Maternal Health Care Utilization Research Articles

The Utilization of Maternal Healthcare Services Among Ethnic Minority Populations in Vietnam.

Previous studies have observed lower utilization of maternal healthcare services by ethnic minority groups in Vietnam compared with the majority Kinh community. This study sought to assess the utilization of maternal healthcare service-associated factors within 12 ethnic minority groups. The cross-sectional study enrolled 996 women from 12 ethnic minority groups in Vietnam in 2019. Women had pregnancy outcomes in the last 5years. The two variables for maternal healthcare utilization were [1] a minimum of four antenatal contacts and [2] health facility-based delivery. We examined the association of individual characteristics of maternal healthcare services using multilevel modeling. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. This nationally representative study found that 34.1% of women from ethnic minority backgrounds had four or more antenatal contacts during pregnancy, ranging from 8.3% in Mong community to 80.2% in Cham An Giang. Most of the women (94.4%) delivered at health facilities. Factors independently correlated with having fewer than four antenatal contacts included being illiterate, early marriage, unemployment, religious affiliation, household economy, and distance to the nearest health facility. Factors significantly associated with home delivery were living in the most disadvantaged areas and having fewer than four antenatal contacts. Substantial inequity exists in antenatal coverage both within ethnic minority groups and between socio-economic groups. The low coverage of having at least four antenatal contacts and its' correlates with facility-based delivery suggests that the government should focus efforts on increasing the number of antenatal contacts for ethnic minority women.

Maternal Health-Care Access and Utilization in Sidoluhur, Lawang

The geographical conditions influence infrastructure development, such as public health services. The utilization of facilities depends on the socio-economic characteristic of the community itself. Accessing and utilizing health services would maternal mortality. This study aims to describe the maternal health behavior and to assess the correlation between access and utilization with regards to socio-economics maternal characteristics. This research used a quantitative method and samples 75 women of childbearing age. This study uses cross-sectional primary data, and analysis was performed using descriptive and inferential statistics nonparametric. Correlation analysis was performed using the Kendal Tau correlation to determine the relationship of independent variables to the dependent variable. The influence of independent variables on dependent variables measure using logistic regression. The results of this study were 31% of respondents still carrying out traditional births through an attendant called ”dukun”. Public health service availability is sufficient, although not everyone can access easily. While in traditional services, traditional birth attendants come to patients so they preferred this method because it’s effortless. Access to health services and access to information simultaneously give a 72.2% impact towards maternal behavior of ante-natal care.
 Keywords: socio-economics characteristic, maternal healthcare utilization, maternal delivery

The Impact of Maternal Health Care Utilization on Probability of Child Survival in India

Maternal and child health programmes plays a key role in reducing infant and child mortality in any population. The Government of India started maternal and child health care services in the first five year plan (1951-56). This study uses data from the fourth round of the National Family Health Survey (NFHS, 2015-16). We are interested to examine the effect of child delivery at a healthcare facility, on child survival. We are followed by Mosley and Chen’s framework (1884), according to the framework, several socioeconomic determinants are grouped into some categories, namely, maternal, environmental contamination, nutrient deficiency, and personal illness control. Consequently, we reduced the number of independent variables to women’s age at birth and education, birth order, low child birth weight, household wealth, and healthcare.

Mass media exposure and maternal healthcare utilization in South Asia.

Maternal mortality remains a major population health problem in the developing world due in part to inadequate healthcare before, during, and after childbirth. Mass media has the potential to disseminate information about maternal healthcare that can improve well-being for mothers and infants, particularly among women with limited educational attainment. This study examines the impact of mass media exposure (e.g., television, radio, and newspaper) and sociodemographic factors on maternal healthcare utilization in four South Asian countries: India, Bangladesh, Nepal, and Pakistan. Analyses use 2014–2017 Demographic and Health Surveys, which are nationally representative of women aged 15–49 years. Results show that maternal healthcare utilization is significantly higher among women exposed to mass media across countries, even after controlling for mother's, husband's, and household sociodemographic factors. Women exposed to mass media are 46–86% more likely to receive antenatal care, 24–53% more likely to deliver their babies by skilled birth attendants, and 36–94% more likely to receive postpartum check-ups across countries. Mother's educational attainment moderates the association between mass media exposure and some maternal healthcare services in three of the four countries. Governments and public health organizations can consider mass media as a key intervention in promoting maternal health in developing contexts.

Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study.

BackgroundAntenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes.ObjectiveThis study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance.MethodsThis study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics.ResultsThe comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women.ConclusionsThese results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization.

Determinants and Utilization of Maternal Health Care Services in Urban Slums of an Industrialized City, in Western India.

Objective: To assess the status of utilization of Maternal Health Care (MHC) services in slums of an industrialized city and elucidating the various determinants influencing the utilization. Materials and methods: A Cross-sectional study using multi stage sampling methodology was conducted in slums of an industrialized city. The study participants were the women who had given a live birth in the last one year before 4 weeks of the study starts. Total one hundred eighty families were interviewed & analysed. Results: The utilization of MHC services was poor as compared to national averages in urban slums. There was no association between age of mother, birth order, educational and occupational status of head of family with utilization of services while education and employment of mother, category and type of family, distance and time to reach health facility, were significantly associated. Conclusion: The reduction of maternal mortality and morbidity mostly depends on the utilization of MHC services. The findings of this study have important implications for improving utilization of maternal health care services.

PMU48 EFFECT OF MOBILE HEALTH INTERVENTIONS ON MATERNAL AND CHILD HEALTH: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Recently, attempts have been made to use mobile phone text messaging, phone calls, and application to achieve positive outcomes in maternal and child health outcomes. Existing evidence on its use to improve the outcomes in mother and child are sparse. This study synthesizes and critically reviews the existing level of evidence on the use of mobile-based services for maternal and perinatal healthcare utilization and its impact. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search was performed in MEDLINE. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials. A total of 551 references were identified, of which nine studies were included in this review. The maternal education using text messages was found to be effective in decreasing both maternal and perinatal morbidity and mortality. Further, maternal education reported to increase, facility delivery, vaccine uptake, care-seeking for newborn illness and postnatal-care appointments. In particular, management of gestation diabetes using mobile health intervention was associated with positive outcomes in terms of decreased complications in both pregnant women and fetuses. Postnatal care appointments were reported higher with the use of mobile health interventions as compared to their control groups the group using mobile health interventions on comparing to controls. Mobile phone utilization was also reported to improve the coverage of recommended antenatal care practices, including syphilis and HIV testing. The call center was an efficient approach for the measurement of post-discharge childbirth outcomes. Mobile phone call/SMS/Application utilization was found to increase the healthcare facility uptake and reporting. Its usage was associated with favorable outcomes in both mother and child. Mobile health interventions could be successfully used for improving outcomes in different healthcare programs.

SOCIAL DETERMINANTS OF HEALTH AFFECTING UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A NARRATIVE REVIEW

Despite improvements in maternal health, Sub-Saharan Africa countries still experience high maternal deaths. The provision of quality maternal health services has been adopted as a key strategy to reduce maternal mortality. However, low utilization rates and inequitable access to maternal health services across the region continue to hinder progress. The objective of the study was to synthesize evidence on the social determinants of maternal health services utilization in sub-Saharan Africa. A narrative review of peer-reviewed articles published between 2010 and 2019 was conducted. Peer-reviewed published studies were electronically searched from databases using search terms covering access and use, social determinants, maternal health services and sub-Sharan Africa. Data were qualitatively analyzed, and results summarized using the World Health Organization’s Social Determinants of Health Framework. A total of 36 studies were reviewed. The study identified several social determinants that act as barriers or facilitators to maternal health utilization. Factors identified include socioeconomic status, educational level, women’s autonomy, urban residence, gender norms, geographical proximity, access to media, high social capital, social support, exposure to media and functional health system. Maternal healthcare utilization is still low in sub-Saharan Africa and it reflects disparities according to socioeconomic status and rural/urban residence. Programs and interventions to improve maternal health should target social determinants that create inequalities in society.

Exploring Challenges of Maternal Healthcare Utilization in Bangladesh: A Cross-sectional Survey in Saturia, Manikganj District

Exploring Challenges of Maternal Healthcare Utilization in Bangladesh: A Cross-sectional Survey in Saturia, Manikganj District

Determinants of low immunization coverage among children aged 12-23 months in narok south narok county kenya

