Postnatal Care Utilization Research Articles

Predictive accuracy of the logit model to determine factors affecting delivery and postnatal care services utilization in Tanzania

PurposeThis paper examines factors affecting the delivery care (DC) and postnatal care (PNC) services utilization in Tanzania using the predictive accuracy of the binary logit model by including DC as among the predictors of PNC utilization.Design/methodology/approachThe study used secondary data from the Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022) based on a sample of 13,266 women aged 15–49. Binary logit was used to analyze the association between independent variables and each binary dependent variable, followed by a stepwise likelihood ratio test for binary logistic regression analysis to select the most important predictors associated with DC and PNC. Odds ratios were used to predict the likelihood of the occurrence of significant explanatory variables in explaining the outcomes.FindingsThe results showed that the type of place of residence, wealth index, region, highest educational level, husband/partner’s level of education and respondent’s occupation were significant predictors of DC utilization. In contrast, the woman’s age, region, highest educational level, wealth index, DC and husband/partner’s educational level were significant predictors of PNC utilization. Public health interventions are needed to promote and increase the utilization of delivery and postal care services. The targets should be poor women and those residing in rural or remote areas.Originality/valueIncluding DC as a predictor variable (which was not used before) in PNC utilization improved the predictive power of the model and the robustness of the results.

Utilization Postnatal Care Services in Hyolmo Community

Postnatal care (PNC) utilization among the Hyolmo community highlights significant gaps in existing literature and underscores the critical need for targeted healthcare interventions in remote and ethnically distinct populations. This study reveals that, while considerable attention is given to urban and accessible rural populations, remote communities face unique challenges that can impede access to essential maternal health services. The results demonstrate that age, education, and socio-economic factors significantly influence PNC uptake, suggesting disparities that are compounded in remote areas like the Helambu Rural Municipality of Sindhupalchowk District. This study shows that younger mothers, often less aware or hindered by accessibility barriers, are less likely to utilize PNC services compared to their older counterparts. This disparity highlights the necessity for community-specific educational programs that can enhance understanding and encourage the use of PNC services among younger women. Additionally, the influence of education and socio-economic status on PNC utilization points to the broader implications of systemic inequities in healthcare access. Moreover, the study brings to light the role of cultural practices and beliefs in shaping healthseeking behaviors, which varies significantly across different communities. In the traditional beliefs may conflict with modern healthcare practices, there is a clear need for culturally sensitive health interventions that respect and integrate local customs and practices. This research not only contributes to a deeper understanding of the factors affecting PNC service uptake in a specific Nepalese community but also calls for comprehensive policy responses. By addressing the multifaceted challenges faced by the Hyolmo community ranging from geographic isolation to cultural and educational barriers the study advocates for a holistic approach to healthcare. This should include the development of policies that ensure equitable access to health services, enhance community health education, and promote cultural competence among healthcare providers. Ultimately, such efforts are essential for improving maternal and infant health outcomes in remote communities, ensuring that every individual, regardless of their socio-economic or cultural background, has access to the necessary postnatal care.

Postpartum Women's Experiences of Postnatal Care in Sub-Saharan Africa: A Qualitative Evidence Synthesis.

Postnatal care (PNC) is a critical service for the health and well-being of new mothers and newborns. However, in sub-Saharan Africa (SSA), most efforts to improve maternal and child health have been directed toward enhancing skilled birth attendance and urgent obstetric and neonatal care. This is despite the fact that more than half of maternal deaths globally occur in the postnatal period, with 65% of these occurring in the first week following birth. One of the health system factors influencing PNC utilization is the women's previous PNC experience at healthcare facilities. The aim of this review was to gain a better understanding of women's experiences of PNC in SSA. This study followed a qualitative evidence synthesis design. The phenomenon of interest was postpartum women's experiences of PNC in SSA. PubMed, CINAHL, EMBASE, Science Direct, Africa Journals Online (AJOL), SCOPUS, and Google Scholar were searched for peer-reviewed articles published in English between 2013 and 2023. To assess the quality of the included studies, we used an appraisal tool developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. Two authors independently extracted relevant data from the included studies. Thomas and Harden's thematic synthesis framework was used to synthesize the data. Eight articles were used in this review. Seven articles reported on qualitative studies, and one reported on a mixed-method study. All the included studies fully or partially met the 12 quality assessment criteria. Synthesis of the data resulted in the development of five analytical themes. The five themes were the adequacy of physical examination and communication of the findings, adequacy of PNC information, the quality of interactions with healthcare workers (HCWs), the availability of resources and adequacy of HCWs, and denial of care. The overall confidence in the review's findings was either moderate or high. Based on our findings, we recommend that countries in the region address staff shortages, implement task shifting, electronic medicine stock management systems, optimal supply chain policies, and train HCWs on PNC and interpersonal communication skills.

