Maternal Health Care Utilization Research Articles

Disparities in three critical maternal health indicators amongst Muslims: Vis-a-vis the results reflected on National Health Mission

BackgroundThe post national health mission era has been recognized for India’s accelerating improvement in maternal health care utilization. Concurrent investigations with the purview of examining inequalities in maternal care utilisation have rigorously examined across various socio-economic groups, focusing on Muslim women. The present study examined socio-economic differentials in maternal health care utilisation among Muslims and the delineated factors which are contributing for these inequalities.MethodsStudy used the data from National Family Health Survey (NFHS) conducted in 2005-06 and 2015-16. the present study applied concentration index and Wagstaff-type decomposition analysis to measure and decompose the inequality in maternal health services.ResultsThis study found that utilisation of full antenatal care (full ANC), skilled attendants at birth (SBAs) and postnatal care was increased during 2005-06 to 2015-16. However, the least improvement was observed in full antenatal care whereas substantial improvement was achieved in utilising skilled attendants at birth. Further, the poor and non-poor gap in maternal health care utilisation mostly prevailed among the educated, urban resident, other backward castes among Muslims. The inequality has been declined largely in SBA utilisation compared to full ANC and PNC, especially in the southern India. Higher education, mass media exposure, higher birth order and urban residence contribute and explain most of these inequalities in maternal care among Muslim womenConclusionsDespite the fact that free and cash benefitted health programmes, wealth, mass media exposure and education etc welfare programs benefitted a large number of citizens, it also produced most of the inequalities among Muslims in India. The results focus on the significance of wealth, education, and mass media exposure in bridging the socioeconomic gap in maternal health care utilization among Muslims.

Geospatial differences among natural regions in the utilization of maternal health care services in India

BackgroundThe chances of a woman dying or becoming disabled during childbirth are closely connected to her socioeconomic status, cultural norms and values, and her home's geographical remoteness. Most of the studies were undertaken to address the issue of accessibility of the hospital's location and its impact on utilization of maternal healthcare utilization. Some studies also attempted to understand the pattern of utilization of healthcare utilization according to administrative and political regions. ObjectivesThis study aims to identify the Geographical differences in the utilization of maternal health services in India according to geographical regions, caste, religion, wealth status, and place of residence. Data and methodsData for analysis was taken from the National Family Health Survey-4 (2015–16). Data management and analysis were performed using statistical software Stata 13.0. To identify the regional differences in the use of maternal healthcare services, study used the 75 th round of NSS's classification of India into 88 natural regions. Regional variations in the usage of maternal health care were plotted using ArcGIS 10.5, and the bivariate method. ResultsResults shows that the utilization of partial ANC ranges from 33.8% to 91.9%. Utilization is lowest in the Northern Kerala region (33.8%) and, in ascending order, higher in Lakshadweep (34.4%), Goa (36.2%), Puducherry (43.1%), Southern Kerala (43.4%), Inland Tamil Nadu (44.5%), and Andaman and Nicobar Island (46.2%), the mountainous region of Jammu and Kashmir (46.7%), Coastal northern Tamil Nadu (49.9%) and Eastern Maharashtra (51.6%). Institutional delivery was the highest in Northern Kerala (100%) and lowest in the Nagaland (35.7%). Near-universal institutional delivery was also found in Southern Kerala (99.9%), Puducherry (99.9%), Coastal Northern Tamil Nadu (99.6%) and Lakshadweep (99.2%). ConclusionsDifferences in the utilization of MCHS by women can be seen among India's natural regions. Utilization is lagging in the Himalayan Mountain ranges, areas with dense forest cover, the Ganga and Brahmaputra plains, and the Desert region of Rajasthan.

Individual and contextual factors associated with maternal healthcare utilisation in Mali: a cross-sectional study using Demographic and Health Survey data

ObjectiveWe examined the national prevalence as well as the individual and contextual factors associated with maternal healthcare utilisation in Mali.SettingThe study was conducted in Mali.ParticipantsWe analysed data on 6335 women...

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the...