Childhood immunization remains one the primary health care core component and the most effective public health interventions for controlling and eliminating life-threatening vaccine preventable diseases in the world. According to 2014 Kenya National Demographic and Health Survey (KDHS), a few children of ages 12 to 23 months in Kenya presented below average in terms of vaccination coverage of children who are fully immunized. Delayed vaccinations would increase the risk for vaccine preventable diseases in the community, therefore the information obtained from this study is to help policy makers come up with sound strategies to increase immunization coverage from 57%- 90% as recommended by World Health Organization. The broad objective of the study was to determine reasons influencing low vaccination coverage between children of ages 12 to 23 months in Narok South sub-county, Narok County in Kenya. This is to contribute to the reduction of morbidity and mortality caused by infectious diseases of public health importance related to vaccine preventable disease. Methods: This was a cross-sectional descriptive study. The study used mixed methods, both quantitative and qualitative. A structured questionnaire was used to collect data on social demographic and social cultural factors, maternal health care utilization and knowledge. Key informative Interviews and Focus Group Discussions were used to collect qualitative data on 454 mothers/caretakers with children aged between 12-23 months reached in Narok South sub county. Results: The total number of mothers/caregivers who were interviewed were 454, with a response of 100%. Results of immunization coverage; BCG 73%, OPV1 59%, OPV2 51%, OPV3 49%, Penta1 58%, Penta2 51%, Penta3 50%, Measles 54% and Fully Immunized Children 47%. Further, 47% of the children in the sub-county were fully immunized and 53% were unimmunized. The SD mean for mothers/caregivers and children 31.4 and 17.0 respectively and over 70% of the mothers/caregivers had no formal education. There were significant association predictors with immunization coverage included maternal education (X2 =11.75, df=4 p value=0.02), distance to health facility (X2 =62.30, df=2 p value=0.00), also, there was strong significant association with childbirth ranking (OR=1.218, p value=0.04). Bivariate analysis, there was an association with mothers/caregivers’ who had more than one visits with fully immunized children (χ2=13.54, df =2 and p value =0.001), source of the immunization information OR=0.75 and p value=0.02 and, ultimately, there was association between mother’s/caregiver place of delivery with non-fully immunized children (X2=74.40,df=1 p value=0.01). Predictors of non-fully immunized children in the study population were; place of delivery, family size, education level, source of income, none attendance of Antenatal clinics, distance to the health facility, source of the vaccination information was associated with incomplete fully immunized children. Conclusion: The immunization coverage for the fully immunized child in the sub county was very low 47%, compared to national 77%. Key players in the immunization sector should identify children who are at risk, deploy reach every child strategy, encourage pregnant mothers to attend ANC, expand outreach services, increase funds allocation to health sector and build more health facilities to improve immunization coverage.

Impact of Recurrent Floods on the Utilization of Maternal and Newborn Healthcare in Bangladesh.

Floods are one of the most common types of disasters in Bangladesh and lead to direct and indirect impacts on health. The aim of the study was to assess the impact of floods on Maternal and Newborn Healthcare (MNH) utilization in Bangladesh between the years 2011 and 2014. We used variables from the Bangladesh Demographic and Health Survey 2014 data and georeferenced data of floods between 2011 and 2014 from the Emergency Events Database. Multivariate logistic regression was used to determine whether the flood-affected exposures were significant in predicting differences in MNH utilization. The odds for the received antenatal care by skilled providers, institutional deliveries, deliveries by c-section, and postnatal care of the babies were significantly lower (Unadjusted OR = 0.81, 0.88, 0.83, and 0.82 respectively; P < 0.05) in the flood-affected area than the non-affected area. Additionally, the odds of postnatal checkup of women was statistically significant (P < 0.001) and less likely to be received in flood-affected area (OR = 0.76). The odds of all indicators were significantly lower (OR < 1) for the women living in the twice and four times flooded areas compared to the once flooded areas. The study shows that floods can have a negative impact on MNH utilization. In addition, repeated floods have a worse impact on MNH utilization than incidental floods. Extra effort should be put on ensuring access to MNH of women in flood-affected areas.

Family support and community respect for community health workers and the association of these with CHW productivity and clinic health care utilization

