Prenatal Health Care Services Research Articles

Equity in prenatal healthcare services globally: an umbrella review

BackgroundTimely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics.MethodsFor this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews.ResultsThe search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors.ConclusionsThis umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.

Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19

BackgroundPsychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes. AimTo explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period. MethodsA mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants’ experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed. ResultsApproximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress. ConclusionHealthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.

Somatometric alterations and lower APGAR score in indigenous newborns

Introduction: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. Aim: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. Methods: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. Results: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). Conclusions: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities.

Preceding birth interval, timing and number of antenatal contacts in Africa, 2010-2020.

Utilization of adequate and quality prenatal healthcare services confers critical benefits to women and their unborn children. However, utilization rates remain low in many countries in Africa. Several studies have attempted to understand the primary drivers behind these low statistics. This article contributes to this discourse by examining the associations between birth interval and timing and number/frequency of antenatal care visits in Africa. We pooled data from the publicly available Demographic and Health Surveys conducted in the last decade (2010-2020) for 32 African countries. Data were analysed using descriptive proportions and mixed effect binary logistic regression. The results illustrate moderate significant associations between spacing on the most recent birth by ≥36months and early (first trimester) first antenatal care contact in both our bivariate (odds ratio [OR] 1.18, p<0.001) and multivariate (OR 1.106, p<0.001) analyses. The benefits on optimal antenatal contacts predicted on spacing are also noticed with birth intervals of 24-35months (OR 1.08, p<0.001) and ≥36months (OR 1.48, p<0.001). Optimal birth spacing is beneficial for ANC utilization in terms of timing and total number of contacts. Post-partum family planning/contraceptive use can be an effective pathway to prolonging birth intervals. We argue that maternal and child health programmes strengthen prioritizing contraceptive use between births.

Female Genital Mutilation/Cutting and Breastfeeding Outcomes: The Modifying Effects of Healthcare Access and Women’s Attitudes to FGM/C

The prevalence of female genital mutilation/cutting (FGM/C) in Nigeria is on the rise, although the practice has no known medical/health benefits. This study aims to assess FGM/C’s effect on breastfeeding outcomes and to identify the role of women’s attitudes and their access to healthcare services on these relationships. Associations between FGM/C and breastfeeding outcomes were measured using multi-logistic regression. About 32% of women underwent FGM/C, and 23% believed FGM/C should continue. Women exposed to FGM/C were less likely to initiate early breastfeeding (OR = 0.56, [95% CI = 0.47–0.66]) or to breastfeed exclusively (0.64, [0.57–0.73]). FGM/C acceptance reduced odds of early initiation of breastfeeding (0.57, [0.45–0.73]) (p for interaction &lt; 0.001) and exclusive breastfeeding (0.65, [0.59–0.78]) (p for interaction &lt; 0.001). Four or more antenatal care visits while pregnant modified the associations between FGM/C and early initiation (1.55, [1.26–1.90) (p for interaction &lt; 0.001) or exclusive breastfeeding (2.01, [1.73–2.330]) (p for interaction &lt; 0.001), respectively. FGM/C is associated with breastfeeding outcomes, but this association may be improved with healthcare access and attitudinal changes towards FGM/C. Targeted public health education interventions raising awareness about FGM/C and breastfeeding and policy changes increasing access to prenatal healthcare services in underserved areas are recommended.

Progress of research on clinical use of non-invasive prenatal screening for special groups of pregnant women

As a prenatal testing for chromosomal abnormalities, non-invasive prenatal testing (NIPT) has been integrated into prenatal healthcare service. NIPT has shown a high sensitivity and specificity for screening fetal trisomies 13, 18 and 21, and has attained excellent clinical results. With the propagation of the NIPT screening, international organizations have issued guidelines and comments for its clinical utility with regular updating. China has also developed guidelines for NIPT in 2016. NIPT guidelines in various countries have provided valuable guidance for its target diseases and suitable patient groups, but there has been few research data on its clinical application for special groups of patients. Based on the guidelines and comments of various professional bodies and published data on the clinical utility of NIPT, in addition with consideration of the conditions in China, clinical utility of NIPT for particular groups of pregnant women, including those with advanced maternal age, obesity, twin pregnancy and fetal ultrasonographic anomalies, are reviewed. The value of genetic counseling for NIPT is also emphasized, which is critical for the clinical application of NIPT.