Awareness Regarding Maternal Health Services And Birth Spacing Among The Post-Natal Mothers At A Tertiary Care Hospital, Bangalore: A Cross-Sectional Study

Background In developing nations majority of family planning programmes promote post-adolescent marriage optimal spacing and reproductive cessation at 30-34 years of age all of which result in smaller family size patterns. Such a practice would not only increase likelihood that parents would meet their parenting responsibilities but it would also have a significant influence on lowering maternal and newborn mortality. In general when maternal age drops below 20 or increases above 30 many obstetrical complications can occur during the pregnancy which is the risk factor leading to poor maternal and perinatal outcomes. With increasing parity and advanced maternal age there is an increased risk of stillbirths neonatal and post-neonatal mortality.Objective To assess knowledge and awareness regarding maternal health MCH services and postpartum family planning and birth spacing among post-natal mothers.Methodology A cross-sectional study was conducted from April to May 2022 among post-natal mothers admitted in post-natal wards inborn wards Kangaroo mother care KMC and post-partum care units in Vanivilas Hospital BMCRI Bangalore. A sample size of 131 was c based on the parent study by Pranita Achyut et al. A pre-tested semi-structured validated questionnaire was used for face-to-face interview method. Data collected was entered in Microsoft Excel and analyzed using SPSS version 21.0.Results It was observed that 52.9 of women were in the 21 to 25 years age group belonging to urban areas 59.4 from the middle class 49.6 with high school education 47.3. Association between the place of living with education p0.026 an association of education with maternal and child health services p0.024 and birth spacing p0.0001 were found to be statistically significant.Conclusion In this study most of the women were aware of maternal services in general but there was a lack of comprehensive knowledge of the services. According to this study mothers utilization of maternal health care was significantly influenced by their age level of education and parity. There are still women with misconceptions about the adverse effects associated with contraceptives and spacing methods thus its important to emphasize the awareness regarding the methods available and the need for birth spacing.

Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study.

Introduction:The term ‘unintended pregnancy’ refers to a pregnancy that occurred when no children were desired or occurred earlier than desired. Unintended births account for one out of every three births in Ethiopia, and they are the leading cause of maternal morbidity and mortality. During the coronavirus disease (COVID-19) pandemic, this could be useful. COVID-19 has a significant impact on maternal health care utilization, including family planning services. As a result, this study aimed to assess unintended pregnancy and associated factors in Ethiopia during the COVID-19 pandemic.Method:A community-based cross-sectional study was conducted in Gedeo zone, Ethiopia, from April 1 to May 30, 2021. A simple random sampling technique was utilized to get 383 pregnant women from their respective kebeles. A structured questionnaire was used to collect data during a face-to-face interview. The data were coded, cleaned, and entered into Epidemiological Data Version 3.1 before being exported to the Statistical Package for Social Science Version 23.0 for analysis. A bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio, with a 95% confidence interval and a P value of 0.05%, was considered statistically significant.Result:A total of 383 pregnant women participated in the study, giving a response rate of 90.8%. During the COVID-19 pandemic, 140 (36.6%) participants stated that their current pregnancy was unintended. Unintended pregnancy was significantly associated with respondents’ age (adjusted odds ratio (AOR) = 5.214 (1.449–18.762)), primary decision maker for family planning services (AOR = 9.510 (5.057–17.887)), and fear of COVID-19 to visit a health care facility (AOR = 7.061 (2.665–18.710)).Conclusion:During the COVID-19 era, more than one-third of women had unintended pregnancies. Unintended pregnancy was significantly associated with respondents’ age, autonomy to use contraceptive methods, and fear of COVID-19, which required them to attend a health care institution.

Determinants of Maternal Health Care Utilization in Nepal

This study aims to analyze the determinants of maternal health care utilization in Nepal. Maternal health still remains a public health problem in Nepal though it has been improving in the last decade since the number of women seeking antenatal care and opting for institutional delivery has increased. This study is based on Nepal Demographic and Health Survey data of 2016. The sample size consists of 3998 married women aged 15-49 years who had a live birth in the five years preceding the survey. Bivariate analysis is used to examine the association between adequate ANC visits and institutional delivery. A strong association is observed between women’s higher level of education and women involved in non-agricultural occupation with receipt of antenatal care and choosing of institutional delivery. The study findings conclude that there is a significant gap among different sub-groups of women in Nepal in the utilization maternal health care based on factors like women’s age, place of residence, level of education, occupation and wealth status. In order to address the existing gap and variation in ANC service utilization, particular attention should be given to women from less education, poor wealth quintile, living in rural areas, utilization of services among older age group. The results of this study put forward the need for efforts from government bodies and agencies in implementation of appropriate policies and programs to bring an improvement in the use of maternal health care services in Nepal.

Women Empowerment and Utilization of Maternal Health Care in Pakistan

The impact of women's empowerment is examined on the utilization of maternal health care services in Pakistan. The empirical analysis based on logistic regression shows that women's education is the most important factor to improve maternal health among women. Other predisposing factors like parity and health belief are also contributing factors. Household wealth status turned out to be the most significant factor among other enabling factors like ease of access and source of information. Death of the child in previous pregnancies is the only need factor and we have found it statistically significant in the case of postnatal care.

