Use Of Maternal Health Care Research Articles

Using the theoretical domains framework to identify the sociocultural barriers and enablers to access and use of primary and maternal healthcare services by rural Bangladeshi women: a qualitative study

In Bangladesh, increasing the use of primary healthcare (PHC) and maternal healthcare (MHC) services is the main focus of achieving the United Nations Sustainable Development Goal-3, ensuring healthy lives and wellbeing for all. However, little is known about the sociocultural barriers and enablers to accessing and using PHC and MHC services among rural Bangladeshi women. This qualitative study aimed to identify sociocultural barriers and enablers to accessing and using PHC and MHC services among Bangladeshi rural women by using the Theoretical Domains Framework (TDF). This exploratory qualitative study used focus groups and interviews to collect data from women (28), their husbands (8) and healthcare providers (18). Data were analysed using Framework approach underpinned by the TDF. Four main themes emerged from data analysis, of which key barriers were summarised in three themes: (i) family barriers including lack of family reinforcement, (ii) social barriers including gender of healthcare providers, and (iii) cultural barriers including superstition to access and use of healthcare services. The remaining theme, sociocultural support, included information about key enablers, such as family support, neighbourhood connection and media influence. Several key behavioural constructs that aligned with the TDF need to be targeted when developing an intervention to promote access and use of PHC and MHC services.

Exposure to family planning messages on social media and its association with maternal healthcare services in Mauritania

BackgroundMauritania, a lower-middle-income country in Northwest Africa, has one of the highest maternal and infant mortality rates worldwide and struggles to ensure optimal use of maternal healthcare services. Raising health awareness through family planning messages can promote maternal healthcare use, potentially reducing preventable maternal and child mortalities. The objective of the study was to assess the potential impact of exposure to family planning messages through social media on the utilization of maternal healthcare services among Mauritanian women.MethodsData from the 2019-20 Mauritania Demographic and Health Survey (MDHS) on 7,640 women were analyzed. Multiple logistic regression models were applied to examine the associations between exposure to family planning messages through social media and maternal healthcare services, specifically the timing and adequacy of ANC visits, and facility-based childbirth. Adjusted odds ratios with 95% confidence intervals (CI) were estimated.ResultsThe percentage of timely initiation and adequate use of ANC among the participants were 65.6% and 45.1%, respectively. Approximately 75.0% of the women reported giving birth to their last child at a healthcare facility. Exposure to family planning messages on social media was significantly associated with increased odds of receiving adequate antenatal care visits (OR = 1.38, 95% CI = 1.12,1.71) and giving birth in a health facility (OR = 1.83, 95% CI = 1.09,3.08), Other factors such as age, health insurance, wealth, and desired timing of the last child were also found to be important predictors of maternal healthcare.ConclusionThe findings suggest that exposure to family planning messages on social media is strongly associated with adequate antenatal care and health facility-based childbirth, but not with early timing of antenatal care. Comprehensive maternal healthcare policies should consider the role of social media in promoting family planning messages.

Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions

BackgroundOver the last 20 years, global healthcare has placed a major focus on improving the survival rates of mothers and children, recognizing the potential to prevent a significant number of deaths resulting from pregnancy and childbirth. Nevertheless, there remains an ongoing obstacle to the insufficient utilization of critical obstetric services to achieve optimal health outcomes for pregnant women. This study aimed to assess the magnitude and determinants of maternal healthcare use in the Jimma Zone, Ethiopia.MethodsData were obtained from a household survey as part of the baseline assessment of a cluster randomized controlled trial. The study participants comprised 588 women in early pregnancy, specifically those with a gestational age of less than 20 weeks. Logistic regression analysis was employed to identify factors associated with the use of maternal health services. Adjusted odds ratios (AORs) were used to assess the strength of the associations, with significance level set at a p-value ≤ 0.05.ResultsThe overall prevalence of maternal health service utilization was 87.9% (CI: 85.1, 90.4) for antenatal care, 74.7% (CI: 73.2, 79.9) for health facility delivery, and 60.4% (CI: 56.4, 64.3) for postnatal care. Multivariable logistic analysis revealed that maternal health service use was significantly influenced by access to health facilities (AOR: 6.6; 95% CI: 2.39, 18.16), financial hardship (AOR: 3; 95% CI: 1.97, 4.61), perceived respectful care (AOR: 2.3; 95% CI: 1.07, 5.11), perceived privacy of service provisions (AOR: 2.4; 95% CI: 1.47, 4.06), and attitudes toward maternal service use (AOR: 2.2; 95% CI: 1.48, 3.24).ConclusionsThe study revealed slightly higher rates of antenatal care, facility delivery, and postpartum care utilization. However, there was a low proportion of early antenatal care initiation, and high rates of antenatal care dropout. Mobile phone-based messaging intervention may enhance maternal health service use by addressing factors such as lack of access, economic challenges, disrespectful care, no privacy of procedures, and unfavorable attitudes.