Socioeconomic inequality in postnatal care utilisation among reproductive age women in sub-Saharan African countries with high maternal mortality: a decomposition analysis.

To assess the socioeconomic inequality in postnatal care (PNC) utilisation and its contributors among women in 14 sub-Saharan African countries with high maternal mortality. Community-based cross-sectional study using Demographic Health Survey SETTING: Africa countries with the highest maternal mortality ratio (14 countries) PARTICIPANTS: All women who had given birth within 2 years prior to the survey (n=64 912) PRIMARY OUTCOMES: Postnatal care utilisation RESULTS: The percentage of women who had PNC utilisation was lowest in Ethiopia (23.4%: 95% CI: 22.1%, 24.7%) and highest in The Gambia (91.5%: 95% CI: 90.6%, 92.4%). There was statistically significant pro-rich inequality in the PNC utilisation in all countries except Liberia, meaning PNC utilisation was disproportionately concentrated among women from wealthier households. The weighted Erreygers Normalized Concentration Index (ECI) ranged from 0.0398 in The Gambia to 0.476 in Nigeria; the second-highest inequality was in Cameroon (0.382), followed by Guinea (0.344). The decomposition analysis revealed that the wealth index was the largest contributor to inequality in PNC utilisation in seven countries: Benin, Burundi, The Gambia, Guinea, Nigeria, Sierra Leone, Tanzania. In contrast, educational status emerged as the primary contibutor in Cameroon and Zimbabwe, media exposure in Mali and Mauritania, and distance to healthcare facilities in Ethiopia. However, in Liberia, the weighted ECI of 0.0012 with a p value of 0.96 indicate that there is no significant socioeconomic inequality in PNC utilisation, suggesting that the distribution of PNC utilisation is almost equal across different socioeconomic groups. Our study revealed a pro-rich inequality in PNC utilisation across all included sub-Saharan African countries with high maternal mortality, except Liberia. This implies that PNC utilisation disproportionately favours the wealthy. Therefore, financially better-off women are more likely to utilise PNC services compared to those who are poor. Addressing the identified contributors of socioeconomic inequalities in PNC utilisation in each country remains crucial for achieving equity in PNC utilisation.

Postnatal care utilization in the Oshana region of Namibia: Prevalence, associated Factors, and a decision framework

BackgroundNamibia faces a persistent challenge of high maternal and neonatal mortality, particularly within the postnatal period. This study assessed postnatal care (PNC) utilization prevalence in Namibia’s Oshana region, identified influencing factors, and aimed to develop a decision framework for healthcare providers to predict women who are unlikely to utilize PNC. MethodsA quantitative cross-sectional survey employing a systematic random sample (n = 814) and self-administered questionnaires was conducted. Data analysis employed Chi-squared tests, bivariate and multivariate logistic regression, and classification tree analysis. ResultsPNC utilization was 43.8 %, 95 % (CI 40.3 % – 47.3 %). Respondents who stayed in rural areas and the unemployed were less likely to utilize PNC services, AOR = 0.51, 95 % CI (0.35 – 0.74) and AOR = 0.26, 95 % CI (0.17 – 0.40), respectively. Respondents with poor PNC knowledge and poor PNC perception were less likely to utilize PNC services, AOR = 0.63, 95 % CI (0.41 – 0.98) and AOR = 0.32, 95 % CI (0.21 – 0.49), respectively. Classification analysis revealed mode of delivery, employment status, and marital status as significant predictors of PNC utilization. ConclusionExpanding healthcare facilities in rural areas, empowering women through education and income-generating projects, and utilizing community health workers for PNC education are crucial strategies to improve utilization rates.