Maternal Continuum of Care as Independent Determinants for Timely Initiation of Modern Contraceptive Methods Utilization Among Postnatal Women in Arba Minch Zuria District, Southern Ethiopia

Background: Initiation of family planning use during the postpartum period is crucial for both maternal and child health. Moreover, this period is the extension of maternal health care and its level of uptake is built up on the level of continuum of care of maternal health care utilization. Continuum of maternal health care including, antenatal care, skilled delivery and postnatal care is crucial for women’s reproductive health. Despite that, there was no data regarding with the importance of continuum of care of maternal health care on the postpartum modern contraceptive utilization. Thus, the aim of this study was to assess the association of the continuum of maternal care on subsequent timely use of postpartum family planning. Methods: a community based cross sectional study was employed on 828 women. A multistage sampling technique was used to enroll the study participants. The data were collected by a semi-structured and pretested, face-toface, interviewer administered questionnaire. Data were entered into EpiData 3.1 and analyzed by using SPSS 23 software. Bivariate and multivariable logistic regression analyses were used to declare the association between dependent and independent variables. Odds ratio, its 95% confidence interval (CI) and P-value <0.05 were used to determine the significance level. Results: the prevalence of timely initiation of postpartum contraceptive methods was 16.1%. Having of postpartum care (AOR: 2.0(95%CI: 1.2, 3.2)), completion of delivery level continuum of care (AOR: 2.9(95%CI: 1.4, 6.1)), and completion of postnatal level continuum of care (AOR: 4.0(95%CI: 2.0, 7.8)) were factors of timely intuition of postpartum contraceptive methods. Conclusion and recommendation: The prevalence of timely initiation of postpartum contraceptive methods was low. The finding of this study implies that the need of strengthening the connection between maternal continuum of care and reproductive components of continuum of care.

Trend and decomposition analysis of risk factors of childbirths with no one present in Nigeria, 1990–2018

ObjectivesTo assess the trend and decompose the determinants of delivery with no one present (NOP) at birth with an in-depth subnational analysis in Nigeria.DesignCross-sectional.SettingNigeria, with five waves of nationally representative...

Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016\u20132018

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016–2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.

Estimating heterogeneous policy impacts using causal machine learning: a case study of health insurance reform in Indonesia

Policymakers seeking to target health policies efficiently towards specific population groups need to know which individuals stand to benefit the most from each of these policies. While traditional approaches for subgroup analyses are constrained to only consider a small number of pre-defined subgroups, recently proposed causal machine learning (CML) approaches help explore treatment-effect heterogeneity in a more flexible yet principled way. Causal forests use a generalisation of the random forest algorithm to estimate heterogenous treatment effects both at the individual and the subgroup level. Our paper aims to explore this approach in the setting of health policy evaluation with strong observed confounding, applied specifically to the context of mothers’ health insurance enrolment in Indonesia. Comparing two health insurance schemes (subsidised and contributory) against no insurance, we find beneficial average impacts of enrolment in contributory health insurance on maternal health care utilisation and infant mortality, but no impact of subsidised health insurance. The causal forest algorithm identified significant heterogeneity in the impacts of contributory insurance, not just along socioeconomic variables that we pre-specified (indicating higher benefits for poorer, less educated, and rural women), but also according to some other characteristics not foreseen prior to the analysis, suggesting in particular important geographical impact heterogeneity. Our study demonstrates the power of CML approaches to uncover unexpected heterogeneity in policy impacts. The findings from our evaluation of past health insurance expansions can potentially guide the re-design of the eligibility criteria for subsidised health insurance in Indonesia.

The impact of civil conflict on child health: Evidence from Colombia

Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low- and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from intermittent presence of armed groups.

Analysis of antenatal care, intranatal care and postnatal care utilization: Findings from the 2017 Indonesian Demographic and Health Survey.

Background and objectiveMaternal healthcare utilization by young women and adolescent girls is associated with maternal health outcomes and plays a critical role in reducing maternal mortality rates in low- and middle-income countries. This study sought to analyze current data on antenatal care (ANC), intranatal care (INC), and postnatal care (PNC) utilization with a focus on mothers aged 15–24 years in Indonesia.MethodsThis study was a secondary analysis of data from the 2017 Indonesian Demographic and Health Survey. The unit data analyzed 2,584 mothers aged 15–24 years who had delivered babies within the five-year period preceding the survey. Bivariate analysis and multiple logistic regression utilizing descriptive statistics were used to explore correlations between the independent variables and ANC, INC, and PNC visits.ResultsAmong the mothers included in the study, the prevalence of service utilization was 90.9% for ANC, 79.4% for INC, and 68.9% for PNC. Women’s age, education level, number and birth order of children, difference in age between the mother and her husband, her husband’s occupation, wealth index, access to the health service, and regional factors were significantly associated with the utilization of ANC, INC, and PNC services.ConclusionThis study provides insights for policymakers on how to strengthen healthcare policies and laws with the aim to improve maternal healthcare services for mothers aged 15–24 years. To improve maternal healthcare utilization among young mothers, national policy should focus on service equality, accessibility, and reliable implementation.