Background This paper examines associations between family support and community respect as perceived by community health workers, and their productivity and maternal health care utilization in India. Methods We conducted cross-sectional surveys with the community health workers, known as accredited social health activists (ASHA) and her clients, women with a child aged one year or less. The data were matched and merged for dyadic analysis. ASHA productivity was defined as number of households visited, number of women accompanied to a health facility, and earnings as reported by ASHAs. It also included two variables reported by the clients - number of ASHA visits during the clients’ pregnancy and ASHA visits during postnatal period. Maternal health care utilization included client reports of 4+ antenatal care visits and facility delivery. Husband/family support in domestic work referred to sharing of household responsibilities. Support in ASHA-related work included help in reaching target households, help in taking clients to facilities, help in organizing village health and nutrition days, and help in filling out required paperwork. We used bivariate, multivariate, and hierarchical logistic regression models to test the associations. Results Husband/family support in domestic work was associated with a significantly higher number of households reached by ASHAs (regression coefficient, beta (β)=0.21, P&lt;0.001), higher number of clients accompanied to a facility for delivery (β=0.14, P=0.04), higher odds of a client receiving an ASHA visit during pregnancy (adjusted odds ratio AOR: 1.20; 95% confidence interval (CI)=1.04-1.37), and receiving 4+ antenatal care (adjusted odds ratio (AOR)=1.20, 95% CI= 1.00-1.43). Husband/family support for ASHA-related work (eg, taking on domestic labor) was also associated with a significantly higher number of households reached by ASHAs (β=0.32, P&lt;0.001), but no significant associations were observed for health care utilization with respect to antenatal care or facility delivery. Male community members’ respect for ASHAs was associated with a significantly higher number of households reached by ASHAs (β=0.36, P=0.02), and earnings (β=0.23, P=0.04). Conclusions The study indicates the need for family support and community respect in improving ASHAs’ productivity as well as health outcomes within the community they serve. Findings also suggest the need for more equitable distribution of domestic labour.

Trends, Differentials, and Social Determinants of Maternal Health Care Services Utilization in Rural India: An Analysis from Pooled Data.

Background:Millennium development goal 5 aimed at reduction of maternal deaths by three-quarters from 1990 to 2015: a target India commendably achieved, but this milestone remains overshadowed by inequalities in utilization of health services that are driven by determinants both at community and at individual level.Materials and Methods:We studied the utilization trends using descriptive statistics and analyzed the relative contribution of various socioeconomic predictors on the use of maternal health care services in rural India using binary logistic regression analysis on pooled data from three rounds of National Family Health Survey. Outcome variables included four or more antenatal care visits, skilled birth attendance, and postnatal care.Results:Although utilization of maternal health care services showed an upward trend from 1998–1999 to 2015–2016, factors such as illiteracy, female age ≥40 years, having five and more children, belonging to scheduled tribes, rural residence, and not possessing a health card were associated with significantly low utilization of maternal health care services. However, partner's education, good economic status, women's autonomy, and infrastructure at village level were associated with better odds of availing these services.Conclusions:The study generates evidence on the role of various socioeconomic determinants in maternal health care utilization and identifies gaps that must be strategically addressed to reach sustainable developmental goal maternal mortality target of 70 deaths per 100,000 live births by 2030. It reemphasizes the need for ensuring convergence among different stakeholders while structuring maternal health policies so that health reforms can be accomplished effectively at all levels of health care.

Evaluating a Conditional Cash Transfer Scheme in a Maternal Health Care Utilization Program Among Rural Pregnant Women in Mysore District, India.

Background: According to the World Bank report in 2015, the maternal death rate in India was 174 per 100,000, which is among the highest in the world. The Indian Government launched the Janani Suraksha Yojana (JSY) conditional cash transfer program in 2005 to curb the adverse birth outcomes by promoting institutional delivery and providing antenatal care (ANC) services for pregnant women. This study evaluates the factors associated with JSY conditional cash transfer program in rural Mysore, India.Methods: Between 2011 and 2014, a prospective cohort study was conducted to examine the feasibility and acceptability of integrated ANC and HIV testing using mobile clinics in rural Mysore. Pregnant women in the Mysore Taluk provided an informed consent and answered an interviewer-administered questionnaire in local language, Kannada. All women underwent routine ANC services and were followed-up immediately after delivery, and 6 months and 12 months after delivery. Binary logistic regression was performed to identify factors associated with JSY benefits.Results: The mean age of the 1,806 mothers was 21.2 ± 2.2 years and 58.9% of the mothers had primary education. Nearly half (51.6%) of the women reported having received JSY benefits. Factors associated with receiving JSY benefits included pregnant woman's partner not having any formal education (adjusted odds ratio [AOR]: 1.35; 95% confidence interval [CI]: 1.01–1.80), having income ≤4,000 Indian Rupees (AOR: 1.47; 95% CI: 1.04–2.09), rare visits (once in 3 months visit) with Accredited Social Health Activists (AOR: 3.55; 95% CI: 1.55–8.51), and delivery in a public institution (AOR: 1.23; 95% CI: 1.01–1.51).Conclusions: While JSY has been operational in India since 2005, there continue to remain major gaps in the receipt of JSY services in rural India. Future interventions should include targeted services and expansion of JSY scheme, specifically among rural pregnant women, who are most at need of these services.