Factors associated with postnatal care utilization in Afghanistan

Afghanistan has one of the highest maternal mortality rates in the world. Inadequate postnatal care (PNC) increases the risk of maternal mortality. This study aimed to analyze the socioeconomic and demographic factors that affect postnatal care utilization. A secondary analysis was conducted in 2019 based on the data from the 2015 Afghanistan Demographic and Health Survey. The sample included 29,461 married women aged 15–49 interviewed during the survey. This was a cross-sectional study in which a frequency distribution of independent variables for the study sample was carried out, Pearson’s chi-square test was conducted for association, and the strength of association was measured using binary logistic regression. The study found that 39.9% of married women used postnatal care services. The findings of this study suggest that place of delivery and women who gave birth at health facilities were more likely to use PNC than women who delivered at home. Women age 30–39 and 20–29 positively associated with PNC use compared with mothers aged < 20 years. Each level of women’s educational attainment increased their use of PNC, and women with higher education were more likely to use PNC than those without education. Furthermore, women who visited 1–3 and more than four ANC visits were more likely to use PNC than women who did not visited ANC. Moreover, women exposed to mass media were more likely to use PNC than those who were not exposed to mass media. Finally, women who lived in the northern and western regions were more likely to use PNC than those who lived in the central region, while women who lived in the southern and southeastern regions were less likely to use PNC than those who lived in the central region. Therefore, strengthening the provision of information, education, and communication could be a communication channel to further improve PNC utilization. Meanwhile further studies are needed to focus on the quality of maternal health care and PNC services in Afghanistan in order to obtain more precise information.

Analysis of Influential Factors on Postnatal Care Utilization: A Community-based Cross-sectional Study in Kwadaso Municipality, Ghana

Background: Postnatal care is central to maternal well-being as it averts cognitive complications and illnesses that come from childbirth. Non-utilization of postnatal care hinders initiatives aimed at improving maternal morbidity and mortality because postnatal care is an essential component of those initiatives. This study sought to determine factors associated with the utilization of postnatal care services among mothers in Kwadaso Municipality. Subjects and Method: Community-based cross-sectional study to assess the factors associated with utilization of postnatal care services among mothers in Kwadaso Municipality. A multistage sampling technique was used to recruit 568 women for the study. The dependent variable was mothers' utilization of postnatal care (PNC). The independent variable was demographic characteris­tics of mothers, socio-economic status, educational level, accessibility to healthcare facilities, know­ledge of PNC Services, and awareness of PNC services. The data were collected using a structured questionnaire, the data obtained were analyzed using STATA version 14.0, and the variables were analyzed using the chi-square test and multiple logistic regression and p=0.050 was considered statistically significant. Results: The mean age was 20-25 years 22.4 (SD=3.7 years) and 55.5% were married. The level of knowledge of the mothers on postnatal care services was 71.8% and 82.3% of the subjects knew postnatal period is more dangerous to the lives of mothers and their babies. The unadjusted odds of women who were married (OR= 2.11; 95% CI= 0.86 to 7.46; p=0.042), with two children (OR=4.17; 95% CI= 0.03 to 5.30; p= 0.025), earned GHC 500.00 monthly (OR= 3.47; 95% CI= 0.26 to 5.73; p=0.038), or delivered at the hospital (OR= 3.18= 95%CI= 0.02 to 8.06; p=0.014) were statistically significantly higher in women who were not married, had more than or less than four children, earned less than GHC 500.00 or delivered at other places aside the hospital. Conclusion: This study contributes to the ongoing discourse on maternal health and underscores the importance of evidence-based interventions to improve the health and well-being of mothers and infants.

