Use Of Skilled Birth Attendants Research Articles

Prevalence and determinants of utilizing skilled birth attendance during home delivery of pregnant women in India: Evidence from the Indian Demographic and Health Survey 2015-16.

Utilization of skilled birth attendance during home delivery of pregnant women is proven to reduce complications during and after childbirth. Though the utilization of skilled birth attendance (SBA) during home delivery has increased significantly in recent times, the rate of utilizing skilled birth attendance is still low in several regions across India. The objective of this study is to analyze the prevalence and to identify the determinants of the utilization of skilled birth attendance during home delivery of pregnant women in India. To conduct this study, data and information from the Indian Demographic and Health Survey 2015-16 have been utilized. The sample size for this study is a weighted sample of 41,171 women. The sample consisted of women who had given a live birth in the three years preceding the survey. For women with more than one child, only the first live birth was considered. The binary logistic regression model and the log-binary logistic regression analysis have been applied as the adjusted odds ratios (AORs) with 95% confidence intervals for identifying the determinants of home-based skilled birth attendance during delivery. That allows us to select the most appropriate model for our study objective by ensuring that the determinants of skilled birth attendance for home delivery are accurately assessed based on the characteristics of the data. The analyses show that only 18.8% of women had utilized skilled birth attendance during delivery. Women residing in urban areas are more likely to utilize skilled birth attendance during home delivery (AOR: 1.14; 95% CI: 1.08-1.20). Women having higher education levels are associated with increased use of SBA during home delivery (AOR: 1.15; 95% CI: 1.04-1.28). Exposure to media is associated with increased utilization of SBA (AOR: 1.17; 95% CI: 1.11-1.23). Overweight women are also more likely to avail the SBA during home delivery (AOR: 1.11; 95% CI: 1.03-1.19). Women belonging to affluent households have higher odds of utilizing skilled birth attendance (AOR: 1.41; 95% CI: 1.33-1.49). Having 3+ tetanus injections is associated with the utilization of SBA (AOR: 1.56; 95% CI: 1.43-1.69). Women having 4+ antenatal care visits were more likely to utilize SBA (AOR: 1.81; 95% CI: 1.71-1.92). Women belonging to the Hindu religion were 1.12 times more likely to utilize SBA (AOR: 1.12; 95% CI: 1.07-1.18). Women with 1 to 3 birth orders were 1.40 times more likely to utilize skilled birth attendance during home delivery (AOR: 1.40; 95% CI: 1.30-1.51). The percentage of women utilizing skilled birth attendance during home delivery is still very low which is a matter of serious concern. Several factors have been found to be associated with the utilization of SBA during home delivery in India. As skilled birth attendance has significant positive health outcomes for pregnant women and newborns, efforts to increase the rate of SBA utilization during home delivery should be undertaken.

Client’s Experiences on Skilled Delivery Services among Women of Reproductive Age in Rural Communities in Kenya

Background: Globally Skilled delivery services are critical aspects to combat Maternal and neonatal mortality. In Kenya, skilled deliveries account for 62% of all deliveries; unskilled deliveries pose a higher risk of maternal and neonatal mortality and morbidity. The maternal mortality ratio in Kenya is currently 462 per thousand live births, with 40% of these deaths occurring at home. The main objective of the study was to explore the experiences of women of reproductive age on skilled delivery services.
 Materials And Methods: The baseline study was conducted between November 2022 and January 2023. It employed a cross-sectional research design involving 347 women of reproductive age. The study aimed to examine their current practices, challenges, and experiences with skilled delivery services. Focus Group Discussions (FGDs) were conducted with 48 recently delivered women (within one year), as well as with 48 Community Health Volunteers (CHVs) and 10 Community Extension Workers (CHEWs). In-depth interviews were also held with local health facility administrators. Quantitative data analysis was performed using SPSS version 25.0. Measures of central tendency were employed for continuous data tabulation. The analyzed data was then presented through charts, tables, and frequencies. The qualitative data underwent thematic arrangement and analysis using NVIVO version 13 and then triangulated with descriptive data.
 Results: The results revealed that (90.6%) of women's previous childbirth experiences influenced their utilization of skilled birth attendance services in subsequent pregnancies. Women who had never given birth in health facilities or had chosen home births were less likely to utilize skilled birth attendance services.
 Conclusion and Recommendations: This study identified factors influencing skilled birth attendance use in Kandara SubCounty, highlighting the role of previous childbirth experiences, health facility-related factors, and danger signs during pregnancy. To improve utilization, interventions should focus on health facility conditions, health worker attitudes, and community awareness programs.

Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey.

Studies examining skilled birth attendants (SBA) use and its correlation with maternal mortality at lower administrative levels are scarce. This study assessed the coverage and variations of SBA, the physical accessibility of health facilities for SBA, and the association of SBA with maternal mortality. A cross-sectional study using a population-based household survey was conducted in six Sidama National Regional State, southern Ethiopia districts, from July 2019 to May 2020. Women who had given birth in the past two years before the study were included. Stata 15 and ArcGIS 10.4.1 were used for data analysis. A multilevel logistic regression analysis was conducted to assess the effect of the sampling units and identify factors independently associated with SBA. The association between SBA and maternal mortality was examined using maternal mortality household survey data. A total of 3191 women who had given birth in the past two years and resided in 8880 households sampled for the associated maternal mortality household survey were interviewed. The coverage of SBA was 46.7%, with high variations in the districts. Thirty percent of SBA use was accounted for by the differences among the districts. One-third of the women travel more than two hours on foot to access the nearest hospital. Districts with low coverage of SBA and located far away from the regional referral centre had high maternal mortality. Education of the mother, occupation of the husband, pregnancy-related complications, use of antenatal care, parity, and distance to the nearest hospital and health centre were associated with the use of SBA. The coverage of SBA in the Sidama Region was low, with high variations in the districts. Low SBA use was associated with high maternal mortality. Due attention should be given to districts with low coverage of SBA and those located far away from the referral centre. Access to hospitals has to improve. All women should be encouraged to get antenatal care services.

Intimate partner violence and its association with skilled birth attendance among women in Nigeria: evidence from the Nigeria Demographic and Health Surveys

BackgroundIntimate Partner Violence (IPV) has been identified as a violation of human rights and a major public health challenge. IPV against women has negative effects on women’s mental well-being and leads to unfavourable health outcomes through poor maternal healthcare services utilisation, especially skilled birth attendance (SBA). This study examined the trends in IPV and SBA, as well as the different forms of IPV as predictors of SBA in Nigeria.MethodsData for the study were derived from a nationally representative weighted sample of 34,294 women selected and interviewed for the questions on the domestic violence module in the three consecutive Nigeria Demographic and Health Surveys conducted in 2008, 2013 and 2018. Descriptive and analytical analyses were carried out, including frequency distribution and binary logistic regression model at the multivariate level. The results of the explanatory variables were expressed as odds ratio (OR) and 95% confidence intervals (CI).ResultsThe prevalence of emotional and physical IPV among the sampled women decreased in 2013 from 2008 but later increased in 2018. Sexual IPV increased from 4.1% in 2008 to 7.6% in 2018, while births delivered with the assistance of skilled providers increased from 37.7% in 2008 to 50.8% in 2018. The likelihood of using SBA significantly decreased among women who experienced emotional IPV in 2008 (aOR: 0.74; CI: 0.63–0.87) and sexual IPV in 2018 (aOR: 0.62; CI: 0.45–0.86). Women who experienced physical IPV were more likely to use SBA in 2008, 2013 and 2018 (aOR: 1.72; CI: 1.55–1.92; aOR: 1.40; CI: 1.26–1.56 and aOR: 1.33; CI: 1.15–1.54, respectively). The covariates have varying degrees of influence on SBA across the survey years.ConclusionsThe showed that the prevalence of emotional and physical IPV increased in 2018 after a decrease in 2013, with an increase in sexual IPV and the use of SBA across the survey years. Also, emotional and sexual IPV, unlike physical IPV are associated with low chances of using SBA. There is a need for more pragmatic intervention programmes towards eliminating all forms of violence against all women, reducing maternal and child mortality and promoting the empowerment of women.

