Maternal Care Services Research Articles

Population-level trends over a decade in geographical inequality for opportunity in access to maternal care services: a cross-sectional analysis from the National Family Health Surveys in India

ObjectivesThe objective of this study is to examine the trends in geographical inequality of opportunity in maternal health services in India considering the Every Newborn Action Plan (ENAP) 2025 coverage...

The "Doing" of Compassionate Care in the Context of Childbirth From a Women's Perspective.

Women who are giving birth need to be met with compassion and understanding from healthcare professionals. However, there are growing concerns about the perceived lack of compassion in the delivery of healthcare services in general and maternity care in particular. We conducted 15 qualitative interviews with women who had given birth in Norway within the previous year, asking them to describe their experiences of compassionate care. We aimed to explore what healthcare professionals "do" that is experienced as compassionate. The analysis was informed by Paul Gilbert's theory of compassion and a concept analysis of compassionate midwifery undertaken by Ménage and colleagues. The compassionate caring actions of healthcare professionals that were identified in the women's narratives generated five themes: attuning actions, validating actions, contextualizing actions, empowering actions, and small acts of kindness. The findings build on the prior theoretical concepts used for the study and provide a nuanced account of how women perceive compassionate care from healthcare professionals. They could contribute to understanding more of the meaning and nature of compassionate care during childbirth. The analysis indicates the importance of ensuring that compassionate care is at the very core of maternity care services.

Community-Level Internet Connectivity and Utilization of Maternal Telehealth.

Background: The COVID-19 pandemic brought about a drastic increase in the utilization of telehealth services in place of or as a complement to in-person health services. Telehealth is a tool to help reduce disparities in the receipt of maternal health care. However, a stable internet connection is required for patients to connect to providers via telehealth; lack of internet connectivity is a barrier to maternal telehealth access. Methods: The objectives of this research were to determine whether community-level internet penetration is associated with community-level utilization of maternal telehealth services and assess the heterogeneity of this association across the maternal telehealth utilization spectrum. A cross-sectional study of community-level maternal telehealth is utilized in the United States in 2019. The underlying population is comprised of commercially insured maternal health patients receiving any antenatal, delivery-related, or postpartum care in the United States. The individual-level utilization data are aggregated to the geo-zip level (n = 404), which is a regional subdivision comprised of all zip codes that share the first three digits. Results: Findings show that the estimated relationship between the proportion of households with home-based internet connectivity was statistically significant at the 10th and 25th quantiles of maternal telehealth utilization. For these quantiles, an increase in community-level internet connectivity was associated with an increase in the utilization of maternal telehealth services. Conclusion: There is a positive association between community-level internet connectivity and maternal telehealth utilization, and the association varies in magnitude across the maternal telehealth utilization distribution. Policymakers should consider digital access when addressing telehealth policy for maternal care services.

Institutional Discrimination in Health Security Policies against Immigrants in South Korea

Abstract Background South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services. Methods This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants. Results Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements. Conclusions The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all. Key messages • A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities. • Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.

Obstetric violence and associated factors among women who gave birth at public hospitals in Addis Ababa city administration, Ethiopia.

Obstetric violence during labor and delivery is one of the main reasons that women do not seek care from health caregivers in health facilities. Developing respectful maternity care services for women is the most important approach to ensure better newborn and maternal outcomes. This study aimed to assess the magnitude of obstetric violence and associated factors among women who gave birth at public hospitals in Addis Adaba city administration, Ethiopia. An institution-based cross-sectional study was carried out among 409 mothers who had given birth at two public hospitals (Gandhi Memorial Hospital and Abebech Gobena Mothers and Children's Health Hospital) in Addis Ababa, Ethiopia, from 1 to 30 May 2023. A systematic sampling method was applied and data were collected using a structured face-to-face interview questionnaire and entered into EpiData 3.1. The data were analyzed using Statistical Package for Social Science version 25. Bi-variable and multivariate analyses were performed. Statistical significance was declared at a P-value <0.05. In total, 318 mothers [77.8% with a 95% CI (73.64-81.96)] had experienced obstetric violence in the study settings. Being more educated [Adjusted Odds Ratio (AOR) = 6.43; 95% CI 2.92-14.17], having ≥4 antenatal care contacts (AOR = 3.59; 95% CI 1.91-6.75), being multiparous (AOR = 2.65; 95% CI 1.32-5.32), induction of labor (AOR = 3.39; 95% CI 1.69-6.79), vaginal delivery (AOR = 0.25; 95% CI 0.11-0.62), and female birth attendants AOR = 2.42, 95% CI (1.31-4.47) were significantly associated with obstetric violence. More than three-fourths of the participants experienced obstetric violence. Thus, stakeholders need to develop interventions by taking all risk factors of obstetric violence into account.

