Use Of Maternal Health Care Services Research Articles

Predisposing and enabling factors influencing the utilisation of maternal healthcare services at fishing landing sites in Buikwe district, Uganda

Background: Studies have demonstrated that women who get professional healthcare personnel's prenatal, delivery, and postnatal care have better pregnancy outcomes, which lowers the incidence of both neonatal and mother deaths. Uganda is among the sub-Saharan African countries with the highest percentages of maternal deaths of which the majority of the deaths take place in remote, resource-constrained areas, such as fishing landing sites. We investigated the factors influencing the use of maternity healthcare services by women from remote Lake Victoria islands fishing settlements in the Buikwe district of Uganda. Methods: A cross-sectional study design with a quantitative approach was used. One hundred and four mothers were recruited in the study carried out at Ssenyi, Kiyindi and Nkombwe landing site in Buikwe district. Questionnaires were used to obtain information from mothers about predisposing factors, and enabling factors. Multinomial logistic regression was used to determine which factors influenced the use of maternal healthcare services. Results: Marital status (p=0.045, aOR=0.582; 95% CI=0.163-2.082) and paternal occupation (p=0.017, aOR=1.335; 95% CI=0.059-8.348) were the factors influencing maternal healthcare service utilisation among the respondents. Conclusions: Increasing the amount of actions meant to raise socioeconomic standing and involving the men in maternal health seeking might aid in enhancing maternal healthcare services use by women at the landing sites in Uganda.

Adolescents’ experience of mistreatment and abuse during childbirth: a cross-sectional community survey in a low-income informal settlement in Nairobi, Kenya

BackgroundAdolescent girls in Africa have poorer maternal health outcomes than older women partly because they are less likely to access antenatal and facility-based delivery care. Mistreatment and abuse of adolescents...

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study

BackgroundProper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15–49 years.MethodsThis study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15–49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16.ResultsOverall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services.ConclusionsFindings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women’s economic empowerment and education to reduce the barriers.

Health-seeking behaviours of pregnant adolescents: a scoping review

Background/Aims Adolescent pregnancy has become a global concern because of its potential impact on health and childbirth, as well as its socioeconomic and psychological consequences. The aim of this study was to investigate pregnant adolescents' experiences seeking healthcare, to identify factors influencing their use of maternal healthcare services. Methods A scoping review for articles published in the last 10 years from six databases was conducted. A total of 25 studies that described pregnant adolescents' health-seeking behaviour during pregnancy and childbirth were included. Results The majority of studies were conducted in Africa and most aimed to assess factors influencing health-seeking behaviours and use of antenatal care among pregnant adolescents. Ten studies used behavioural change theories and models. Several enabling factors and barriers influencing behaviour were identified. Conclusions Adolescents, families, communities and healthcare providers should work together to promote health-seeking behaviours among pregnant adolescents. Midwives should encourage pregnant adolescents to visit healthcare centres and provide positive antenatal care experiences.

Is there a link between the autonomy of women and maternal healthcare utilization in Nigeria? A cross-sectional survey

BackgroundDespite legislation and intervention programmes, the rates of maternal and child mortality in Nigeria remain high. Sustainable development goals on mother and child mortality would be a mirage if this continues. The study investigated the autonomy of women (women’s decision-making autonomy) and the use of maternal health-care services in Nigeria.MethodsSecondary data obtained from the Nigeria Demographic and Health Survey, 2018 were used in this investigation. Women who indicated they gave birth in the five-year before the surveys were considered in the study. The association between autonomy of women and maternal health-care utilization was studied using binary logistic regression models.ResultsIn total, about one-fifth of the women (19.6%) indicated they had at least eight ANC visits for their most recent birth. Overall, 40.5% of the women gave birth in a health institution, and 20.1% went for postnatal checkups. The use of health-care services was significantly related to the autonomy of women. Women’s and husbands/partners’ educational levels, residency and ethnicity were socio-demographic characteristics that influenced women’s healthcare service consumption.ConclusionsFor most recent childbirth, most women did not utilise the health-care services in Nigeria. To enhance the autonomy of women and, as a result, maternal health-care services use in Nigeria, effective interventions, policies, and programmes are required.

Inequalities in maternal healthcare use in Sierra Leone: Evidence from the 2008-2019 Demographic and Health Surveys.

BackgroundSierra Leone is one of the countries with poor health outcomes. The country has made some progress in the uptake of maternal health services. Despite improvements in the national coverage rates, there is no evidence of how equal these improvements have been.ObjectiveTo estimate inequalities in maternal healthcare use in Sierra Leone.MethodsUsing cross-sectional study data from 2008, 2013, and 2019 Demographic and Health Surveys (DHS), we study inequalities in maternal health services by computing rate ratios, and concentration indices (as well as concentration curves) using selected inequality stratifiers such as household wealth index, maternal education, and rural/urban place of residence.ResultsWe found that considerable progress has been made in increasing the uptake of maternal health services as well as reducing inequalities over time. We also found that inequalities in the selected health indicators favoured women from wealthy households, educated women, as well as women from urban areas. Although inequalities declined over time, the use of delivery services was highly unequal. However, of the selected health interventions, the use of four or more antenatal visits was almost at perfect equality in 2013 and 2019.ConclusionAlthough efforts have been made to increase the use of maternal healthcare services among women with a lower socioeconomic status, the use of maternal health services remains favourable to women with a higher socioeconomic standing. Therefore, policy initiatives need to prioritise women of lower socioeconomic status through projects aimed at increasing women’s educational levels as well as focusing on poverty reduction.

Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa

BackgroundPrevious studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa.MethodsWe utilized data from 29 sub-Saharan African countries’ Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval.ResultsYoung women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors.ConclusionOur study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.

Child marriage and its association with Maternal Health Care Services utilisation among women aged 20–29: a multi-country study in the South Asia region

Despite pervasiveness of child marriage in South Asian countries, its association with the usage of Maternal Health Care Services (MHCS) is poorly explored. In this study, we examined the impact of child marriage on MHCS utilisation among the prime reproductive aged women of five South Asian countries Afghanistan, Bangladesh, India, Nepal and Pakistan. Data for this study are extracted from the most recent Demographic and Health Surveys. The effect of child marriage on the use of MHCS was assessed by the multivariate logistic regression analysis. Findings reveal that in the South Asian region, the prevalence of child marriage is more common in Bangladesh, followed by Afghanistan, Nepal, India and Pakistan. Child marriage significantly (p< .01) deters the usage of MHCS – at least once antenatal care (ANC) visit, at least four ANC visit, Institutional delivery and seeking assistance from skilled birth assistance (SBA), though the effect size was somewhat different across the countries. Findings stipulate to remain girls in schooling more and the marriage acts of the countries should be enacted properly to diminish child marriage not only for increasing MHCS use, also for individual wellbeing and overall development of each country. Impact Statement What is already known on this subject? Child marriage in South Asian countries is commonplace despite substantial improvements of socioeconomic status. Although child marriage have many adverse reproductive and health outcomes, empirical evidence and systematic studies, particularly the association of child marriage with the usage of Maternal Health Care Services (MHCS) in the South Asian women are few. What do the results of this study add? Findings of this study affirm that prevalence of child marriage in South Asian region is still common. Although every country has set out minimum age at first marriage by acts, the acts are poorly followed, which adversely impacts the usage of MHCS among married women. What are the implications of these findings for clinical practice and/or future research? The study findings provide important insights of the consequence of child marriage on the skilled MHCS utilisation. The marriage acts of the countries should be enacted properly to restrict child marriage not only for increasing MHCS, also for individual wellbeing and overall development of each country. Study has important implications for planners, organisation managers and policy makers.

Geospatial differences among natural regions in the utilization of maternal health care services in India

BackgroundThe chances of a woman dying or becoming disabled during childbirth are closely connected to her socioeconomic status, cultural norms and values, and her home's geographical remoteness. Most of the studies were undertaken to address the issue of accessibility of the hospital's location and its impact on utilization of maternal healthcare utilization. Some studies also attempted to understand the pattern of utilization of healthcare utilization according to administrative and political regions. ObjectivesThis study aims to identify the Geographical differences in the utilization of maternal health services in India according to geographical regions, caste, religion, wealth status, and place of residence. Data and methodsData for analysis was taken from the National Family Health Survey-4 (2015–16). Data management and analysis were performed using statistical software Stata 13.0. To identify the regional differences in the use of maternal healthcare services, study used the 75 th round of NSS's classification of India into 88 natural regions. Regional variations in the usage of maternal health care were plotted using ArcGIS 10.5, and the bivariate method. ResultsResults shows that the utilization of partial ANC ranges from 33.8% to 91.9%. Utilization is lowest in the Northern Kerala region (33.8%) and, in ascending order, higher in Lakshadweep (34.4%), Goa (36.2%), Puducherry (43.1%), Southern Kerala (43.4%), Inland Tamil Nadu (44.5%), and Andaman and Nicobar Island (46.2%), the mountainous region of Jammu and Kashmir (46.7%), Coastal northern Tamil Nadu (49.9%) and Eastern Maharashtra (51.6%). Institutional delivery was the highest in Northern Kerala (100%) and lowest in the Nagaland (35.7%). Near-universal institutional delivery was also found in Southern Kerala (99.9%), Puducherry (99.9%), Coastal Northern Tamil Nadu (99.6%) and Lakshadweep (99.2%). ConclusionsDifferences in the utilization of MCHS by women can be seen among India's natural regions. Utilization is lagging in the Himalayan Mountain ranges, areas with dense forest cover, the Ganga and Brahmaputra plains, and the Desert region of Rajasthan.

Adopting Andersen's behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh.

Equitable maternal healthcare service access and it's optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen's behavior model of health service use as the theoretical framework. The 2017-18 Bangladesh Demographic Health Survey (2017-18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30-20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband's education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69-42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child's birth order, administrative regions, and area of residence (rural vs. urban). Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.

Decomposing the urban\u2013rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa

BackgroundThere has been a substantial improvement in reducing maternal mortality in the Sub-Saharan African region. The vast rural-urban gap in maternal health outcomes, however, is obscured by this average achievement. This study attempts to measure the contribution of identified risk factors to describe the average rural-urban difference in the use of antenatal care, health facilities for delivery, and health professional assistance at delivery.MethodTo achieve this objective, we used descriptive analysis and Fairlie non-linear decomposition method to quantify covariates’ contribution in explaining the urban–rural difference in maternal healthcare services utilisation.ResultThe study’s finding shows much difference between urban and rural areas in the use of maternal healthcare services. Socio-economic factors such as household wealth index, exposure to media, and educational level of women and their husbands/partners contributed the most in explaining the gap between urban and rural areas in healthcare services utilisation.ConclusionsInterventions to bridge the gap between urban and rural areas in maternal healthcare services utilisation in Sub-Saharan Africa should be centred towards socio-economic empowerment. Government can enforce targeted awareness campaigns to encourage women in rural communities in Sub-Sharan Africa to take the opportunity and use the available maternal health care services to be at par with their counterparts in urban areas.

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.

Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017\u201318 Jordan demographic and health survey

BackgroundDespite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan.MethodsThis study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression.ResultsOut of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001).ConclusionsJordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

Comparative study on maternal healthcare services utilisation in selected Empowered Action Group states of India.

The utilisation of maternal healthcare services is a principal indicator to measure the success of any maternal and child health programme. Suboptimal utilisation of maternal healthcare services is a vexatious problem in Empowered Action Group (EAG) states of India. This study aims to examine the currents status and socioeconomic determinants of antenatal services, skilled birth attendance and post-natal services in four infamous EAG states of India. This study used nationally representative, National Family Health Survey (NFHS, 2015-16) data for analysis. Descriptive statistics were used to depict the current status of maternal healthcare services utilisation and a discrete choice model was applied to examine the associated factors across the selected EAG states. The utilisation of maternal health services was higher in Rajasthan followed by Madhya Pradesh, Uttar Pradesh and Bihar respectively. Utilisation was consistently low among the socioeconomically disadvantaged women in all the selected EAG states. The study highlights that female education, mass media exposure, women's autonomy and economic status were significantly associated with the use of maternal healthcare services. The actualisation of our national and Sustainable Development Goals at the ground level is happening relatively slowly in the EAG states. Hence, achieving equitable distribution of resources, universal availability and access to information, counselling and reproductive services coupled with women empowerment are vital to the realisation of these goals.

Trends and projections of under-5 mortality in Bangladesh including the effects of maternal high-risk fertility behaviours and use of healthcare services.

This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services. Data from seven waves of the Bangladesh Demographic and Health Survey (1994-2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders. U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994-2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23-2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02-2.37) found to be significant determinants. There was a 39-53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27-0.97), delivery care (aOR, 0.47, 95% CI: 0.24-0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41-0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29-0.82) compared to its non-use. The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed.

Multidimensional Socioeconomic Deprivations of Maternal Health Care Services Utilisation: Evidence from Bangladesh

This paper examines the combined effect of three socioeconomic deprivations: education, wealth, and health on the utilisation of maternal health care services (MHCSs) among Bangladeshi women using the data of Bangladesh Demographic and Health Survey 2014. Both bivariate and multivariate statistical analyses were employed in this study. Multivariable logistic regression analysis is used to examine the effect of the multidimensional socioeconomic deprivations on the use of MHCSs. Of the women who had given at least one live birth in the three years preceding the survey, 43% were non-deprived by any dimension; 31% were deprived in one, 20% in two and 6% in all three dimensions. The prevalence of receiving four or more antenatal care (ANC) services was 31%; 38% used facility-based delivery (FBD) and 42% sought skilled birth assistance (SBA). When education and wealth deprivations were combined, women were significantly (P&lt;0.01) least likely to seek assistance from SBA (OR=0.18, 95% CI: 0.14-0.24) and FBD (OR=0.17, 95% CI: 0.12-0.22); and when all three deprivations were combined women were less likely to receive ANC at least once (OR=0.16, 95% CI: 0.12-0.22) than those who were not deprived. Programmes should be undertaken to expand maternal health voucher schemes in more sub-districts and quality of care should be ensured for equal accessibility and availability of MHCSs targeting deprived and disadvantaged areas and women to ensure safe motherhood practices in Bangladesh. Our findings show that the situation of maternal health care in Bangladesh is not satisfactory.Antenatal care