Catastrophic Health Care Expenditure on Maternal Health Care in India: Evidence from National Level Data

Introduction: Catastrophic health expenditure is defined as payments for health services exceeding 40% ofhousehold disposable income after subsistence needs are met. Utilization of maternal health care serviceshas been recognized as a significant factor in influencing maternal and child mortality. India continuesto account for a quarter of all maternal and child deaths at the world level. The cost of health care iscomparatively higher in private sector than the public health facilities. Households using private inpatientservices are more likely to face catastrophic expenditure.Materials and Method: This paper has utilized the data collected by the National Sample SurveyOrganization (NSSO) during January-June, 2014. It is a cross sectional dataset available in public domain.The dataset provides information on Social Consumption and Health scenario of the population. To carry outthe research, descriptive statistics, bivariate and logistic regression analysis has been used.FINDINGSThe study shows that urban sector, primary educated and women belonging to poorest wealth quintilebear high catastrophic health expenditure than their other counterparts. Western and Southern region havelow percentage of women going for catastrophic expenditure on maternal health care. The likelihood ofcatastrophic health expenditure on maternal health care decreases with the increase in wealth quintile frompoorest to richest.Conclusion: Place of residence, educational status and wealth index plays an important role in determiningthe catastrophic health expenditure on maternal health care. Further research needs to be done in exploringthe factors that leads to inequity of the expenditure used in the utilization of maternal health care.

Socio-economic Determinants in the Utilization of Maternal Health Care in India: Exploring National Level Data

Socio-economic Determinants in the Utilization of Maternal Health Care in India: Exploring National Level Data

Inequalities in the utilisation of maternal health Care in Rural India: Evidences from National Family Health Survey III & IV

BackgroundSince the implementation of National Rural Health Mission (NRHM) in 2005, Maternal Mortality Ratio has significantly declined in India through a noticeable improvement in maternal health care services. However, India did not succeed to achieve the target of millennium development goal to reduced maternal mortality ratio by 2015. Also, there is substantial inequality exist at the regional, geographic, economic, and social level, and various socioeconomic factors contribute to the significantly large share in inequality in utilisation of maternal health care in India.MethodsUsing data from the National Family Health Survey (2005 and 2015), this study examined the degree of inequality exist in maternal health care namely full antenatal care (full ANC), skilled attendants at birth (SBA), and postnatal care (PNC) in rural India. Descriptive statistics, concentration index (CI), and Wagstaff decomposition method have been performed to understand the pattern of maternal health care utilisation, and to explain the extent of inequality in maternal health care utilisation.ResultsThe study revealed that a substantial gap across socioeconomic groups exist in utilisation of maternal health care has significantly reduced in rural India during 2005–16. The results found a noticeable improvement in maternal health care utilisation, especially in utilisation of skilled attendants at birth (SBA). During this decade, the concentration index for SBA showed a significant decline from 0.28 in 2005–06 to 0.09 in 2015–16, while that of full ANC declined from 0.47 to 0.32 over the same period, and reduction of inequality in full ANC was least. Further, the results of decomposition analysis suggested that secondary and higher education, mass media exposure, and scheduled tribe contributed a significant share to the inequality.ConclusionThe exposure to mass media is the most significant contributor to inequality, and hence, there is a need for broad dissemination of awareness regarding maternal health care schemes in rural parts of country. Based on findings of study, it is suggested that health scheme related to maternal and child health care under NRHM be continued and focused for lower socioeconomic groups and marginalized mothers to reduce maternal health services inequality, particularly in the component of full ANC.