Ukrainian women's maternity care strategies in Poland after the outbreak of the full-scale war: Understanding unequal access to quality care

The outbreak of the full-scale war launched by Russia against Ukraine and, following it, significant migrations have not only increased the diversity of the Ukrainian migrant population in Poland, but also added to the complexity of their health needs and strategies. This study seeks to explore Ukrainian migrant women's experiences and practices related to the use of maternity care services. The article is based on fieldwork conducted between February and October 2023 and included 23 semi-structured interviews with Ukrainian migrant women who gave birth in Poland after February 24, 2022. To understand Ukrainian women's pathways to maternity care in Poland and unpack the differences in experiences within this group of migrants, we explore participants' healthcare strategies against the background of existing inequalities in access to quality care in Poland and Ukraine, in particularly the division between private and public services. We consider the role of financial, social and cultural resources and distinguish for this purpose between three groups of permanent, circular and wartime migrants. We show the decisive role of economic resources, nonetheless in articulation with the creation and mobilisation of social networks and time spent in Poland, which play a role in shaping migrant women's capacity to access better maternity care.

Dr Bonté Elgood (1874-1960): First woman doctor in Egypt and pioneer of maternal and child care.

Bonté Elgood, née Amos, was one of the early women doctors who qualified from the progressive London School of Medicine for Women, established in 1874. She chose to practice in Egypt which was then under British administration. When she arrived in 1900, Egyptian medical provision for mothers and children was rudimentary where it existed at all. For over 50 years, Bonté Elgood played an important role in setting up maternity care and child health services, first in Cairo and later in the whole country. For her work, she was awarded the OBE and CBE by the British government, and she also received decorations from the French and Egyptian governments.

Developing Music Therapy in Maternity Care in Ireland: A Qualitative Study.

Music therapy can be a form of preventive or early intervention. It strengthens and utilizes women's own resources to build resilience, aids relaxation, reduces symptoms of anxiety and depression, promotes parent-infant attachment, and adapts to physical and psychological challenges during the perinatal period. The inclusion of music therapy in Irish maternity services has the potential to improve the quality of healthcare delivery provided to parents and infants. Recent studies demonstrate that the prospect of music therapy is welcomed by parents and perinatal healthcare professionals in Ireland, but such services are yet to be formally embedded in maternity care. Building on a cross-sectional survey, this qualitative study employed 6 semi-structured interviews with women and perinatal healthcare professionals in Ireland to understand their perspectives on developing music therapy in Irish maternity care services. Four themes were identified from the thematic analysis of these interviews: (1) music has multiple functions during the perinatal period; (2) music programs contribute to holistic perspectives and approachability in perinatal care; (3) music therapy provides specialist support; and (4) further development of music therapy services is challenging. The findings offer important insights and practical considerations on the key components of the music therapy programs and strategies in developing music therapy in Irish maternity settings. This information can directly inform music therapy researchers and practitioners in designing music therapy programs and developing relevant services in collaboration with maternity care professionals and policymakers.

State and Development Prospects of the Maternal and Childhood Care Service of the Kyrgyz Republic

The National Center for Maternity and Childhood Care (NCMCC), operating under the Ministry of Health of the Kyrgyz Republic is a premier institution dedicated to the advanced treatment, diagnostics, and overall healthcare of women and children. As a tertiary-level center, NCMCC plays a pivotal role in organizational, methodological, educational, and scientific endeavors related to maternal and child health. In alignment with its mandate, the NCMCC develops and implements comprehensive programs focusing on the prevention, early detection, and treatment of diseases. These initiatives are crucial in reducing maternal and infant mortality rates and promoting a healthy lifestyle among children and their parents. Furthermore, the center ensures the organized provision of essential medicines, specialized medical nutrition products, and other medical supplies for children.

Is MIStreatment of women during facility-based childbirth an independent risk factor for POstpartum Depression in Ethiopia and Guinea? A mixed methods prospective study protocol—MISPOD study

BackgroundWorldwide, 10% of postpartum women experience postpartum depression, which can lead to diverse sequalae at individual, family, and societal levels. In sub-Saharan Africa, it is estimated that 17% of women experience depression in the postpartum period, which could be an underestimate as 48% of women in the region do not receive postnatal care (81% in Ethiopia and 51% in Guinea) and a large share of postpartum depression remains undiagnosed and untreated as a result. Globally, despite a critical evidence gap, there are growing reports of postpartum depression among women mistreated (disrespected and abused) during childbirth in health facilities, making a strong case to examine the association between mistreatment and postpartum depression. This study in Addis Ababa (Ethiopia) and Conakry (Guinea) uses a mixed methods design to 1) examine the link between mistreatment and postpartum depression, 2) explore the health system capacity to provide respectful maternity care and maternal mental health services, and 3) explore the experiences of women in accessing care and support for postpartum depression.MethodsWe will conduct a prospective longitudinal survey of women (434 in Addis Ababa and 408 in Conakry) from the third trimester of pregnancy to eight weeks postpartum and carry out in-depth interviews with key health system informants (20–25 in each city) and women who recovered from a clinically confirmed episode of postpartum depression (15–25 in each city). Quantitative data from the women’s survey will be analysed using a multilevel mixed-effects model; qualitative data from key-informants will be analysed by using a hybrid thematic analysis approach, whereas data from women’s in-depth interviews will be analysed using the phenomenological approach. The inclusion of two different settings in our study (Addis Ababa and Conakry) will enable us to apply a comparative health systems lens to explore the dynamics of respectful maternity care and maternal mental health services within the broader health systems of the two countries (Ethiopia and Guinea).DiscussionThe findings from this study will inform actions aimed at mitigating the mistreatment of women in maternity settings and improving promotive, preventive, and treatment interventions for postpartum depression in Ethiopia and Guinea. The findings can also be extrapolated to other low-resource settings.

Cultural diversity in maternity care in improving the quality of care services: a systematic review

This study aimed to elucidate the significance of cultural diversity in maternity care in the context of enhancing the quality of care services. To undertake this systematic review, we conducted searches across multiple databases, including CINAHL, SAGE, ScienceDirect, ProQuest, Scopus, and Springer. The process of article selection was executed through Science Direct and Sage, with adherence to specific inclusion criteria, such as articles published within the last five years, written in English, and focusing on maternity care. This study excluded articles with unclear literature reviews and those written in languages other than English. To analyze the risk of bias and the caliber of the included articles, we used the JBI assessment checklist and the PRISMA flow chart. A total of 20 relevant articles were selected for review. In order to enhance the quality of maternity care services, it is imperative to consider a range of facets, including showing respect and tolerance for cultural diversity, fostering effective communication, and honing relevant skills. Maternity care providers must cultivate an attitude of respect and tolerance towards the cultural diversity of their patients and their families.

South Asian women’s views on and experiences of maternity care services in Hong Kong: A qualitative study

BackgroundHealth disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia. ObjectiveTo understand South Asian women’s views and experiences regarding maternity care services in Hong Kong. MethodsA qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis. FindingsFour themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants’ health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours. DiscussionSouth Asian appreciate Hong Kong’s public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication. ConclusionThe quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment.