Barriers and incentives influencing the use of partograph in Nigeria: A comprehensive review.

This comprehensive review examines the barriers and incentives influencing the use of partographs in maternal healthcare within Nigeria. Maternal mortality remains a critical concern in the country, making it imperative to evaluate the factors that shape the adoption of essential tools like the partograph. The literature review underscores the global significance of partograph utilization, emphasizing its role in improving maternal outcomes. A particular focus is placed on existing studies and findings relevant to Nigeria, providing a nuanced understanding of the challenges and opportunities faced by healthcare providers. The article delves into the barriers hindering the widespread adoption of partographs in Nigeria, including issues related to training, resource availability, and cultural considerations. Additionally, it explores the incentives that can positively influence healthcare practitioners and facilities to integrate partographs into their maternal care protocols. Government policies and initiatives in Nigeria related to maternal healthcare and partograph use are also analyzed, shedding light on the broader contextual factors impacting implementation. Through examining case studies, the review presents real-world examples that illustrate successful and challenging instances of partograph implementation. The article concludes with actionable recommendations to overcome identified barriers and enhance incentives for effectively integrating partographs into maternal healthcare practices in Nigeria. This study contributes valuable insights to the ongoing discourse on improving maternal healthcare, emphasizing the need for tailored strategies in the Nigerian context.

Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews.

Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81%). The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77.

Impact evaluation of invisible intimate partner violence on maternal healthcare utilization in Pakistan

IntroductionExisting research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan.MethodsWe analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012–2013 and 2017–2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women’s last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples.ResultsExposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups.ConclusionsPregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

Maternal healthcare use by women with disabilities in Rajasthan, India: a secondary analysis of the Annual Health Survey

BackgroundWomen with disabilities face a number of barriers when accessing reproductive health services, including maternal healthcare. These include physical inaccessibility, high costs, transportation that is not accessible, negative attitudes from family and healthcare providers, and a societal belief people with disabilities shouldn’t be parents. While qualitative studies have uncovered these barriers, there is limited quantitative research to determine their effect on use of maternal health services. This study aims to analyze associations between disability and maternal healthcare use among married women in Rajasthan.MethodsThis study is a secondary analysis of the Indian Annual Heath Survey first wave data from 2011. The sample includes 141,983 women aged 15–49 who had given birth between 2007 and 2009. Logistic regression was used to assess the association between disability and use of antenatal, delivery, and postnatal care. Stratified models were created to analyze difference based on birth order of the pregnancy and whether the woman’s place of residence is rural or urban.ResultsThe prevalence of disability was 1.23%. Attending at least three antenatal care visits was reported by 50.66% of the sample, skilled delivery use by 83.81%, and receiving postnatal care within 48 h of birth by 76.02%. In the regression model, women with disabilities were less likely to report attending the minimum antenatal care visits (OR = 0.84; CI: 0.76, 0.92). No association was found between disability and skilled delivery or postnatal care. Once the sample was stratified by birth order, women with disabilities reporting their first birth were more likely to report receiving postnatal care than women without disabilities (OR = 1.47; CI: 1.13, 1.91).ConclusionAdditional research is needed to determine use of maternal healthcare among women with disabilities in India. Maternal services need to be assessed to determine their accessibility, especially regarding recent laws requiring accessibility.

A qualitative investigation into pregnancy experiences and maternal healthcare utilisation among adolescent mothers in Nigeria

BackgroundAdolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria.MethodsThe study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software.ResultsThe findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers.ConclusionsInterventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive.

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers

BackgroundIt is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda.MethodsA qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software.ResultsThe main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care.ConclusionsDespite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature.

This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.

African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study.

The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women. Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting. Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.

Household Poverty-Wealth and Decision-Making Autonomy as Predictors of Reproductive and Maternal Health Services Utilization among Rural Women in Nigeria: Evidence from a National Survey.

Adequate reproductive and maternal healthcare services utilization are significant in reducing maternal deaths, however, the prevalence rate of contraceptive use remains low, with inadequate maternal health services utilization among rural women in Nigeria. This study examined the influence of household poverty-wealth and decision-making autonomy on reproductive and maternal health services utilization among rural women in Nigeria. The study analyzed data from a weighted sample of 13,151 currently married and cohabiting rural women. Descriptive and analytical statistics including multivariate binary logistic regression were conducted using Stata software. An overwhelming majority of rural women (90.8%) have not used modern contraceptive methods, with poor utilization of maternal health services. About 25% who delivered at home received skilled postnatal checks during the first 2 days after childbirth. Household poverty-wealth significantly reduced the likelihood of using modern contraceptives (aOR: 0.66, 95% CI: 0.52-0.84), having at least four ANC visits (aOR: 0.43, 95% CI: 0.36-0.51), delivering in a health facility (aOR: 0.35, 95% CI: 0.29-0.42) and receiving a skilled postnatal check (aOR: 0.36, 95% CI: 0.15-0.88). Women's decision-making autonomy regarding their healthcare significantly increased the use of modern contraceptives and the number of ANC visits, while women's autonomy on how their earnings are spent positively influenced the use of maternal healthcare services. In conclusion, the use of reproductive and maternal health services among rural women was associated with household poverty-wealth and decision-making autonomy. Government should formulate more pragmatic policies that will create awareness and promote universal access to reproductive and maternal healthcare services.