Factors Associated with the Use of Skilled Birth Attendants in Indonesia

The maternal mortality rate in Indonesia of 305/100,000 live births is still far from the SDGs target in the year 2030, which is 70/100,000 live births. The WHO states that the main causes of maternal mortality are bleeding, infection, preeclampsia-eclampsia, complications of childbirth, and unsafe abortion. This can be prevented if the mother can access health services, especially the use of skilled birth attendants to overcome complications of pregnancy and childbirth. This study aims to determine the factors associated with the use of skilled birth attendants in Indonesia. This cross-sectional study with a total sample of 4.543 women aged 15-49 years who gave birth to the last child selected in a sample of secondary data Indonesia Demographic Health Survey (IDHS) 2017. The dependent variable of the study was a skilled birth attendants and the independent variable was sociodemographic factors (age, education, employment, area of residence), antenatal factors (antenatal care examiner, antenatal place, antenatal frequency), medical factors (pregnancy complications and birth complications). The results of this study indicate that the dominant factor in the selection of skilled birth attendants is pregnancy examiners. Pregnancy examiners who examine the pregnancy by an obstetrician have the opportunity to choose a permanent delivery at an obstetrician, which is 8.33 (95% CI 6,75 – 10,29) times compared to choosing a midwife after being controlled by other variables.

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

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

Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs

ObjectiveData from the Nigeria Demographic and Health Survey indicate that many pregnant women in rural Nigeria use traditional birth attendants (TBAs) rather than skilled birth attendants (SBAs) for maternal health care. This is one factor that accounts for the persistently high rate of maternal mortality in Nigeria. The objective of this study was to identify the pervading reasons that women use TBAs for pregnancy care in rural Nigeria and to make recommendations for policy and programmatic reform. DesignQualitative research design consisting of focus group discussions, key informant interviews, and community conversations, followed by inductive thematic analysis. SettingTwenty rural communities (villages) in Etsako East, and Esan South East Local Government Areas of Edo State, South-South, Nigeria. ParticipantsTwenty focus group discussions with men and women in a marital union; 15 key informant interviews with policymakers, senior health providers, and women leaders; and 10 community conversations with key community leaders. FindingsSome reasons proffered for using TBAs included perceptions of higher efficacy of traditional medicines; age-long cultural practices; ease of access to TBAs as compared to SBAs; higher costs of services in health facilities; and friendly attitude of TBAs. Key conclusions and implications for practiceThe continued use of TBA is a major challenge in efforts to achieve the Sustainable Development Goal 3 in Nigeria. We conclude that efforts to address the factors identified by community stakeholders as inhibiting the use of SBAs will promote skilled birth attendance and reduce maternal mortality in rural Nigeria.

Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis.

IntroductionIn 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA.Materials and methodsThis study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs).ResultsThe overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance.ConclusionThese findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Factors influencing maternal healthcare seeking in a highland region of Madagascar: a mixed methods analysis

BackgroundIn Madagascar, maternal mortality remains stable and high (426 deaths per 100,000 live births). This situation is mainly due to a delay or lack of use of maternal healthcare services. Problems related to maternal healthcare services are well documented in Madagascar, but little information related to maternal healthcare seeking is known. Thus, this paper aims to identify and analyze the factors that influence the utilization of maternal services, specifically, the use of antenatal care (ANC) during pregnancy and the use of skilled birth attendants (SBAs) at delivery.MethodWe used quantitative and qualitative approaches in the study. Two communes of the Vakinankaratra region, which are located in the highlands, were the settings. Data collection occurred from October 2016 to July 2017. A total of 245 pregnant women were included and followed up in the quantitative survey, and among them, 35 participated in in-depth interviews(IDIs). Logistic regressions were applied to explore the influencing factors of antenatal and delivery healthcare seeking practices through thematic qualitative analysis.ResultsAmong the 245 women surveyed, 13.9% did not attend any ANC visits. School level, occupation and gravidity positively influenced the likelihood of attending one or more ANC visits. The additional use of traditional caregivers remained predominant and was perceived as potentially complementary to medical care. Nine in ten (91%) women expressed a preference for delivery at healthcare facilities (HFs), but 61% of births were assisted by a skilled birth attendant (SBA).The school level; the frequency of ANCs; the origin region; and the preference between modern or traditional care influenced the use of SBAs at delivery. A lack of preparation (financial and logistics problems) and women’s low involvement in decision making at delivery were the main barriers to giving birth at HFs.ConclusionThe use of maternal healthcare services is starting to gain ground, although many women and their relatives still use traditional caregivers at the same time. Relatives play a crucial role in maternal healthcare seeking. It would be necessary to target women’s relatives for awareness-raising messages about ANC and childbirth in healthcare facilities and to support and formalize collaborations between traditional healers and biomedical caregivers.

