict affected areas of the Democratic Republic of Congo: a political economy analysis.

Maternal and neonatal mortality remains a major concern in the Democratic Republic of Congo (DRC), and the country's protracted crisis context exacerbates the problem. This political economy analysis examines the maternal and newborn health (MNH) prioritization in the DRC, focussing specifically on the conflict-affected regions of North and South Kivu. The aim is to understand the factors that facilitate or hinder the prioritization of MNH policy development and implementation by the Congolese government and other key actors at national level and in the provinces of North and South Kivu. Using a health policy triangle framework, data collection consisted of in-depth interviews with key actors at different levels of the health system, combined with a desk review. Qualitative data were analysed using inductive and then deductive approaches, exploring the content, process, actor dynamics, contextual factors and gender-related factors influencing MNH policy development and implementation. The study highlighted the challenges of prioritizing policies in the face of competing health and security emergencies, limited resources and governance issues. The universal health coverage policy seems to offer hope for improving access to MNH services. Results also revealed the importance of international partnerships and global financial mechanisms in the development of MNH strategies. They reveal huge gender disparities in the MNH sector at all levels, and the need to consider cultural factors that can positively or negatively impact the success of MNH policies in crisis zones. MNH is a high priority in DRC, yet implementation faces hurdles due to financial constraints, political influences, conflicts and gender disparities. Addressing these challenges requires tailored community-based strategies, political engagement, support for health personnel and empowerment of women in crisis areas for better MNH outcomes.

Maternal and child oral health barriers and solutions: Case studies from South Africa, Brazil, and Indonesia.

The World Federation of Public Health Associations (WFPHA) has introduced a maternal oral health framework and launched its Global Maternal and Child Oral Health Initiative, advocating for maternal and child health as a strategic entry point for oral health to be integrated into primary healthcare systems. This article delves into maternal oral health initiatives in South Africa, Brazil, and Indonesia, exploring challenges and proposing context-specific solutions aligned with the WFPHA maternal oral health framework and its Global Maternal and Child Oral Health Initiative. The apartheid legacy in South Africa has led to the gross health inequalities, including oral health disparities characterized by maldistribution of dental facilities and dental professionals in the public sector. The proposed objectives focus on effective leadership, human resource capacity building, and integration of maternal and child oral health policy into existing health policies. Brazil faces challenges in reaching pregnant women, especially pregnant teens, due to workforce shortages. Brazil's Oral Health National Program mandates all pregnant women undergo at least one dental appointment, but a shortage of oral health teams persists and impedes timely access to dental care during pregnancy. Dental students' outreach to vulnerable pregnant teens can enhance the future oral health workforce's sensitivity to maternal oral health matters. In Indonesia, the Antenatal Care Innovative (iANC) Project has introduced a co-training model for midwives and oral health professionals addressing oral health needs of mothers and their spouses and fostering a comprehensive understanding of the interplay between oral health and maternal well-being. These country cases demonstrate the importance of tailored policies, health promotion, and care delivery interventions in maternal oral health. All cases highlight the importance of workforce training and distribution, fostering cross-disciplinary collaboration and future oral health workforce who can promote health beyond treatment delivery.

Maternal and child health policy: A global review of current practices and future directions

Maternal and child health remains a paramount concern worldwide, with policy frameworks playing a pivotal role in shaping outcomes for mothers and children. This paper provides a concise overview of the global landscape of maternal and child health policies, encompassing current practices and outlining key directions for the future. Current practices in maternal and child health policies vary significantly across regions and nations. Successful policies often integrate evidence-based interventions that span the continuum of care, from preconception to postpartum and early childhood. Maternal health policies typically focus on ensuring access to quality antenatal care, skilled birth attendance, and postnatal support. Child health policies emphasize immunization, nutrition, and early childhood development programs. However, disparities persist, reflecting the need for targeted interventions to address specific regional challenges. Future directions in maternal and child health policies emphasize a holistic and integrated approach. The global community recognizes the importance of addressing social determinants, promoting gender equity, and strengthening health systems to ensure comprehensive care for mothers and children. Innovations in digital health, community engagement, and cross-sectoral collaborations are identified as crucial components for improving policy effectiveness. Additionally, a life-course perspective, extending beyond childbirth to adolescence and beyond, is gaining prominence to address the evolving health needs of women and children. This paper provides a snapshot of the intricate landscape of maternal and child health policies globally. By understanding current practices and identifying future directions, policymakers, healthcare professionals, and stakeholders can contribute to advancing maternal and child health outcomes on a global scale.

Intersectionality in Black Maternal Health Experiences: Implications for Intersectional Maternal Mental Health Research, Policy, and Practice.

Black women experience significant maternal mortality and morbidity disparities in the United States. Although emerging research has focused on reducing maternal mortality rates among Black birthing individuals, we must explore structural and social factors contributing to mental health outcomes during the perinatal period. Gaps exist where intersectional identities and experiences in maternal and child health are examined. This study explores the intersectional stress experiences of Black perinatal women in the South. We collected qualitative data through virtual semistructured interviews with 9 pregnant and 7 postpartum participants (N = 16).These interviews assessed feelings, attitudes, and perceptions about psychological stress due to their intersectional experiences of being Black, pregnant, and a woman in the United States. Findings were analyzed through the lens of critical race theory and intersectionality. We identified 5 overarching themes: (1) perinatal mental health experiences, (2) birthing and parenting while Black, (3) socioeconomic factors, (4) how we cope, and (5) community and social support. Overall, this study revealed how the layers of race, gender, pregnancy, and socioeconomic status influence mental health during the perinatal period. These findings show the need for antiracist and intersectional maternal mental health policies and practices.

"How I wish we could manage such things": A qualitative assessment of barriers to postpartum hemorrhage management and referral in Kenya.

Maternal mortality rates in Kenya have remained high, with the country reporting 342 deaths per 100,000 live births. A major contributor to this is postpartum hemorrhage (PPH), responsible for 40% of maternal deaths in Kenya and the leading cause globally, particularly in low- and middle-income countries. Timely and effective PPH care is crucial; however, challenges arise when referrals between facilities become necessary. Although Primary health care facilities (PHCs) in Kenya oversee many births and are crucial in PPH risk detection and management, they often fall short due to ill-equipped facilities and inefficient referral systems. This study traced PPH patients from tertiary institutions to their initial PHCs. Through qualitative interviews with healthcare providers, we aimed to examine the primary challenges in PPH management and referral decision-making. We found that, in addition to structural gaps, challenges in collaboration and communication between providers from different health facilities, which may also stem from inadequate training, greatly influenced referral efficacy. Our findings are pivotal for maternal health discourse and policy. Importantly, while many solutions focus on structural inputs, our study underscores the importance of communication between facilities in ensuring timely care. Our findings suggest a need for bolstered emergency preparedness, informed clinical decision-making, and strategic interventions where they are most impactful.

Knowledge about unintended pregnancy shortly after childbirth: An issue of ineffective counseling or adherence?

Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03-1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance.