Uptake Of Maternal Healthcare Research Articles

The effect of child marriage on the utilization of maternal health care in Nepal: A cross-sectional analysis of Demographic and Health Survey 2016

A range of demographic and socioeconomic factors are known to account for enormous disparities in the uptake of maternal health care in low- and middle-income countries. In contrast, contextual factors such as child marriage are far less explored as a deterrent to the uptake of maternal health care. The present study aimed to assess the total effect of child marriage on the utilization of maternal health services in Nepal. This study drew on data from the Nepal Demographic and Health Survey 2016. The study restricted its analysis to a subsample of 3,970 currently married women of reproductive age who had at least one live birth in the five years preceding the survey. After descriptive analysis, logistic regression models were constructed to estimate adjusted odds ratios. The results of logistic regression controlling for confounders suggested child marriage decreased the likelihood of antenatal care visits (AOR 0.74; 95% CI 0.63–0.86), skilled attendance at delivery (AOR 0.66; 95% CI 0.56–0.78), facility-based delivery (AOR 0.65; 95% CI 0.56–0.77), and postnatal care use (AOR 0.80; 95% CI 0.67–0.96). The findings of this study reinforced the existing evidence for the adverse effect of child marriage on maternal health-seeking behaviors. Women’s restricted access to household resources, limited autonomy in decision-making, social isolation, and the dominant power of husbands and mothers-in-law may play a role in the findings. Addressing women’s social vulnerability as a barrier to accessing health care may help to increase the uptake of maternal health services.

A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study.

BackgroundThe public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization.ObjectiveIn this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs).MethodsCross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques.ResultsMore than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas.ConclusionsThe findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care.

The effects of individual and community-level factors on maternal health outcomes in Ghana.

BackgroundUtilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services.Methods and findingsUsing the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services.ConclusionsThe findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana.

Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia

BackgroundThe progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005–11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities.MethodsData for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services.ResultsIn this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor.ConclusionThe challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus, addressing socioeconomic inequalities in accessing maternal health services is central to resolving challenges of maternal health. Furthermore, as Ethiopia moves forward with the sustainable development agenda, socioeconomic inequalities in uptake of maternal health services should also be continuously monitored.

Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

BackgroundDiscussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai’s informal urban settlements, and to explore the reasons underlying their choices.MethodsThe study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15–49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices.ResultsThree thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider.ConclusionsIn Mumbai’s informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.