Prevalence and Correlates of Prenatal Depression, Anxiety and Suicidal Behaviours in the Volta Region of Ghana.

Pregnancy is associated with several physical and psychosocial challenges that influence women’s health and wellbeing. However, prenatal mental health has received little attention. Therefore, this study examined the prevalence and correlates of prenatal depression, anxiety and current suicidal behaviors among pregnant women in the Volta Region of Ghana. Two hundred and fourteen (n = 214) pregnant women recruited from two hospitals responded to the hospital depression and anxiety scale (HADS), the insomnia severity index, and a set of psycho-behavioral, socioenvironmental and demographic characteristic questions. Chi-squared, bivariate and multivariate logistic regression were used for data analysis. Prevalence of prenatal depression, anxiety and current suicidal behaviors was 50.5%, 35.5% and 3.3%, respectively. After controlling for other variables, average monthly income, insomnia, non-nutritious food consumption (pica), and body image satisfaction were significantly associated with depression. Marital status, insomnia, lifetime suicidal behavior and partner support were significantly associated with anxiety. Current partner abuse was the only factor significantly associated with current suicidal behavior. The high prevalence rates of anxiety and depression among pregnant women and intimate partner violence remain important maternal health issues in the region. Therefore, brief mental health screening and counseling services should be integrated into prenatal healthcare services.

Oral rehydration salts therapy use among children under five years of age with diarrhea in Ethiopia.

Background: Oral rehydration salts (ORS) therapy for diarrheal diseases is considered an effective therapy that can be applied in many resource-poor settings. Nevertheless, it has been consistently underutilized, and as a result, its potential to reduce child mortality has not been fully exploited. In Ethiopia, the use of ORS therapy for children under five has been inadequate. Like any other health behavior, the provision of ORS therapy to children during diarrheal episodes by caregivers is complex and context dependent. Identifying the factors may help promote wider application.Design and methods: We used data from the 2016 Ethiopia Demographic and Health Survey (EDHS-2016). Samples were selected by a two-stage stratified cluster sampling method. We used data on children under five years of age whose mothers (aged 15-49 years) reported that the child had had diarrhea within two weeks before the survey was conducted (n=1221). The dependent variable was whether these children received ORS therapy. The contextual independent factors were socio-demographic variables (mothers’ age, child’s age, child’s sex, child’s place of residence, household wealth, and mother/ husband/partner’s education levels and work status), as well as media exposure and healthcare utilization.Results: The prevalence of ORS therapy use among the children was 30%. Mothers who had made at least four prenatal visits during their last pregnancy were 87% more likely to use ORS therapy for their children than those who had fewer prenatal visits (OR=1.874; CI: 1.140-3.082; p=0.013).Conclusions: Integrating efforts for scaling-up ORS use with prenatal health care services may have an extra benefit of promoting children’s wellbeing and survival.Significance for public healthIn Ethiopia, diarrheal diseases are the second leading cause of death among children under five years of age. One of the United Nation’s Sustainable Development Goals is aimed at substantially reducing preventable child mortality by 2030. Oral rehydration salts (ORS) therapy is the most effective intervention for diarrheal case management, but it is consistently underutilized. Understanding the contextual factors of caregivers of children and their association with ORS use in children under five may help achieve wider use. Our results show that ORS therapy use for children under five with diarrhea was inadequate at just 30%. We also found that women who had visited prenatal health facilities four times or more during their last pregnancies were 87% (OR=1.874; CI: 1.140-3.082; p=0.013) more likely to use ORS therapy for their children with diarrhea than women with fewer prenatal visits. In scaling-up ORS therapy, integrating efforts with prenatal health care services for pregnant women may contribute to expanded use and improved child survival.

Prevalence and risk factors for typical signs and symptoms of toxoplasmosis in children born to at risk pregnant women attending prenatal care in Temeke district, Tanzania