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.

Floods and maternal healthcare utilisation in Bangladesh

Floods are a common natural hazard in Bangladesh, and climate change is expected to further increase flooding frequency, magnitude and extent. Pregnant women in flood contexts could face challenges in utilisation of maternal healthcare. The aim of this paper is to analyse associations between flood exposure and the use of maternal healthcare (antenatal care visits, birth assisted by skilled birth attendants, and giving birth in a health facility) in Bangladesh for pregnancies/births between 2004 and 2018. Bangladesh Demographic and Health Survey data from four surveys in the time period 2007–2018 and data on floods from the Emergency Events Database and the Geocoded Disasters Dataset are analysed using multilevel linear probability models. In line with previous results, we find clear bivariate associations between exposure to flooding and maternal healthcare use. These associations are largely confounded by socioeconomic and demographic variables. In general, exposure to flooding — whether measured as exposure to any floods or severe floods — does not affect maternal healthcare use, and we suggest that the lower usage of maternal healthcare in areas exposed to flooding rather relates to the characteristics of the flood-prone areas and their populations, which also relate to lower maternal healthcare use. However, we find negative associations in some supplementary analyses, which suggest that even if there is no effect of floods on average, specific floods may have negative effects on maternal healthcare use.

Determinants of cervical cancer screening utilization among women in Southern Ethiopia

Cervical cancer has been an important public health problem. Despite the availability of screening services, its utilization in Ethiopia is low. This study therefore, aimed to identify contextual predictors of cervical cancer screening utilization among eligible women. This study employed facility-based unmatched case–control study design. Data were collected from 410 participants using interviewer-administered techniques. The collected data were entered using EpiInfo version 7 and transported to SPSS version 20 for statistical analysis. We performed descriptive analysis and logistic regression to identify predictors of screening utilization. This study demonstrated that urban residence, being in marital union, membership in women development army, knowledge of cervical cancer screening location, use of maternal health care in the previous year and knowledge on cervical cancer and its screening were predictors of screening utilization. Therefore, it is important to improve women’s knowledge on cervical cancer, promote maternal health care use, disseminate health information through women’s groups and consider all positive effects of urban residence among rural women to improve screening utilization.

Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study.

IntroductionExisting studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers.MethodsIn this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches.ResultsPolicymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare.ConclusionThe emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.

Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study

ObjectivesThis study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal...

Utilization of Postnatal Care During the COVID-19 Pandemic: Perception and Intents of Postpartum Women at Tertiary Health Facility in Southwest, Nigeria.

Coronavirus disease (COVID-19) pandemic took the world unawares and disrupted maternal health care services. This study assessed postnatal care (PNC) utilization, perception, and intent of postpartum women to use PNC. This was a descriptive cross-sectional study conducted during the COVID-19 pandemic over a 2-months period. Inclusion criteria—consenting women, aged ≥18years, and delivery at the study site; 115 women were selected by simple random sampling technique. The information included sociodemographic, obstetric characteristics, perceived effects of COVID-19 on maternal healthcare, and willingness to return for PNC using pre-tested interviewer-administered questionnaires. The maternal healthcare register was also reviewed for the proportion of women accessing services before and during the pandemic. Data were analyzed using IBM Statistical Package and Service Solutions (SPSS) Version 23. The total No. of deliveries and PNC attendance/month was reduced. Respondents were multiparous women (61.7%), with no pregnancy complication (73.9%). About 93% were counseled on PNC; while only 47.8% of the respondents had good knowledge of PNC. The pandemic affected antenatal care in 25.2%, 7.8% perceived it would affect PNC, 62.6% perceived themselves at risk of COVID-19; 13.9% had fears of coming for PNC. Despite this, more than 75% were willing to come for PNC. COVID-19 affected the use of maternal healthcare. Counseling on the role and benefits of PNC can improve its use.

Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link

Introduction: Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. Methods: A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. Results: Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community; high direct transport costs from home; and high costs for missing drugs and other supplies in hospitals. Middle (5th-7th) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7th pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare. Conclusion: The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7th Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.