Do women empowerment indicators predict receipt of quality antenatal care in Cameroon? Evidence from a nationwide survey

BackgroundWorld Health Organisation (WHO) recommends quality antenatal care (ANC) for all pregnant women, as one of the strategies for achieving targets 3.1 and 3.2 of the sustainable development goals. Maternal mortality ratio remains high in Cameroon (782 maternal deaths per 100,000 live births). Extant literature suggest a positive association between women empowerment indicators and maternal healthcare utilisation in general. In Cameroon, this association has not received scholarly attention. To fill this knowledge gap, we investigated the association between women empowerment indicators and quality ANC in Cameroon.MethodsData of 4615 women of reproductive age were analysed from the women’s file of the 2018 Cameroon Demographic and Health Survey. Quality ANC (measured by six indicators) was the outcome of interest. Binary Logistic Regression was conducted. All results of the Binary Logistic Regression analysis were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). All analyses were done using Stata version 14.ResultsIn all, 13.5% of the respondents received quality ANC. Women with low knowledge level (aOR = 0.66, CI 0.45, 0.98) had a lesser likelihood of receiving quality ANC compared to those with medium knowledge level. Women who highly approved wife beating (aOR = 0.54, CI 0.35, 0.83) had lesser odds of receiving quality ANC compared to those with low approval of wife beating.ConclusionThe study has pointed to the need for multifaceted approaches aimed at enhancing the knowledge base of women. The Ministry of Public Health should collaborate and intensify female’s reproductive health education. The study suggests that women advocacy and maternal healthcare interventions in Cameroon must strive to identify women who approve of wife beating and motivate them to disapprove all forms of violence.

Married women's decision-making autonomy in the household and maternal and neonatal healthcare utilization and associated factors in Debretabor, northwest Ethiopia.

Women's decision-making autonomy is very crucial for the improvement of women empowerment, and maternal, neonatal, and child healthcare utilization. As time immemorial, Ethiopian culture is largely gender stratified, and the position of women is subordinate to men in various household and health-seeking decision-making matters. However, there is a dearth of empirical evidence on women's decision-making autonomy, especially in the household and on maternal and newborn healthcare utilization. Therefore, this study assessed married women's decision-making autonomy in the household and on maternal and neonatal healthcare utilization and associated factors in Debretabor, Northwest Ethiopia. A community-based cross-sectional study was conducted from October 1st to 30th, 2019. A two-stage sampling technique was used to select 730 married women. Data were collected using a structured, pretested, and interviewer-administered questionnaire. Data were entered into EPI INFO 7 and analyzed by SPSS version 23. Multivariable logistic regression model was fitted to identify factors associated with women's decision-making autonomy in the household and maternal and neonatal healthcare utilization. The adjusted odds ratio with its 95% confidence interval was computed to determine the level of significance at a p-value of ≤ 0.05. A total of 730 married women were included in the analysis. Thus, three-fourths (75.1%) of women had higher decision-making autonomy on their health, neonatal health, and other socio-economic aspects. Besides, the proportion of four and above antenatal visits, delivery at a health facility, postnatal checkup, knowledge of neonatal danger signs, and appropriate health-seeking practices for sick newborns among autonomous women were 52.1%, 56.1%, 71.4%, 32%, and 80% respectively. Age greater than 35 years old (AOR = 2.08; 95% CI: 1.19, 3.62), monthly income of > 5000 ETB (AOR = 3.1; 95% CI: 1.36, 7.07), husband involvement (AOR = 2.36; 95% CI: 1.55, 3.43), and adequate knowledge of neonatal danger signs (AOR = 2.11; 95% CI: 1.4, 3.2) were factors independently associated with women's decision-making autonomy on maternal and neonatal healthcare utilization and other socio-economic affairs. Our findings show that women's decision-making autonomy in the household and maternal and neonatal healthcare utilization was optimal. Increasing household income level, promotion of husband's involvement starting from the prenatal period, and increasing women's knowledge of maternal and neonatal danger signs will have a great role in the improvement of women's decision-making autonomy.