An assessment of factors associated with full vaccination coverage rate among children aged 12-23 months in Masvingo district; Zimbabwe. A cross-sectional study

Introduction: Immunization is one of the most cost-effective nursing interventions aimed at reducing ill health and premature death among children. Despite tremendous efforts by governments, vaccination coverage remains low, especially in developing countries. Masvingo district is one of the districts with low vaccination coverage in the country. Objectives: This study sought to assess immunization coverage, identify determinants of vaccination coverage and assess factors associated with low full immunization coverage in Masvingo district, Zimbabwe. Methods: An analytical cross-sectional study design was conducted between January 2019 and February 2019. Masvingo province was purposively selected due to its low vaccination coverage (60.3%) according to the Zimbabwe Demographic and Health Survey 2015. WHO cluster sampling was used to select households. A total of 354 children and their mothers residing in Masvingo district were recruited for the study. Pre-tested interviewer-administered questionnaires were used to collect data. Bivariate analysis was employed to assess factors associated with low vaccination coverage. Results: An estimated 89.5% of children aged 12-23 months were fully vaccinated by card or mothers’ recall. Factors significantly associated with full vaccination coverage rates (P&lt;0.001) included birth order, distance to the nearest health facility, waiting time, place of birth, number of Antenatal care visits, possession of a vaccination card, place of residence, mother/caregiver’s highest level of education, household expenditure per month, and overall knowledge of the vaccination schedule. After controlling for all these factors, only household expenditure per month (P=0.001), having a vaccination card (P=0.047), and overall knowledge of the vaccination schedule (P=0.002) were statistically significant predictors of full vaccination coverage rates. Conclusion: Although full vaccination coverage is improving, it is still below the Global Vaccine Action Plan target. Factors associated with low full vaccination coverage include marital age, marital status, level of education, religion, household expenditure, distance to the health center, waiting time, and Antenatal Care and Post-natal Care care utilization. There is no single factor solely responsible for low vaccination coverage; rather, it is influenced by a combination of multiple factors. Nursing interventions at community level should focus on increasing community mobilization strategies that foster saturation coverage to achieve herd immunity for all vaccine preventable child diseases.

Women utilisation, needs and satisfaction with postnatal follow-up care in Oman: A cross-sectional survey

BackgroundIn Oman, there is a lack of data on utilisation, needs and women's satisfaction with care and information provided during postnatal follow-up period. AimTo investigate postnatal follow-up care utilisation and women's needs; level of postnatal information received and satisfaction with services. MethodsA purposive sample of women (n = 500), recruited in the immediate postnatal period at one metropolitan and one regional birthing hospital in Oman. An electronic survey link was sent to participants at 6–8 weeks postnatally. Quantitative variables were analysed as frequencies and chi-squared test. ResultsA total of 328 completed surveys were received; a response rate of 66 %. Most respondents were located in the metropolitan area (n = 250) and between 20 and 39 years (n = 308). Utilisation was low as women reported no need or no benefit in attending. Women's information needs were not sufficiently met by HCPs, requiring women to seek information from family and the internet to meet their needs. Satisfaction with services was mostly neither satisfied nor dissatisfied (30 %) or satisfied (30 %). ConclusionPostnatal follow-up care utilisation in both metropolitan and regional areas is less than optimal and not utilised as there was no advice to attend or no appointment date/time given, no benefit experienced previously, no need and information needed sourced from family or the internet. The information provided by postnatal follow-up care consumers can be used to enhance service delivery, inform future updates to the national maternity care guidelines, and provides a baseline for future evaluation and research.

Community-Based Health Education Led by Women's Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial.

This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ2 = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ2 = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ2 = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. NCT05865873.

Multilevel analysis of determinants in postnatal care utilisation among mother-newborn pairs in India, 2019-21.

Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India. Using India's 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories. Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother's PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother's PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn's PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories. Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.

Early Postnatal Care Utilization and Associated Factors Among Women Who Give Birth in the Last Six Weeks in Hosanna Town, Southern Ethiopia, 2022.

Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7-30.0). No formal and primary educational level of husband (AOR = 0.05, 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13, 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (AOR = 0.3, 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08, 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication.