Trends, regional inequalities and determinants in the utilization of prenatal care and skilled birth attendant in Ethiopia: A multilevel analysis

BackgroundEthiopia has made a substantial reduction in maternal mortality over the last two decades. However, maternal health care utilization among 15–49 aged women remains low despite this progress. The study aimed to examine trends, regional inequalities, and potential determinants associated with prenatal care utilization and a skilled birth attendant from 2000 to 2016 in Ethiopia. MethodsNationally representative data extracted from the 2000 to 2016 Ethiopia Demographic and Health Surveys (EDHS), conducted every five years among 15–49 age women in Ethiopia. We used multilevel logistic analysis incorporating the demographic, socioeconomic, and health variables that are independently associated with prenatal care (PNC) and skilled birth attendant (SBA) use. ResultsThe prevalence of prenatal care utilization was relatively stagnant between 2000 and 2011 but showed an overall increase nationwide from 26.7% to 62.4% between 2000 and 2016 (p-value < 0.001). The prevalence of skilled birth assistance increased only by 16.5% in the past fifteen years, from 5.6% in 2000 to 22.1% in 2016. Rural type of residence, lower maternal education, lower household wealth index, lower partner's education, an immense distance of getting medical help were steadily significantly associated with prenatal health care use and skilled birth attendants. Further, male household heads, younger age women, and no covered health insurance were associated with lower odds of skilled birth attendant use. ConclusionsThough overall prenatal care and skilled birth attendant use prevalence have improved nationally, the regional disparity is uneven. Therefore, to sustain the progress equals more attention is needed for Afar, Somali, and Oromia regions to increase maternal health care services utilization in Ethiopia.

Maternal health care service utilization among young married women in India, 1992\u20132016: trends and determinants

BackgroundMaternal deaths among young women (15–24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India.MethodsThe study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15–24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05.ResultsThe use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992–2016. SBA utilization was 88 and 83% during 2015–16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time.ConclusionsIn India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.

Pengaruh Pemberdayaan Wanita terhadap Pemilihan Penolong Persalinan pada Tenaga Kesehatan Terampil

Angka Kematian Ibu (AKI) di Indonesia tahun 2015 diperkirakan sebesar 305 kematian per 100,000 kelahiran hidup. Upaya besar perlu dilakukan untuk mencapai target SDGs pada tahun 2030, yaitu 70 kematian maternal. Peningkatan otonomi dan pemberdayaan wanita diharapkan mampu meningkatkan peran wanita dalam keputusan terkait dengan kese-hatannya. Penelitian ini bertujuan untuk menunjukkan pengaruh pember-dayaan wanita terhadap pemilihan penolong persalinan pada tenaga kesehatan terampil, dengan menggunakan data SDKI 2017. Jumlah sampel penelitian ini adalah 14.835 wanita yang berumur 15-49 tahun dengan minimal satu anak lahir hidup, berstatus kawin atau hidup bersama dengan pasangan. Indikator pemberdayaan wanita yang digunakan adalah pendidikan, partisipasi pengambilan keputusan, negosiasi berhubungan seksual dan perilaku terhadap pemukulan. Analisis data dilakukan dengan analisis regresi logistik biner. Seluruh indikator pemberdayaan perem-puan, kecuali partisipasi pengambilan keputusan, berpengaruh positif dan signifikan terhadap penggunaan tenaga kesehatan terampil, setelah di-kontrol dengan karakteristik sosiodemografis. Hasil penelitian ini menun-jukkan bahwa meningkatnya penggunaan tenaga kesehatan terampil saat persalinan dapat dilakukan dengan meningkatkan pemberdayaan perem-puan, antara lain melalui pendidikan dan penundaan usia kawin. Kebijakan yang tepat sasaran dapat dilakukan dengan mengidentifikasi faktor-faktor yang meningkatkan penggunaan tenaga kesehatan terampil.

Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study

BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where...

Dominant Factors Affecting Regional Inequality of Infant Mortality in Vietnam: A Structural Equation Modelling Analysis.

Background: Despite Vietnam’s acclaiming achievements of reducing overall infant mortality rate (IMR), the IMR decline does not occur equally in all regions in Vietnam. This study aims to investigate dominant factors that affect the inequality of infant mortality across regions in Vietnam during the period 2005-2015. Methods: We use nationally representative data to construct a panel data of 6 economic regions in Vietnam from 2005 to 2015. We employ the structural equation modelling (SEM) approach to quantify the causal effect of socio-economic status (SES), accessing to skilled birth attendance (SBA) and other relevant factors on the disparity of IMR across regions. Results: SES, which is measured by 3 indicators – illiteracy rate (IR), poverty rate (PR) and income per capita – is the dominant factor causing regional inequalities of infant mortality, followed by the use of SBA. Among these indicators, the PR is the most important one causing the regional disparity of IMR and accessing to SBA. The total effect of SES on infant mortality disparity is 2.6 times as high as that of accessing skilled healthcare personnel. Conclusion: Bridging the regional gap of using skilled health personnel would contribute to improving the infant mortality inequality in Vietnam. This inequality, however, is not significantly improved only with medical interventions but also with broader and more comprehensive socio-economic interventions at both national and regional levels. Our findings confirm that poverty reduction and growth strategies should be the main focus to boost medical interventions and improve IMR all over the country.