The study determined the prevalence of typical signs and symptoms of toxoplasmosis in children born to at risk pregnant women in Temeke district, Dar es Salaam City, Tanzania. It was a cross sectional study of 371 pregnant women attending Prenatal clinics for prenatal health care services in Temeke district.The overall prevalence of signs and symptoms typical of toxoplasmosis was 13% (95% CI=9.5-16.4%).The proportions of signs and symptoms related to Toxoplasmosis reported in children are as follows; eye problems (4.8%, 95% CI=2.7-7.0%), hydrocephalus (3.2%, 95% CI=1.6-5.4%), mental retardation (3%, 95% CI=1.4-5.0%) and paralysis (2%, 95% CI=0.7-3.6%). After adjusting for other factors, we found a very strong association with a wide confidence interval between multigravida and prevalence of typical signs and symptoms of toxoplasmosis in children (AOR=40.89, 95% CI=4.65-359.93%). Marriage was also found to be strongly associated with signs and symptoms of toxoplasmosis in children (AOR=8.22, 95% CI=2.91-23.21%).The study findings indicate that there is low prevalence of signs and symptoms typical of toxoplasmosis among children born to at-risk pregnant women attending prenatal clinics in Temeke district, but are of clinical relevancy considering the sequelae of the disease in affected children.Based on the current study findings, it is imperative to either clinically or serologically screen both pregnant women and newborns for Toxoplasma gondii infection in order to get a conclusive evidence of prevalence of toxoplasmosis in children born to at risk women in Temeke District in Tanzania and thus limits the risk of occurrence of congenital toxoplasmosis and clinical outcomes of the disease in newborns in Tanzania.

Is there a relationship between basic birth beliefs and pregnancy-related anxiety in Turkey.

It is important to investigate the relationship between the beliefs about birth as a natural or medical process and the pregnancy-related anxiety that has a powerful impact on the negative outcomes of labor. This study was aimed at investigating the relationship between basic birth beliefs and pregnancy-related anxiety in Turkey. This descriptive, cross-sectional and correlational study was conducted in a University hospital located in eastern Turkey. The study sample included 473 primiparae having completed 14 weeks of pregnancy. The Birth Belief Scale and Pregnancy-Related Anxiety Questionnaire/PRAQ-R2 were used to collect the data. A relationship was found between birth beliefs and pregnancy-related anxiety. Strong beliefs about birth as a medical process or weak beliefs about birth as a natural process were found to be related with fear of giving birth and worries about bearing a handicapped child. A relationship was detected between beliefs of pregnant women about birth as a medical and natural process and fear of giving birth, worries about bearing a handicapped child., concern about own appearance. It is highly important to detect the birth beliefs in order to help women have a healthy pregnancy period and to decrease their anxiety levels. Pregnancy-related anxieties of women must be detected, and their birth beliefs that result in anxiety must not be overlooked during the provision of prenatal healthcare services.

Turkish version of the Pregnancy-related Anxiety Scale: A psychometric study.

To adapt the Pregnancy-related Anxiety Scale (PrAS) into Turkish and evaluate its psychometric properties. This cross-sectional study comprised of 400 pregnant women. The PrAS was translated using the methods of translation, back-translation, consensus meetings, and a trial of potential users. Then, its psychometric properties were evaluated by exploratory factor analysis and confirmatory factor analysis. The PrAS consists of 33 items. Following the exploratory factor analysis, the two items in the scale were discarded because factor loads were less than 0.50, therefore, the number of items decreased from 33 to 31. In the confirmatory factor analysis, the goodness-of-fit indices of the scale were found to be suitable. The internal consistency coefficient calculated for the reliability of the scale was .89. After correlating it with another scale for measuring pregnancy distress, the Turkish version of the PrAS shows discriminant validity. The Turkish version of the PrAS is a valid and reliable instrument that can be used to evaluate pregnancy-related-anxiety. The use of the PrAS in prenatal healthcare services will contribute to the early diagnosis, treatment, and management of pregnancy-related anxiety.

Reproductive Healthcare Experiences of Incarcerated Women: A Qualitative Study [30F

INTRODUCTION: The U.S. prison population has reached an all-time high, with women representing the fastest growing sub-population. Recently, national medical organizations recognized inadequate correctional health care as a major problem. Despite this awareness, the U.S. correctional health care system remains fragmented and non-uniform in practice, particularly in women’s healthcare, with poor transitions between incarceration and the community. The purpose of this study was to examine how formerly incarcerated women navigate this system to address their reproductive healthcare needs. METHODS: Adult, English-speaking women with history of incarceration within the last 10 years were interviewed using a semi-structured interview tool. Interviews were analyzed using modified grounded theory and stopped upon thematic saturation. Interview themes were used to create a conceptual framework to describe this fragmentation. RESULTS: 21 women completed the study interview. They were on average 43 years old, with 7 periods of incarceration. 80% had children, and 52% were pregnant while incarcerated. Most women described fragmentation of care with inability to consistently access reproductive and prenatal healthcare services. Frequent transitions between institutions exacerbated problems with access. A high prevalence of mental health issues, including high rates of substance use disorder contributed to difficulty accessing needed services. Women suggested better coordination of care could improve their long-term health. CONCLUSION: This study illuminates the persistent reproductive health barriers that face formerly incarcerated women. Programs are needed to address the physical and mental health needs for women transitioning from incarceration back into the community.