Factors Influencing Postnatal Care Utilization Among Women in Sub-Saharan Africa: A Scoping Review

BACKGROUND:Considerable progress has been made globally in improving maternal and child health. However, Sub-Saharan Africa (SSA) and South Asia together accounted for 86% of all maternal deaths in the world during the 2000–2017 period. It is estimated that more than 60% of global maternal deaths occur during the postnatal period. The utilization of postnatal care (PNC) services remains low in SSA. This scoping review aimed to determine factors that influence PNC utilization among women in SSA.METHODS:Peer-reviewed articles published in English from 2018 to 2023 were searched from Google Scholar, ScienceDirect, MEDLINE, African Journals Online, SCOPUS, and PubMed databases. Two authors independently screened the articles and extracted the data.RESULTS:Thirty-nine articles were included in this review. Thirty-three of the studies were of a quantitative cross-sectional study design, four were mixed-methods, and two were qualitative studies. The review identified several enablers and barriers to PNC utilization among women, which were categorized into individual, community-level, and healthcare system factors. Some of the individual factors included the place of residence, marital status of the woman, employment status, educational level of both the woman and her partner, and household income. Health system factors included accessibility of healthcare facilities, availability of resources, and the quality of healthcare.CONCLUSION:To improve PNC utilization in SSA, several strategies should be implemented. These strategies should address issues such as women’s empowerment, accessibility of healthcare facilities, the quality of healthcare services, and healthcare services financing.

The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries: a systematic review of the evidence

BackgroundLow- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries.MethodsThe review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies.ResultsA total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment.ConclusionThe introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries’ progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status.Trial registrationThis study was registered with Prospero (CRD42021285776).

Pregnancy Care Utilization, Experiences, and Outcomes Among Undocumented Immigrants in the United States: A Scoping Review

BackgroundUndocumented immigrants face many barriers in accessing pregnancy care, including language differences, implicit and explicit bias, limited or no insurance coverage, and fear about accessing services. With the national spotlight on maternal health inequities, the current literature on undocumented immigrants during pregnancy requires synthesis. ObjectiveWe aimed to describe the literature on pregnancy care utilization, experiences, and outcomes of undocumented individuals in the United States. MethodsWe performed a scoping review of original research studies in the United States that described the undocumented population specifically and examined pregnancy care utilization, experiences, and outcomes. Studies underwent title, abstract, and full-text review by two investigators. Data were extracted and synthesized using descriptive statistics and content analysis. ResultsA total of 5,940 articles were retrieved and 3,949 remained after de-duplication. After two investigators screened and reviewed the articles, 29 studies met inclusion criteria. The definition of undocumented individuals varied widely across studies. Of the 29 articles, 24 showed that undocumented status and anti-immigrant policies and rhetoric are associated with lower care utilization and worse pregnancy outcomes, while inclusive health care and immigration policies are associated with higher levels of prenatal and postnatal care utilization as well as better pregnancy outcomes. ConclusionsThe small, heterogeneous literature on undocumented immigrants and pregnancy care is fraught with inconsistent definitions, precluding comparisons across studies. Despite areas in need of further research, the signal among published studies is that undocumented individuals experience variable access to pregnancy care, heightened fear and stress regarding their status during pregnancy, and worse outcomes compared with other groups, including documented immigrants.

Good while it lasted? Estimating the long-term and withdrawal effects of results-based financing in Malawi on maternal care utilisation using routine data

ObjectivesThis study aimed to evaluate the effect of introduction and subsequent withdrawal of the Results-based Financing for Maternal and Newborn Health Initiative (RBF4MNH) in Malawi on utilisation of facility-based childbirths,...

Individual and community-level factors associated with women’s utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BackgroundOver time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women’s utilization of postnatal care services in Uganda.MethodsSecondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.ResultsThe result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78–2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01–1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.ConclusionThis study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Coverage and determinants of infant postnatal care in Nigeria: A population-based cross-sectional study.

