Obstetric Services Research Articles

Translating Priorities Into Practice: Midwifery Care for Uninsured Migrant Populations Across Canada.

Immigrants and newcomers are identified by many provincial midwifery associations as "priority populations." Recently, newcomer populations have shifted considerably, with more people coming to Canada with precarious immigration status who are increasingly ineligible for public healthcare insurance and facing barriers to accessing care. Our aims were to: (1) gain an understanding of the policies related to equitable access to midwifery care and how they may apply to migrant groups without public healthcare insurance and (2) identify existing policy themes, gaps, and regulatory barriers that limit access for this vulnerable population in Canada. We conducted a high-level document content analysis using a health equity framework. We aimed to identify language related to equitable access in midwifery services, with particular emphasis on uninsured populations. A total of 64 documents were analyzed, including legislation and publicly available statements from midwifery regulatory bodies and associations. Midwifery regulatory authorities and associations across Canada are consistent in establishing an expectation that midwives will provide accessible care to diverse clientele. However, how these commitments are put into practice varies considerably between jurisdictions. We compared the cases of Manitoba and Ontario to illustrate the disconnect between commitments to priority populations and implementation. While there is a clearly demonstrated intention to provide equitable access to midwifery care to all people, including "priority populations" like migrants and newcomers, in practice, these commitments have not been fully realized. Equity is encumbered by broader structural issues, such as the growth in the number of newcomers without access to public health insurance. Moves toward equity within midwifery and healthcare more broadly need to meaningfully engage with other policy sectors, such as immigration, to be able to adapt to emerging issues affecting reproductive care, such as the growing precarity of newcomer populations in Canada.

Maternal and newborn health prioritization in Yobe State, Nigeria: analysis of stakeholders' perspective.

Maternal and newborn mortality and morbidity in conflict-affected northeastern areas of Nigeria, such as Yobe State, are disproportionately higher than those in the rest of the country. There is limited evidence on the factors that influence maternal and newborn health (MNH) policymaking and implementation in this region, particularly with respect to the impact of conflict and context-specific issues. This study explores the political, economic and health system factors that drive the prioritization of MNH policies in Yobe State. The aim of this study was to elucidate the conflict-related factors influencing MNH outcomes, which could inform targeted interventions to improve MNH. The study is a descriptive case study that relies on multiple data sources and is guided by the Health Policy Analysis Triangle. We reviewed national and subnational research, technical reports and policies related to reproductive health and the MNH in Nigeria since 2010. Following stakeholder mapping, we identified and invited prospective participants in the MNH policymaking space. Nineteen stakeholders from the government, civil society and nongovernmental organizations, donor agencies, and public and private sector health providers in Yobe State participated in the semistructured in-depth interviews. Data were collected from November 2022 through January 2023 and were thematically analysed via Dedoose software. MNH services in Yobe State have received considerable attention through initiatives such as the National Midwifery Service Scheme, free MNH services, training of midwives with deployment to rural areas, and health facility renovations. The effective implementation of MNH services and policies faces challenges due to insufficient funding, and sustainability is hampered by changes in governance and political transitions. The Boko Haram insurgency exacerbated the humanitarian crisis in Yobe State and disrupted MNH services due to the displacement of populations and the decline in the number of health workers. Additionally, sociocultural and religious beliefs hinder timely access to and utilization of MNH services. Although policies and guidelines for MNH services exist in the state, they are inadequately disseminated to health providers, which affects their effective implementation across facilities. Collaboration and intersectoral coordination platforms exist, but competition and rivalries among unions, political entities, and implementing agencies sometimes impede progress. Enhancing MNH services in Yobe state requires increased commitment for funding through the Northeast Development Commission rehabilitation fund; strengthening the health workforce, safety and retention plan; promoting gender inclusivity within the health sector; and addressing sociocultural barriers to women's health-seeking behaviors. Concrete, time-bound plans for policy dissemination are necessary to ensure effective service implementation.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: A mixed methods study

ProblemDespite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women’s perspectives on midwife-led care. BackgroundThe Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services. AimThis study explored women’s attitudes and beliefs towards the implementation of midwife-led care in two southern states of India. MethodsA convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques. FindingsA total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women’s acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced. DiscussionMost participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services. ConclusionInsights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.

Provision of Maternal Health Services Among Ohio Community Pharmacists Practicing in Maternity Care Deserts.

Over 2.3 million reproductive-age women in the United States live in a maternity care desert, a county without obstetric services or providers; over 3 million more reside in a county with low access to maternity care. The National Alliance of State Pharmacy Associations (NASPA) issued a toolkit outlining maternal health services community pharmacists are positioned to provide within their scope of practice. The primary objective of this study was to determine whether community pharmacists practicing in maternity care deserts/low access areas in Ohio provide NASPA-recommended maternal health services. Secondary objectives were to assess knowledge and attitudes related to maternal health; interest and barriers for developing new services; and screening and referrals for key social determinants of health. An anonymous cross-sectional survey was electronically distributed to Ohio community pharmacists working in maternity care deserts/low access areas (n=216) in fall/winter 2023 to evaluate their awareness, practices, and attitudes. Thirty-one pharmacists responded (14%). Almost half knew that maternal mortality had increased in recent years. Although 61% reported familiarity with the term "maternity care desert", only 35% recognized they are currently practicing in one. Provision of NASPA-recommended services to reproductive-age women ranged from 90% (immunizations) to 11% (alcohol use screening/counseling). About 96% believed that community pharmacists can help optimize women's health before and during pregnancy. The majority of respondents reported "never" screening for social determinants of health, but 48% were interested in learning more. While 67% of respondents are interested in providing more services for women at their pharmacy, they also reported obstacles like lack of time and staff. There is a need to raise awareness about maternal mortality and maternity care deserts among Ohio community pharmacists. Given the interest expressed in providing additional services, pharmacists should receive more support to provide needed care for medically-underserved populations.

Maternal and child health services during COVID-19 in India: Highlighting the role of primary care physicians in maintaining continuum of care

ABSTRACT Background: This study aims to address the lack of substantial evidence regarding the effect of COVID-19 on maternal and child health (MCH) services in India and also highlight the role of primary care physicians in maintaining essential services during a pandemic. While studies conducted worldwide and in India have examined the effects of COVID-19 on these services, a significant gap in robust evidence remains. Methods: Forty-two districts were selected randomly from seven regional states of India. Data on five selected MCH indicators were extracted from HMIS for the months from March to June 2019 and 2020. Relative changes in service utilization for each month from March to June over the two years were compared. Comparisons were also made between the selected districts based on the COVID-19 categorization into red and green zones. Results: COVID-19 and its associated restrictive measures created significant disruption to essential MCH service utilization in India across all states reviewed. Both institutional, and outreach services were impacted; however, hospital-based services were more impacted. Institutional deliveries and emergency obstetric services saw a decline in March and April 2020 which gradually improved between May and June in some states. Immunization sessions held in 2020 observed a decrease in April. Conclusions: The analysis indicates a disruption in service delivery during the initial phase of the lockdown. However, the services resumed gradually as national and state-specific operational guidelines were implemented to maintain a continuum of care.

Midwifery Care Continuity of Care at Delta Mutiara Clinic and Maternity Hospital, Sidoarjo

Continuity of Care is a program to improve the provision of midwifery services continuously carried out by Midwives and as the final project for midwifery students by promoting holistic and integrated midwifery care. The aim of this study was to provide continuous midwifery care , 25 year old, Mrs. A at the Delta Mutiara Clinic, Sidoarjo. The research design is descriptive with the case type of study research. The results showed that the midwifery care provided to Mrs. A, starting from pregnancy, childbirth, postpartum, newborns, and family planning, went according to midwifery care standards. Conclusions after being given Continuity of Care midwifery care, the mother feels comfortable, the occurring complications can be resolved and detected since the beginning of pregnancy, the mother and baby received adequate and integrated care.

Improving midwives' knowledge and attitudes in providing lactation education based on local wisdom of the Bugis ethnic in Indonesia

Background: The current rate of exclusive breastfeeding remains low due to several factors, including social and cultural changes, psychological factors, lack of education provided by healthcare workers, and the increasing promotion of formula milk as well as misinformation to the public. Therefore, it is necessary to have productive midwives who provide optimal healthcare services to improve the health status of infants. Currently, the healthcare services provided by midwives can also be carried out through independent practice. A midwife does not only provide obstetric services from a biological perspective but also addresses social, cultural, and spiritual needs. Purpose: To evaluate the impact of providing lactation education based on local wisdom in improving midwives' knowledge and attitudes in the Bugis ethnic in Indonesia. Method: A quasi-experiment method, specifically a pre-test and post-test with a control group design. The study population consists of midwives who have Independent Midwifery Practice in 15 districts of Makassar City. The sample obtained using purposive sampling. The sample size was 30 midwives, consisting of 15 midwives in the treatment group and 15 midwives in the control group. Results: The N-Gain Score test showed a value of 72.89% for the treatment group, while the control group scored 21.89%. The paired t-test showed an Asymp Sig (2-tailed) value of 0.000, which is less than the probability value of 0.05 for the treatment group. Conclusion: The use of printed and online pocketbooks for lactation education integrated with the cultural values of Sipakatau, Sipakalebbi, and Sipakainge in the exclusive breastfeeding program by independent midwives is more effective compared to counseling alone, which is less effective in the control group. Further testing concluded that there was a significant difference between the pre-test and post-test scores in the treatment group, indicating an increase in the midwives' knowledge.

Keeping birth at home: community and service provider visions for perinatal wellness and continued Inuit childbirth in Nunavik

Childbirth on traditional territories is unattainable for many Indigenous peoples living in remote communities in Canada. In Nunavik, Inuit territory in northern Quebec, rapid population growth risks exceeding local midwifery capacity. This poses challenges to community-based childbirth in a region recognized for reclaiming Inuit midwifery and local birthing. To explore community views on protective factors of maternal and family perinatal wellness and continued local birthing. In ten communities, Inuit families and perinatal service providers created a total of 54 fuzzy cognitive maps on protective factors for (1) birth in a good way in Nunavik, (2) maternal and family perinatal wellness, and (3) community-based birthing in Nunavik. We used fuzzy transitive closure to examine direct and indirect connections and collated individual factors into categories using inductive thematic analysis. Well-equipped local medical facilities and services, community birthing centres run by Inuit midwives, and Inuit perinatal traditions had the strongest influence on experiencing birth in a good way in Nunavik. Inuit youth perspectives featured instrumental and emotional support for mothers and families, along with health and self-care in pregnancy as the most influential factors on maternal and family perinatal wellness. Prominent protective factors for community birth in Nunavik included maternal-infant health and wellness, local Inuit midwifery services, and well-resourced medical facilities. Fuzzy cognitive mapping was helpful in informing community visioning of local childbirth and maternal and family perinatal wellness in Nunavik. Inuit-led midwifery services are essential to continued local childbirth in the region.

Epidemiology of obesity during pregnancy in Europe: a systematic review

Abstract Background Obesity during pregnancy poses inter-generational health risks and places added burden on healthcare systems. Characterising levels of obesity during pregnancy is necessary to guide future research, policy and practice. Methods The systematic review was performed according to PRISMA guidelines. PubMed, Embase and Web of Science were searched. Studies published between 2009 and 2023 that report the prevalence of obesity during pregnancy in countries in the World Health Organization (WHO) European region were eligible. The Joanna Briggs Institute Prevalence Critical Appraisal tool was used. Two reviewers screened studies independently. A single reviewer completed data extraction and quality assessments, a second checked 20% of extractions and a third resolved disagreements. Narrative synthesis was completed. Results 100 studies reporting the prevalence of obesity during pregnancy in the WHO European region were identified. 59% from Western Europe, 36% Northern, 4% Southern and 1% Eastern. Data within the studies was collected between 1950 and 2019. 35% of studies reported national estimates, 65% regional. 39% studies had measured height and weight, 34% did not report how either were ascertained, 6% used self-report for both, 17% had self-reported height but measured weight, 4% a mixture of self-report and measurement. The smallest sample was 157 while the largest was 1,891,097. Estimated prevalence of obesity during pregnancy ranged from 2.3% (Sweden, data collected 1982-1989) to 28.3% (England, 2007). Conclusions This review identifies variation in the prevalence of obesity during pregnancy in the WHO European region. This may reflect diverse sociocultural contexts, different methodological approaches and temporal trends. There was limited evidence available for Southern and Eastern Europe. Key messages • There are high levels of obesity during pregnancy within the WHO European region. • Enhanced primary prevention and resourcing of obstetric services is needed.

Acute Cystitis in a Transfeminine Patient: Assessment and Treatment of Urinary Tract Symptoms.

Management of acute cystitis in a transfeminine patient is discussed as an example of treatment of urinary tract infections (UTIs). The case is an introduction for clinicians who typically care for cisgender women and wish to expand the populations they serve to include care of gender-diverse individuals. This is supportive of the 2021 American College of Nurse-Midwives Position Statement on Health Care for Transgender and Gender Non-Binary People. Possible differential diagnoses for urinary symptoms in transfeminine patients are discussed, as well as relevant history taking, examination skills, and treatment guidelines for acute cystitis of patients with penises along with discussion of basic care for transgender individuals seeking midwifery or primary care services.

Adverse Childhood Experiences and Socioemotional Outcomes of Children Born Very Preterm

ObjectiveTo examine whether adverse childhood experiences (ACEs) confer risk for socio-emotional problems in children born very preterm (VPT) Study designAs part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT, 37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner’s Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socio-emotional outcomes. ResultsAfter covariate adjustment, children born VPT experienced more ACEs (p<0.001), particularly medical ACEs (p<0.01), and had worse ADHD and internalizing outcomes (p<.05) than FT children. ACEs mediated the association between birth group and ADHD outcomes (95% CIs: 0.11 – 4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (p<.001) and maternal distress (p<.05) were associated with poorer internalizing outcomes. ConclusionsScreening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children’s socio-emotional development.

The Effects of Baby Calming Training Provided to Primiparous Mothers on Maternal Role Perception, Maternal Attachment, and Breastfeeding Self-Efficacy: A Randomized Controlled Trial.

Background: Mothers of crying babies have difficulty adapting to their roles and problems with breastfeeding and attachment. Objective: This study aimed to assess the impact of the baby calming training provided to primiparous mothers on maternal role perception, maternal attachment, and breastfeeding self-efficacy. Methods: The study was conducted in a randomized controlled experimental design between March 2023 and March 2024 in the gynecology and obstetrics services of a public hospital in northeastern Turkey (Clinical Trial Number: NCT05594836). The research was conducted with a total of 84 primiparous mothers, including 41 intervention and 43 control groups, who met the inclusion criteria. The Baby Calming Training was administered face-to-face in the intervention group, utilizing a baby swaddling blanket, a sleep companion emitting white noise, and a training booklet. The control group received routine care. Data were collected through the Mother and Baby Introductory Information Form, Semantic Difference Scale-Me as a Mother, Maternal Attachment Inventory, Breastfeeding Self-Efficacy Scale-Short Form, and Infant Sleep Activity Record. The data were analyzed using descriptive statistics, Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, Wilcoxon test, mixed design ANOVA analysis, Cohen's d, and 95% confidence interval (CI). This study adhered to CONSORT research guidelines. Results: Mothers in the intervention group exhibited higher mean scores on the perception of maternal role (mean ± SD: 70.37 ± 5.92, t: 8.590, 95% confidence interval [CI]: [1.347-2.375], d: 1.865, p < 0.001), maternal attachment (mean ± SD: 100.42 ± 1.52, U: 151.500, 95% CI: [0.732-0.892], d: 0.828, p < 0.001), and breastfeeding self-efficacy (mean ± SD: 64.00 ± 5.98, t: 8.109, 95% CI: [1.248-2.258], d: 1.757, p < 0.001) than the control group. It was determined that the total sleep time of the babies in the intervention group was higher, and the total crying duration was lower (p < 0.001). Conclusion: The study revealed that infant soothing training for primiparous mothers enhanced maternal role perception, maternal attachment, breastfeeding self-efficacy, and extended infants' sleep duration. Furthermore, infants exhibited reduced crying.

Framework for Stillbirth, Maternal Morbidity, and Mortality Interventions in South Africa: A Systematic Literature Review using VOSViewer

Background: Maternal mortality and stillbirth are significant public health concerns in South Africa, necessitating a comprehensive understanding of effective interventions. This study aims to systematically review existing literature on stillbirth, maternal morbidity, and mortality interventions, employing VOSViewer for network visualization and analysis. Methods: A systematic literature review was conducted, sourcing articles from Scopus. The inclusion criteria encompassed studies focused on stillbirth, interventions, and mortality interventions in South Africa. VOSViewer was utilized to create network visualizations of keyword co-occurrence, highlighting research hotspots and emerging trends. Results: The analysis identified key interventions that significantly impact maternal and neonatal health outcomes. Major themes included enhanced healthcare infrastructure, improved access to antenatal care, emergency obstetric services, skilled birth attendance, and community engagement. Socio-economic determinants, such as education and poverty, were also found to be critical factors influencing maternal health. The Density Visualization and Overlay Visualization provided insights into the density and evolution of research focus areas, with hotspots identified in maternal mortality interventions and emerging trends in stillbirth prevention. Conclusion: The review concludes that a comprehensive strategy integrating healthcare infrastructure improvements, robust policy implementation, socio-economic support, and community engagement is essential for effectively reducing stillbirth, maternal morbidity, and mortality in South Africa. Ongoing commitment such as the National Health Insurance and investment in maternal and neonatal health, coupled with targeted interventions and a holistic approach, are crucial for achieving significant and sustained improvements in health outcomes.

MIDWIFERY SERVICE MANAGERS’ READINESS FOR PREVENTION OF OBSTETRIC VIOLENCE IN NIGERIA: A COMMUNITY READINESS MODEL

Obstetric violence is a public health problem that needs to be prevented at all levels to improve maternal and newborn health outcomes. The midwifery service managers, as custodians of patient care in maternity centres are in a prime position to develop and implement effective obstetric violence prevention interventions. This study explored the midwifery service managers’ level of readiness for the prevention of Obstetric Violence in three maternity centres at three separate hospitals in Oyo State, Nigeria. Data was collected from six midwifery service managers as midwifery community leaders, using the adapted Community Readiness Model as a data collection tool. The Community Readiness Model scoring guide was used to score the six dimensions of community readiness. In addition, a thematic analysis was used to analyze the qualitative data from their views on each of the six dimensions of the Community Readiness Model. The findings revealed an overall level of readiness for the prevention of obstetric violence among midwifery service managers was at level five which is the preparatory level. This means that the community has a modest readiness for Obstetric violence prevention, and it would be easier to develop sustainable prevention interventions for obstetric violence. Understanding the midwifery service managers’ level of readiness for the prevention of obstetric violence is important for governments and other stakeholders intending to develop obstetric violence prevention interventions that are contextually appropriate and acceptable to communities.

Transforming midwifery healthcare services in rural Indonesia: A comprehensive analysis of artificial intelligence integration

Transforming midwifery healthcare services in rural Indonesia: A comprehensive analysis of artificial intelligence integration

Determinants to utilization of emergency obstetric care services among perinatal clients seeking care at Kajiado County Referral Hospital, Kajiado County, Kenya

Background: Worldwide, one or more potentially fatal perinatal obstetric complications affect nearly 15% of all pregnant women. There has been little research on the provision of emergency obstetric care (EmOC) services in Kenya. This study aimed to assess the determinants of EmOC services among perinatal clients seeking care at Kajiado County Referral Hospital, Kajiado County, Kenya. Methods: An analytical cross-sectional study design was embraced in this study while both systematic and simple random sampling were used to recruit study respondents for this research. Associations between the utilization of emergency obstetric care services and associated determinants were established using a Chi-square test and binary logistic regression where a p value of 0.05 or lower was considered significant. Results: The utilization of EmOC services from this research was at 74%. Study respondents aged between 18-25 years (OR=9.4, 95% CI=0.04-0.31), being knowledgeable about EmOC services (OR=3, 95% CI=0.13-9.75), and being knowledgeable about obstetric danger signs (OR=6, 95% CI=0.06-0.45), increased the odds of utilizing EmOC services while earning less than 10000 Kshs (OR=4.3, 95% CI=0.45-4.77), reduced the odds of utilizing EmOC services. Conclusions: The utilization of EmOC services from this research was at 74%. Study respondents aged between 18-25 years, being knowledgeable about EMOC services and being knowledgeable about obstetric danger signs increased the odds of utilizing emergency obstetric care services while earning less than 10000 Kshs reduced the odds of utilizing emergency obstetric care services.

Key Determinants of the Comprehensive Neonatal Emergency Obstetric Services Policy

Background: Effective implementation of comprehensive emergency obstetric and neonatal care programs is vital for improving maternal and neonatal health outcomes. Specific Background: At RSU Al-Islam H.M Mawardi, various factors—including communication, resources, disposition, and bureaucratic structure—affect program implementation. Knowledge Gap: Previous research has often neglected how these factors interact and their influence on healthcare policy implementation. Aims: This study evaluates the relationship between these factors and the implementation of the emergency obstetric and neonatal care program using a quantitative survey approach. Results: Analyzing data from 54 respondents revealed significant correlations between effective communication, resource allocation, and successful policy implementation (p &lt; 0.05), with the questionnaire demonstrating high reliability (Cronbach's Alpha = 0.969). Novelty: This research contributes empirical evidence on the specific elements influencing healthcare policy implementation locally. Implications: Strengthening communication and resource management is essential for enhancing policy implementation effectiveness, ultimately improving community health outcomes. Highlights : Factor Influence: Effective communication and resource allocation significantly impact program success. Research Contribution: The study provides empirical evidence on factors affecting healthcare policy implementation locally. Health Outcomes: Strengthening implementation strategies is crucial for improving maternal and neonatal health outcomes. Keywords: obstetric care, neonatal care, policy implementation, communication, healthcare resources

Main stream and scientific innovations in the field of obstetric services in the Ural Federal District

The article provides analytical data on the results of the obstetrics and childhood service of the Ural Federal District in 2023, analyzes the key indicators of the service over the past five years and provides directions for optimizing the work of the service. In the sphere of implementation of national projects “Healthcare” and “Demography”, applied scientific research and development of the “Ural Research Institute of Maternity and Child Care” of the Russian Ministry of Health makes a significant contribution to the development of medicine by improving methods of prediction, diagnosis, treatment and prevention of perinatal pathology, development of assisted reproductive technologies, which will improve the work of obstetrics and childhood services.

Knowledge of Periconceptional Folic-Acid among Women of Childbearing age Visiting Tertiary Care Hospital in Nepal

The value of periconceptional folic acid supplementation in reducing the incidence of neural tube abnormalities in newborns is widely known. Yet, Nepalese women of childbearing age are mainly ignorant of it. The current study examined different sociodemographic and health factors related to women’s level of knowledge about folic acid among women visiting Obstetrics and Gynaecology outpatients at a Tertiary Care Center in Nepal. It also evaluated the awareness and relevance of knowledge regarding folic acid and its periconceptional supplementation. 400 women aged 18 and 45 who sought Obstetrics and Gynecology Outpatient Services at the Tertiary Care Facility participated in this cross-sectional study. Sociodemographic information was gathered with the help of a self-report questionnaire and processed in IBM-SPSS software at a significance threshold of 0.05. Results of the studies showed that while 47.3% had heard of it, only 34.25% had adequate knowledge of periconceptional folic acid supplementation. Also, besides age (p=.493), knowledge of folic acid was significantly associated with factors including education(p=.026), ethnicity (p=&lt;.001), income (p=.011), employment (p=.001), marital status (p=.007), past pregnancies (p=.031) and ANC visits (p=&lt;.001). The study demonstrates the need for more public awareness to boost folic acid knowledge, adherence, and intake and ultimately lower the prevalence of related birth abnormalities. To quantify the hidden issue, further studies on the prevalence of NTDs in Nepalese society and the contribution of folic acid to their reduction are required.