Effects of Migration on Infant and Maternal Health in China.

We assess the association between maternal migrant status and health outcomes in China, which has one of the world’s largest migrant populations. Health records from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to June 30, 2017, were used to analyze 104 681 live births for Shanghai native-born and migrant women based on International Classification of Diseases, Tenth Revision diagnosis codes and demographic data. Regression analysis including propensity score matching was conducted to investigate the association between maternal migrant status and adverse infant birth outcomes (fetal disease, congenital malformation, neonatal disease) and maternal health after controlling for pregnancy status and socioeconomic factors. The results demonstrate that migrant women had statistically significant increased odds (9.1%-10%, P < .001) of having infants with adverse health outcomes compared with their urban counterparts and that migrant mothers have less likelihood of pregnancy complications and gestational diabetes mellitus. Our results show the mixed effects of migration on infant and maternal health may be a possible outcome of China’s Hukou system that often represents an important barrier in accessing prenatal health care by migrant women. Current reforms that improve access to prenatal health care services for migrant women may enhance the health outcomes of their infants.

“Soothing My Child's Soul and My Own”: Dealing with Pregnancy Loss in Postcommunist Romania

AbstractIn Romania—where induced abortions were legally prohibited during communism and are now morally condemned by many—those who lose a pregnancy against their will have long been regarded with suspicion, confronted with a sense of culpability, and surrounded by silence. This ambiguity is reflected in the local terminology and the perceived etiology of loss. In this article, which is based on 15 months of fieldwork between 2012 and 2015, I illustrate the various meanings and manifestations of a silenced sense of culpability around involuntary pregnancy loss in the lives of women from Bucharest and a small town in Central Romania. I also show how many of these women attempt to break the silence around their lost fetuses and carve out a personal space of commemoration and consolation. Their informal use of forbidden religious rituals paradoxically allows them to confirm the existence of their lost little ones and to position themselves as caring, rather than culpable, mothers. [pregnancy loss, commemoration, culpability, postcommunist Romania]

Turkish adaptation of the pregnancy-related anxiety questionnaire-revised 2: Validity and reliability study in multiparous and primiparous pregnancy

ObjectiveThe purpose of this study was to create a Turkish version of the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQR2), which was revised for application to multiparous and primiparous pregnancy, and to explore its psychometric characteristics in multiparous and primiparous pregnancy. DesignThis study was methodologically designed to assess the reliability and validity of the PRAQ-R2. SettingThe study was carried out in the obstetrics clinic of a training and research hospital in Malatya. ParticipantsA total of 616 healthy pregnant women (399 multiparous and 217 primiparous) constituted the sample of the study. MethodsThe cultural adaptation process of the questionnaire was conducted in three phases: language validity, content validity, and pilot application. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the construct validity of the questionnaire. The reliability of the PRAQ-R2 was evaluated with Cronbach's alpha internal consistency coefficient, item-total correlation, test-retest analysis, and parallel forms reliability. FindingsThe EFA revealed that the PRAQ-R2 consists of 10 items for the multiparous group and 11 for the primiparous group after adding the item ``I am anxious about the delivery because I have never experienced one before.'' The CFA for both groups supported the three-factor questionnaire yielded by the EFA. Good fit index values were obtained in both groups. Cronbach's alpha internal consistency coefficient ranged from 0.81 to 0.93 for the multiparous group and 0.87 to 0.94 for the primiparous group for the complete PRAQ-R2 and each of its subdimensions. In addition, the item-total correlation, test-retest analysis, and parallel forms reliability of the questionnaire were highly correlated. ConclusionThe PRAQ-R2 is a valid and reliable instrument that can be used to evaluate the level of anxiety in Turkish pregnant women irrespective of parity. Implications for practiceThe use of the PRAQ-R2 in prenatal healthcare services will contribute to the early diagnosis, treatment, and management of pregnancy-related anxiety.

Access and Utilization of Prenatal Health Care Services in Rural Communities: A Study of Isiekenesi in Imo State.