In 2019, Nigeria had the largest number of under-5 child deaths globally and many of these deaths occurred within the first week of life. The World Health Organization recommends infant postnatal care (PNC) attendance to support newborn survival; however, utilization of PNC is known to be low in many contexts. This study examined coverage and individual-level determinants of infant PNC attendance in Nigeria. Nigeria Demographic Health Survey (NDHS) 2018 data were used to evaluate infant PNC coverage and determinants. Infant PNC was defined as receipt of care within 2 days of birth. Children delivered up to 2 years before the 2018 NDHS were included. We examined predictors of infant PNC with modified Poisson regression models to estimate relative risks (RRs). The national coverage of infant PNC was 37.3% (95% confidence interval [CI]: 35.8%-38.7%). Significant heterogeneity in PNC attendance existed at state and regional levels. Facility delivery was strongly associated with the uptake of PNC (RR: 6.07; 95% CI: 5.60-6.58). Greater maternal education, maternal employment, urban residence, female head of household, and greater wealth were also associated with an increased likelihood of PNC visits. The uptake of infant PNC is low and interventions are urgently needed to promote equity in access and increase demand for PNC in Nigeria.

Maternal Healthcare Services Utilization and Associated Factors among Childbearing Age of Women in Liben District, East Borena Zone, Oromia Regional Health Bureau, Ethiopia

Background: Utilization of maternal healthcare services is a fundamental health intervention for preventing maternal morbidity and mortality. Despite its importance, the utilization of maternal healthcare services in Ethiopia is low, especially in rural pastoralist communities. Thus, this study aimed to assess maternal healthcare services utilizations and its associated factors in the Liben district of Guji zone, Oromia region, Southern Ethiopia. Methods: A community-based cross-sectional study was conducted with 416 randomly identified mothers in Liben in September, 2020. The respondents were mothers who had given birth 12 months prior to the survey. The data were collected using interviewer administered questionnaires. The data were entered into Epi-data version 4.1 and analyzed using SPSS version 20. Descriptive, bivariate and multivariate logistic regression analyses were also performed. Result: Sixty percent of mothers had received antenatal care at least once. In this study, only 21.2% and 17.5% of women had delivered their babies at health institutions and utilized early postnatal care services respectively. Maternal education [AOR=2.43(95%CI: 1.22–4.89)], decision making power [AOR=2.40(95% CI: 1.3–23.3)], perceived compassionate &amp; respectful care [AOR=0.30(95%CI: 0.18–0.50)], and planned current pregnancy [AOR=0.22(95% CI: 0.12–0.37)] were significantly associated with utilization of antenatal care. Mother’s age [AOR=3.73(95% CI: 1.53–6.04)], time to travel to health facilities [AOR=1.74(95% CI:1.02– 3.08)], knowledge of danger signs [AOR=3.77(95% CI:2.16–6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery, whereas recent antenatal care utilization[AOR=5.34(95%CI:1.96–8.65)], planned current pregnancy and knowledge of danger signs [AOR=2.93(95%CI:1.59–5.41)] were found to be significantly associated with postnatal care utilization. Conclusion: Overall, the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Therefore, considering the identified associated factors and providing information and training on these issues to the community could improve and sustain maternal healthcare services utilization.

Postnatal care utilization and associated factors among women who gave birth within the last 12 months in northwest Ethiopia: a cross-sectional study.

postnatal care after birth is a crucial component in saving the lives of mothers and new-borns. A paucity of evidence indicated that women's unwillingness to receive care after birth remains a challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the level of postnatal care utilization and factors affecting it in northwest Ethiopia. a community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had given birth within the last year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and a p-value of <0.05. the study revealed that postnatal care utilization was 19.85% (95% CI: 20.8-29.4) in northwest Ethiopia. Maternal education of secondary and above (AOR =2.65; 95% CI: 1.43, 4.94); facility delivery (AOR = 3.99; 95% CI: 2.44, 6.55); membership in women associations in the community (AOR = 1.6; 95% CI: 1.07, 2.4); four or more ANC contacts (AOR = 1.51; 95% CI: 1.03, 2.22); having health education at health post level (AOR = 1.77; 95% CI: 1.21, 2.58), and birth order (AOR = 2.64; 95% CI: 1.21, 5.78) were significantly associated with postnatal care utilization. postnatal care utilization is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider community-based intervention strategies focusing on maternal health education, healthcare accessibility, and promoting women's participation in the community to be more effective in improving postnatal care utilization.