Community-based savings groups, women’s agency, and maternal health service utilisation: Evidence from Mozambique

ABSTRACT This study, using data collected as part of an ongoing programme evaluation, investigates whether participation in Saving Groups (SGs)—a community-owned microfinance intervention focused on poor households – is associated with maternal health service utilisation, and whether this association is mediated by women’s agency – as measured by self-efficacy and decision-making autonomy. We compared maternal health service utilisation among SG members (n=105) and non-members (n=100) in rural Mozambique. We estimated prevalence ratios for SG membership and women’s agency using Poisson regression while controlling for confounding factors. We also estimated mediation effects for women's agency. The results showed that SG membership is associated with four or more antenatal care (ANC) visits, skilled birth attendant (SBA) use, and postnatal care within 48 h of delivery. Self-efficacy mediated the relationship between SG membership and ANC vists and SBAuse, but not postnatal care; whereas women’s decision-making autonomy mediated the relationship with SBA use and postnatal care, but not ANC visits. This study suggests that the impact of SG membership on use of maternal health services goes beyond improvements in household income and may operate through women’s agency by giving women the ability to realize their preference for quality health care.

Influence of Socio-cultural and Physical Factors on Use of Skilled Birth Attendants by Pregnant Women at Central Region

The purpose of the study was to assess the effects of socio-cultural and physical factors on the use of SBAs in the Central Region of Ghana. Among socio-cultural and physical factors which may influence use of SBAs with current pregnancy were money for transport and health care (65%), distance (58%), knowledge about signs of labor (51%), and need for closer attention from relatives (51%). The differences from the two logistic regression model analysis that were done were statistically significant (χ2=7.06, p=0.0079). The odds of SBA utilization for mothers who needed closer attention from relatives were 1.6 times higher (OR=1.56, 95% CI=1.05-2.34, p-value=0.027) than mothers who did not need closer attention. It was recommended that health service providers should ensure client and family-centered care is provided to make the health facilities user-friendly.

Nomads’ perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali

AimMore than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women. MethodsWe used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software. ResultsOur results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers’ attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive. ConclusionOur results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA.

Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis

BackgroundWith Bangladesh’s adoption of the third Sustainable Development Goal to reduce maternal mortality, the impetus for Bangladesh to continue to improve uptake of maternal healthcare is strong.MethodsUsing a propensity-score matched analysis, the present study utilized data from the 2014 Bangladesh Demographic Health survey to examine the impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery.ResultsThe results revealed a significant and positive impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery after matching treated and untreated mothers on included socio-demographic characteristics.ConclusionsImplementation of policies to provide at least four antenatal care visits may serve as an effective strategy to increase SBA use and institutional delivery in Bangladesh, which could contribute to the reduction of maternal mortality.

Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

ObjectivesTo examine the association between women’s autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.Design, setting and participantsWe analysed the Demographic and Health Survey (DHS) (2010–2016)...

Investigating pathways linking women's status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach.

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa where use of a skilled birth attendant (SBA) at delivery has remained low. Despite the recognized importance of women’s empowerment as a key determinant of maternal and newborn health, evidence from sub-Saharan Africa is more limited. Using data from the 2010 Tanzania Demographic and Health Survey (n = 4,340), this study employs a robust method–structural equation modeling (SEM)–to investigate the complex and multidimensional pathways through which women’s empowerment affects SBA use. The results show that women’s education and household decision-making are positively associated with SBA use. However, not all empowerment dimensions have similar effects. Attitudes towards sex negotiation and violence as well as early marriage are not significant factors in Tanzania. Mediation analysis also confirms the indirect effect of education on SBA use only through household decision-making. The findings underscore the utility of structural equation modeling when examining complex and multidimensional constructs, such as empowerment, and demonstrate potential causal inference to better inform policy and programmatic recommendations.