Pregnancy and childbirth complications are leading causes of death and disability among women of reproductive age, especially in developing countries, with Nigeria experiencing 576 deaths in every 100,000 births. This is particularly worrisome when most of these deaths could be prevented if pregnant women seek prenatal health care services. It is in the light of the foregoing that this research investigates the level of access and factors that influence use of prenatal health care services in Isiekenesi. Secondary and primary data were used for this study. The study adopted questionnaire, IDI, and FGD as data collection instruments. The data was analyzed at univariate and bivariate levels. The high cost of prenatal health care services was identified as a major factor that influences a woman's decision not to use prenatal health care services. Finally, while all stakeholders should intensify awareness of the importance of using prenatal health care services, concerted effort should be channeled toward reduction of cost or outright free services at least in government-owned health centers in rural areas.

Immigrant mothers and access to prenatal care: evidence from a regional population study in Italy

ObjectivesWe addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results.SettingThis study is on...

Nutritional Status of Under- five Children in Hawassa Zuria District, Southern Ethiopia

Almost, half of the under five children in Ethiopia are malnourished. The objective of this study was to estimate and identify determinants of nutritional status among under-five children in Hawassa Zuria District Southern Ethiopia. This survey was conducted by house to house visit through two-stage sampling using community based cross-sectional study design in 6 randomly selected kebeles during April 15-30, 2011. 721 children in total, aged 6-59 months old were studied to assess nutritional status in terms of stunting, wasting, and underweight. Socio-economic, health related and demographic measures were obtained from structured questionnaire. Also, anthropometric measurements were taken from each child in the study. Binary and multinomial logistic regressions were used to relate underlying factors to the adjusted odds of malnutrition indices. The results indicated that the overall prevalence of stunting, underweight, and wasting were 45.8 %, 31.9 %, and 23.6%, respectively. Female children were more stunted, under weight and wasted relative to males (OR = 1.67, 0.600 and 1.47), respectively. Children who had uneducated mothers were significantly more likely to be moderately underweight as compared to those of whose mothers had secondary and above educational level (OR= 0.35, CI: 0.16–0.79). Nutritional status in the study area among study population was categorized in low levels. However, planning the public preventive strategies in the district can help to control under-nutrition based on underlying factors of in the study population including, maternal education, maternal pre-natal health care services, toilet facility, child health care services and safe water supply

Socio-demographic determinants and access to prenatal care in Italy.

BackgroundMany governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria.MethodsData were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits.ResultsThe study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly.ConclusionsThe aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.

Study on the related factors of prenatal health care among floating women in five cities of China

To understand the current status of prenatal health care (PHC) and its related factors for floating women of childbearing age, and to provide evidence for improving the quality of PHC at childbearing age. With data from the reproductive health survey on floating population in five cities, Beijing, Nanjing, Xiamen, Shenzhen and Chongqing, in 2005, the distributions of PHC among floating women were described. Multivariate logistic regression was performed to investigate the factors related to the utilization of PHC. In 5 399 cases of valid questionnaires, 4 037 floating women who had the history of pregnant, cases who had or did not have PHC services would account for 75.3% (3 041/4 037) and 24.7% (996/4 037), respectively. The initial time of using the PHC service was significantly associated with the level of their education (P < 0.05) received. Data from the multivariate logistic regression analysis in PHC showed that there were differences between regions (P < 0.05). Proportions of women receiving PHC among those under 30 years and 30-39 were 4.09-folds (95% CI:3.11-5.39) and 1.98-folds (95% CI:1.61-2.43), respectively, when compared with that of women over 40-year-old. The proportion of women having received PHC with education levels of senior high school and above or junior high school, were 5.47-folds (95%CI:3.85-7.77) and 2.86-folds (95%CI:2.42-3.39) respectively, compared to that of women with education level of primary school or below. The proportion of married women having PHC was 2.36-folds (95%CI:1.07-5.22) of those unmarried women. The proportions of having PHC of women with one parity and two parities or with family planning certificate were 3.36-fold (95%CI: 2.33-4.84) and 1.61-fold (95% CI:1.12-2.30), 1.44-folds (95% CI:1.21-1.71) respectively, when compared with those women with three parities or without the certificate. Factors as having received higher education, being married, with less parities or having family planning certificate etc. showed protective effects on PHC for floating women of childbearing age. Based on PHC, education should be promoted among the floating women of childbearing age, which would contribute to the prevention and reduction of adverse outcomes related to reproductive health.