How do free healthcare policies impact utilization of maternal and child health services in fragile settings? Evidence from a controlled interrupted time series analysis in Burkina Faso.

Burkina Faso has implemented a nationwide free healthcare policy (gratuité) for pregnant and lactating women and children under 5 years since April 2016. Studies have shown that free healthcare policies can increase healthcare service use. However, the emerging coronavirus disease 2019 pandemic, escalating insecurity and the political situation in recent years might have affected the implementation of such policies. No studies have looked at whether the gratuité maintained high service use under such changing circumstances. Our study aimed to assess the effects of gratuité on the utilization of facility-based delivery and curative care of children under 5 years in light of this changing context. We employed a controlled interrupted time series analysis using data from the Health Management Information System and annual statistical reports of 2560 primary health facilities from January 2013 to December 2021. We focused on facility-based deliveries and curative care for children under 5 years, with antenatal care and curative care for children over 5 years as non-equivalent controls. We employed segmented regression with the generalized least square model, accounting for autocorrelation and monthly seasonality. The monthly utilization rate among children under 5 years compared to those above 5 years (controls) immediately increased by 111.19 visits per 1000 children (95% CI: 91.12, 131.26) due to the gratuité. This immediate effect declined afterwards with a monthly change of 0.93 per 1000 children (95% CI: -1.57, -0.29). We found no significant effects, both immediate and long-term, on the use of maternal care services attributable to the gratuité. Our findings suggest that free healthcare policies can be instrumental in improving healthcare, yet more comprehensive strategies are needed to maintain healthcare utilization. Our findings reflect the overall situation in the country, while localized research is needed to understand the effect of insecurity and the pandemic at the local level and the effects of gratuité across geographies and socioeconomic statuses.

Infant feeding for women with an eating disorder: An interpretative phenomenological analysis.

Mothers with eating disorders can face additional challenges with infant feeding, and there is evidence they are likely to cease breastfeeding earlier than intended. However, there is little research exploring this. The present study used interpretative phenomenological analysis to explore the lived experience of infant feeding for mothers suffering from or recovering from an eating disorder. Semistructured interviews were conducted with six women-five who had breastfed and one who formula-fed. The women experienced two incompatible worlds-motherhood and an eating disorder. Tensions were sometimes resolved by reducing eating disordered behaviour alongside immersion in motherhood. Two participants did not find infant feeding particularly important for their journey into motherhood. Four recounted a positive shift in their relationship to their body through breastfeeding and felt their embodied experience of mothering provided a route out of eating disordered behaviour. However, doubts about their mothering and infant feeding capabilities could be amplified by feeling mistrusted by others and by the relative silence around eating disorders within maternity care services. Respectful dialogue with health care professionals was particularly valued where this occurred. Although long-term outcomes for the participants are unknown, the study suggests women with a history of eating disorders can form successful breastfeeding relationships and may be motivated to engage in collaborative risk assessment. However, they need support in managing emotional challenges. Training around eating disorders for maternity care professionals is likely to be useful for enhancing confidence in engaging mothers proactively to share concerns about eating, weight and body shape.

A review of digital maternal health promotion to optimise access and utilization of care services in sub-Saharan Africa

In sub-Saharan Africa, maternal mortality rates remains high among women as the vulnerable demographics of reproductive age and breastfeeding mothers compared to other parts of the world. The situation is exacerbated by the region’s underperforming healthcare systems. Although digital health interventions have increased since the emergence of COVID-19 pandemic to enhance health promotion in terms of maternal health vulnerability, the access to and utilization of care services, the record of positive impacts remains limited. The objective of this paper was to analyse the status of digital maternal health promotion in supporting female of reproductive age, first-time and nursing mothers to access and utilise maternal healthcare services during their perinatal and postpartum periods in underserved settings of sub-Saharan Africa. A literature review of peer-reviewed publications between 2020 and 2023 was conducted by searching online databases using keywords and filtering the results using a set of inclusion and exclusion criteria. Findings indicate that digital maternal health promotion is increasingly enabling access to hard-to-reach populations, but the utilization of associated care services remains relatively low. Particularly, mHealth and asynchronous audio-visual digital media are critical for delivering maternal health educational content to the targeted populations, including their partners, and are most likely to increase utilization of maternal care services. Digital promotion of maternal health requires multi-stakeholder collaboration to address the limiting socio-economic, cultural and technical factors that determine access to and utilization of care services during the perinatal and postpartum period, if mortality rates are to be reduced towards the sustainable development goal for good health and well-being.

Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers

BackgroundBy addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation.MethodsContextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree.ResultsOuter setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. Innovation: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. Process: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs.ConclusionsWhile the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

Barriers and facilitators of access to maternity care for African-born women living in Australia: a meta-synthesis of qualitative evidence

BackgroundAdverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women’s access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.MethodsThe search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque’s framework of healthcare access.ResultsOut of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.ConclusionsThis review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women’s unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women’s engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.Systematic review registrationPROSPERO CRD42023405458.

Monitoring, evaluation, and learning: the key to building effective partnerships with government to improve maternal and child health in the Rakai and Kyotera Districts of Uganda.

This article emphasizes the significance of the Monitoring, Evaluation, and Learning (MEL) system within Babies and Mothers Alive (BAMA) Foundation in building effective sustainable interventions at scale. The foundation aims to enhance the availability of high-quality reproductive, maternal, and newborn care services within the government health sector. The distinguishing characteristic of the MEL system is its integration of organizational learning as a strategic approach to inform the development of dynamic program designs. To do this, it has been necessary to identify crucial requirements through open data exchange with all pertinent stakeholders. This paper demonstrates that our approach to evidence-based learning in a diverse population of locally-based actors and stakeholders, gives voice to the community-based health practitioners and patients that is necessary for transformative maternal health delivery systems. The act of sharing data has presented several possibilities for enhancing current initiatives and extending the reach and scale of our partnership model. We trace the development of the core components of learning and decision making, and reflect on the transition of the program to scale using the LADDERS paradigm. The application of our model of practice has been associated with the increased financially viability and the potential for the sustainable scaling of the program intervention.

Exploring the factors behind socioeconomic inequalities in Antenatal Care (ANC) utilization across five South Asian natiaons: A decomposition approach.

Maternal and child mortality rates remain a significant concern in South Asian countries, primarily due to limited access to maternal care services and socioeconomic disparities. While previous studies have examined the factors influencing the utilization of antenatal care (ANC) services in individual countries, there is a lack of comparative analysis across South Asian nations. This study aims to investigate the factors affecting ANC utilization among women aged 15-49 in Bangladesh, India, Nepal, Maldives, and Pakistan using the latest Demographic and Health Survey data. The study utilized a total weighted sample size of 262,531 women. Simple bivariate statistics and binary logistic regression were employed to identify potential factors influencing ANC utilization. Decomposition analysis and concentration curve (Lorenz curve) were used to assess inequality in ANC service utilization. The prevalence of ANC utilization varied across the countries, with Maldives having the highest (96.83%) and Bangladesh the lowest (47.01%). Women's and husbands' education, household wealth status, BMI, and urban residence were found to significantly influence maternal healthcare services utilization. Higher education levels, affluent wealth quintiles, and urban living were identified as significant contributors to socioeconomic disparities in accessing ANC services. This study highlights the crucial role of socioeconomic factors in the utilization of maternal healthcare services in South Asian countries. Governments should focus on improving healthcare infrastructure, addressing cultural barriers, and promoting education to address these disparities. Identifying context-specific causes of maternal healthcare utilization is essential to inform targeted interventions and policies aimed at improving access to ANC services and reducing maternal mortality rates.

Ensuring the Quality of Maternity and Child Care Services in Primary Health Care Centers

Ensuring the Quality of Maternity and Child Care Services in Primary Health Care Centers