Explaining changing patterns and inequalities in maternal healthcare services utilization in India

This study aims to examine the long‐term changing patterns of inequalities in maternal healthcare services utilization and to quantify the contribution of selected factors that explain the gap between poor and nonpoor women in the use of maternal healthcare services. This study used three rounds of the National Family Health Survey (NFHS) data conducted during 1998–1999, 2005–2006, and 2015–2016. Using Blinder–Oaxaca decomposition method (BODM), this study explores the inequalities in maternal healthcare services utilization between poor and nonpoor women and examines the relative contribution of each predictor. The findings show that the utilization of maternal healthcare services was low among poor women. Comparison of maternal healthcare services utilization results over the years reveals that inequality has been rising. The decomposition analysis shows that women's education, mass media exposure, partner's education, and women's age at birth of first child contributed an important share to the gap in maternal healthcare services utilization. The use of maternal healthcare services remains disproportionately low among poor women. Therefore, the Government of India should put extra effort to directly target these women for reducing the gap in the use of maternal healthcare services.

Combination of Interventions Needed to Improve Maternal Healthcare Utilization: A Multinomial Analysis of the Inequity in Place of Childbirth in Afghanistan.

Giving birth with a skilled birth attendant at a facility that provides emergency obstetric care services has better outcomes, but many women do not have access to these services in low- and middle-income countries. Individual, household, and societal factors influence women's decisions about place of birth. Factors influencing birthplace preference by type of provider and level of public facility are not well understood. Applying the Andersen Behavioral Model of healthcare services use, we explored the association between characteristics of women and their choice of childbirth location using a multinomial logistic regression, and conducted a scenario analysis to predict changes in the childbirth location by imposing various interventions. Most women gave birth at home (68.1%), while 15.1% gave birth at a public clinic, 12.1% at a public hospital, and 4.7% at a private facility. Women with higher levels of education, from households in the upper two wealth quintiles, and who had any antenatal care were more likely to give birth in public or private facilities than at home. A combination of multisector interventions had the strongest signals from the model for increasing the predicted probability of in-facility childbirths. This study enhances our understanding of factors associated with the use of public facilities and the private sector for childbirth in Afghanistan. Policymakers and healthcare providers should seek to improve equity in the delivery of health services. This study highlights the need for decisionmakers to consider a combination of multisector efforts (e.g., health, education, and social protection), to increase equitable use of maternal healthcare services.

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia

BackgroundMaternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia.MethodsA pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions.ResultsData from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22).ConclusionsBoth the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated.Trial registrationThe trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.

Sociodemographic characteristics associated with the utilization of maternal health services in Cambodia

BackgroundCambodia is a Southeast Asian country and has one the highest rates of maternal and child mortality with inadequate use of maternal healthcare services in the region. The present study aimed to analyse the progress made in terms of using maternal healthcare services since 2000.MethodsTwo rounds of Demographic and Health Surveys (DHS 2000 and DHS 2014) were used in the study. Sample population consisted 11,961 women aged between 15 and 49 years. The outcome measures were: Timing of first antenatal care (ANC) attendance, adequacy of ANC attendance, place of delivery and postnatal checkup. WHO guidelines were used to set the cut-off/define these measures. Data were analyzed in Stata version 14 using descriptive and multivariate regression analyses.ResultsFindings indicated that the overall prevalence of making the first ANC visit in the first trimester was 64.19% [95%CI = 62.22,66.11], and that of having at least four ANC visits was 43.80% [95%CI = 41.89,45.73]. Prevalence of health facility delivery was 48.76% [46.62,50.90] and that of postnatal checkup was 71.14% [95%CI = 69.21,73.01]. Between 2000 and 2014, the percentage of timely and adequate use of ANC increased by respectively 61.8 and 65.3%, while that of health facility delivery and postnatal care increased by respectively 74.5 and 43.9%. Important demographic, socioeconomic and geographic disparities were observed in the utilization of ANC, health facility delivery and postnatal care services. Urban residency, having better educational status, white collar job, access to electronic media showed positive association, whereas higher parity (having > 2 children) and unwanted pregnancy showed negative association with the use of maternal healthcare services. Having at least four ANC visits was associated with significantly increased higher odds of using health facility delivery and postnatal care.ConclusionThere has a been a remarkable increase in the prevalence of women who are using the maternal healthcare services since 2000. The current findings provide important insights regarding the sociodemographic factors associated with the utilization of maternal health services in Cambodia that could contribute to evidence-based health policy making and designing intervention programs.