The influence of pregnancy classes on the use of maternal health services in Indonesia

BackgroundIndonesia has developed the pregnancy class program for mothers in an effort to reduce the high maternal mortality rate. This study aims to understand the influence of pregnancy classes on mothers’ use of maternal and neonatal health services, which are known to improve pregnancy and delivery outcomes.MethodsThis study used data on members of households in communities in Indonesia, based on the 2016 National Health Indicators Survey (Sirkesnas), which covered 34 provinces and 264 districts/cities. The analysis focused on a sample of women ages 10–54 years who had ever been married and had given birth in the previous 3 years. The study analyzed three behaviors as outcome variables: whether a mother had adequate antenatal care, used a skilled birth attendant, and had a facility-based delivery. Logistic and multinomial logistic regression analysis was used to explore those relationships.Results29% of mothers utilized adequate antenatal care (a minimum of five antenatal care components and at least four antenatal care visits), 77% of mothers used skilled birth attendants for delivering their baby, and 76% of mothers used a health facility to give birth. Only 7% of mothers participated in the complete pregnancy class program. Mothers who completed participation in the pregnancy class program had 2.2 times higher odds of receiving adequate antenatal care [OR = 2.19; 95% CI: 1.62 to 2.97; P < 0.001]. Those who completed participation in the class had 2.7 times higher odds of using skilled birth attendants for delivery [OR = 2.69; 95% CI: 1.52 to 4.76; P < 0.001] and 2.8 times higher odds of giving birth in a health facility compared to a non-health facility [OR = 2.77; 95% CI: 1.56 to 4.91; P < 0.001].ConclusionsParticipation in pregnancy classes was positively associated with utilization of adequate antenatal care, skilled birth attendants, and delivery at health facility. Since participation in pregnancy classes in positively associated with maternal healthcare utilization, policy efforts should focus on improving implementation of the KIH program at the local level.

What do women want? An analysis of preferences of women, involvement of men, and decision-making in maternal and newborn health care in rural Bangladesh

BackgroundTo improve the utilization of maternal and newborn health (MNH) care and to improve the quality of care, the World Health Organization (WHO) has strongly recommended men’s involvement in pregnancy, childbirth, and after birth. In this article, we examine women’s preferences for men’s involvement in MNH care in rural Bangladesh and how this compares to husbands’ reported involvement by women.MethodsA cross-sectional household survey of 1367 women was administered in 2018 in the district of Brahmanbaria. Outcomes of interest included supporting self-care during pregnancy, participation in birth planning, presence during antenatal care, childbirth, and postnatal care, and participation in newborn care. Binary and multiple logistic regressions were done to understand the associations between the outcomes of interest and background characteristics.ResultsAlthough women preferred a high level of involvement of their husbands in MNH care, husbands’ reported involvement varied across different categories of involvement. However, women’s preferences were closely associated with husbands’ reported involvement. Around three-quarters of the women reported having been the primary decision makers or reported that they made the decisions jointly with their husbands. The likelihood of women reporting their husbands were actively involved in MNH care was 2.89 times higher when the women preferred their husbands to be involved in 3–4 aspects of MNH care. The likelihood increased to 3.65 times when the women preferred their husbands to be involved in 5–6 aspects. Similarly, the likelihood of husbands’ reported active involvement was 1.43 times higher when they jointly participated in 1–2 categories of decision-making. The likelihood increased to 2.02 times when they jointly participated in all three categories.ConclusionThe findings of our study suggest that women in rural Bangladesh do indeed desire to have their husbands involved in their care during pregnancy, birth and following birth. Moreover, their preferences were closely associated with husbands’ reported involvement in MNH care; that is to say, when women wanted their husbands to be involved, they were more likely to do so. Programmes and initiatives should acknowledge this, recognizing the many ways in which men are already involved and further allow women’s preferences to be realized by creating an enabling environment at home and in health facilities for husbands to participate in MNH care.

Mothers' Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008-2018).

This study was designed to simultaneously examine if mothers’ personal healthcare autonomy within the household, and the level of their maternal-healthcare utilization, translates into better preventive (complete immunization) and curative (treatments for diarrhoea, fever and acute respiratory infection) efforts on morbidities in child healthcare. We analysed data pooled from three consecutive waves of the Nigeria Demographic and Health Survey: the surveys of 2008, 2013 and 2018. Using a multilevel logistic regression, we estimated the odds ratio for each of the outcome variables while adjusting for covariates. Findings revealed that mothers’ health autonomy is positively associated with child immunization and treatment of morbidities (except diarrhoea), a relationship moderated by the frequency of mothers’ exposure to media. Additionally, mothers’ healthcare utilization is positively associated with complete immunization, and all forms of morbidity treatment (except diarrhoea). Although the relationship between mothers’ healthcare-utilization and child immunization is not dependent on family wealth, however, the relationship between mothers’ healthcare utilization and treatment of morbidity is dependent. Policy effort should be geared towards stimulating mothers to seek appropriate and timely child healthcare and future studies could consider looking into the mediating role of paternal support in this relationship.