The impact of i-PUSH on maternal and child health care utilization, health outcomes, and financial protection: study protocol for a cluster randomized controlled trial based on financial and health diaries data

BackgroundUniversal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior, and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.MethodsThis is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach—including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments—in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya.DiscussionPeople in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels—individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based “health wallet,” it enhances enrolment in subsidized health insurance through the mobile platform—M-TIBA—developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool—AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children.Trial registrationRegistered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571: AEARCTR-0006089; date: 29 August 2019) and The American Economic Association’s registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).

Antenatal care dropout and associated factors among mothers delivering in public health facilities of Dire Dawa Town, Eastern Ethiopia

IntroductionMore than two-thirds of the pregnant women in Africa have at least one antenatal care contact with a health care provider. However, to achieve the full life-saving potential that antenatal care promises for women and babies, four visits providing essential evidence-based interventions – a package often called focused antenatal care are required. Hence, identifying the factors associated with dropout of maternal health care utilization would have meaningful implications. The study aimed to assess antenatal care dropout and associated factors among mothers delivering in the public health facilities of Dire Dawa town, Ethiopia.MethodsFacility-based cross-sectional study was conducted from January 1 to 30, 2020. Proportionate sampling and simple random sampling techniques were used to select 230 women. Data were collected using a structured and pretested interview administered questionnaire during delivery. The data were entered into Epidata version 3.1 and analyzed using SPSS version 20. A binary logistic regression model with a 95 % confidence interval was used to analyze the results. Bivariable analysis (COR [crude odds ratio]) and multivariable analysis (AOR [adjusted odds ratio]) was used to analyze the results. From the bivariable analysis, variables with a p-value < 0.25 were entered into the multivariable logistic regression analysis. From the multivariable logistic regression analysis, variables with a significance level of p-value < 0.05 were taken as factors independently associated with ANC dropout.ResultThe proportion of antenatal care dropouts was 86 (37.4 %) (95 % CI: 31.3–43.9). In logistic regression analyses, those who had no past antenatal care follow up were more likely to have ANC dropout (AOR = 7.89; 95 % CI: 2.109–29.498) and those who had no professional advice were more likely to have antenatal care dropout (AOR = 4.64 95 % CI: 1.246–17.254).ConclusionsThis study indicates that a high number of women had antenatal care dropout. Having no past ANC follow-up and professional advice were the major factors of ANC service utilization dropout. Hence, giving more information during the ANC visit is important to reduce the dropout rate from the maternity continuum of care.

Traditional practices influencing the use of maternal health care services in Indonesia.

BackgroundMaternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia.MethodsWe used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates.ResultsTraditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services.DiscussionNot all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

Contrast in utilization of maternal and child health services between Himalayan region and rest of India: Evidence from National Family Health Survey (2015\u201316)

BackgroundMaternal and child health services, like antenatal care, skilled birth attendance and postnatal care, are crucial to improve maternal and neonatal health outcomes. Numerous studies have been conducted on the distribution of utilization of maternal and child healthcare (MCH) services in India with respect to socioeconomic and demographic characteristics. But no study has analyzed the utilization of MCH services with a focus on the topography of a given region (hilly/plain). The present study analyzes the utilization of MCH services in the hilly-Himalayan region of India in comparison to the rest of the country.MethodsData from India’s National Family Health Survey-4 (2015–16), on 190,898 women, was utilized for analysis in the present study. The association between the utilization of MCH services and the topography of the region of residence (hilly/plain) was analyzed by calculating adjusted odds ratios (AOR) with 95% confidence interval (95%CI) and predicted probabilities using a two-level random intercept logistic regression model.ResultsIt was found that the utilization of MCH services was significantly lower in the hilly regions compared to the plain regions. Women living in hilly areas (AOR: 0.42, 95%CI: 0.39–0.45) had 58% lower odds of receiving skilled birth attendance (SBA) than those living in plain areas. Similarly, the odds of receiving PNC, ANC, and full immunization were also lower in the hilly regions compared to the plain regions. The utilization of MCH services was alarmingly low in the rural-hilly regions. The odds of receiving two tetanus injections before birth were 71% lower for women in the rural-hilly areas (AOR: 0.39, 95% CI: 0.36–43) than those in the rural-plain areas. Predicted probabilities also showed that women in the hilly regions were less likely to receive MCH services compared to their counterparts in the plain regions.ConclusionExcept for the consumption of Iron Folic Acid (IFA) and the utilization of AWC services/ICDS (Integrated Child and Development Services), all other MCH services were significantly underutilized in the hilly regions compared to the plain regions. This calls for the attention of and concentrated efforts by policy makers and stakeholders, with a special focus on the rural-hilly regions. We firmly believe that the results of the present study have important policy implications.