Use Of Reproductive Health Care Research Articles

Birth journeys: Multi-level facilitators and barriers to birthing parents access to and use of reproductive health care

Birth journeys: Multi-level facilitators and barriers to birthing parents access to and use of reproductive health care

The association between women’s empowerment and reproductive health care utilization in Cameroon

Abstract Background The context related to maternal mortality has improved over the past decade in Cameroon. However, the demand for reproductive health care use remains insufficient with regard to public health policy targets, and women’s empowerment is identified as a catalyst with a great potential. Objective This study aims to analyse the association between the dimensions of women’s empowerment and the utilization of adequate reproductive health care. Method The data comes from the fifth demographic and health survey of Cameroon carried out in 2018. Women’s empowerment is measured through two indices: the economic status index and the decision-making index. Given the dichotomous nature of reproductive health outcomes, namely the use of at least four antenatal visits during pregnancy, the timing from the first antenatal visit and the place of delivery, a logistic regression model is adopted. Results The results suggest that an increase in the decision-making index was significantly associated with higher chances of having at least four antenatal visits during pregnancy (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.20, 1.29), of making the first prenatal visit during the first 3 months of pregnancy (OR: 1.03; 95% CI: 1.01, 1.07) and delivery in a hospital (OR: 1.34; 95% CI: 1.29, 1.39). However, a better economic status of the woman in the household was associated with lower chances of making the first prenatal visit during the first 3 months of pregnancy (OR: 0.65; 95% CI: 0.60, 0.71) and giving birth in a hospital (OR: 0.92; 95% CI: 0.83, 1.01); but no significant association was found with the number of antenatal visits. These different associations do not remain the same when mother and household characteristics are controlled. In addition, the results illustrate the key role that education, household wealth and media exposure played in the use of reproductive health care. Conclusion One of the strategic objectives of the Health Sector Strategy 2016–2027, the framework document for the public health policy in force, is to reduce maternal mortality rates by improving access to reproductive health care. To achieve this objective, this study suggests that policymakers should emphasize social policies favourable to women’s empowerment in Cameroon by pointing out access to income-generating activities and decision-making within the household.

Trauma-informed abortion care.

People seeking reproductive care experience trauma on many levels including personal, structural, in medical care, and in barriers to care. This article reviews key aspects of a Trauma-Informed Care approach in abortion and reproductive healthcare. Experiences of trauma are common and compounding, including systemic trauma, such as racism, sexism, and transphobia. Reproductive healthcare itself traumatizes and re-traumatizes. Trauma Informed Care (TIC) approach to individual abortion care includes maximize patient safety, choice, and privacy. TIC approach to systemic abortion care includes dismantling barriers to care and stigma. The experience of trauma is prevalent, often unrecognized and can be multifactorial, especially for those seeking abortion and contraception care. Reproductive care can create situations or power dynamics that reactivate a trauma experience. History of trauma influences a person's health, relationships, experience, and use of reproductive healthcare, as well as trust in reproductive health recommendations. Laws restricting access to abortion and reproductive health add another layer of trauma and disproportionately affect marginalized groups. Guidelines for Trauma Informed Abortion Care recognize the complexity of trauma in reproductive health experiences and seek to promote safety, empowerment, and healing on individual and systemic levels.

Socioeconomic inequalities in reproductive health care services across Sub-Saharan Africa. A systematic review and meta-analysis

BackgroundWomen in Sub-Saharan African experience socioeconomic barriers in the use of reproductive health care services. This paper analyzes the evidence on socioeconomic inequalities in reproductive health care utilization in Sub-Saharan Africa and identifies the variance in the estimates of these inequalities. MethodsWe performed a systematic review and meta-analysis of studies on socioeconomic inequalities in the use of reproductive health care services published between January 2008 and June 2019. We used meta-regression to identify heterogeneity sources in reproductive care services use. ResultsTwenty-two studies were included and they reported 305 estimates of the concentration index for different reproductive health care services. We grouped the services into ten categories of reproductive health care services. Socioeconomic status was associated with inequality in reproductive health care use and was on average high, with a pro-wealthy inequality magnitude of the concentration index of 0.202. The meta-analysis indicated that inequality was highest for skilled childbirth services with an average concentration index of 0.343. The average concentration index for family planning and components of antenatal care was 0.268 and 0.142 respectively. Random-effects meta-regression showed that the heterogeneity in reproductive health care use was explained by contextual differences between countries. ConclusionThe magnitude of inequality in reproductive health care use varies with the type of service and the focus on skilled childbirth services through user fees removal appears to have fostered inequality. The one-size-fits-all approach to reproductive health care initiatives has ignored differences in reproductive health care needs and the ability to overcome use barriers.

Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps

BackgroundFamily planning and maternal care services have become increasingly available in West Africa but the level of non-use remains high. This unfavorable outcome may be partly due to the unaffordability of reproductive health care services.MethodsUsing the Demographic Health Survey data from Burkina Faso, Niger, Nigeria, Ghana, and Senegal, we perform a decomposition analysis to quantify the contribution of socio-demographic characteristics to disparities in exposure to mass media information on family planning, use of modern contraceptives, adequate antenatal care visits, facility-based childbirth and C-section between low-wealth and high-wealth women.ResultsOur study shows that differences in maternal characteristics between the wealth groups explain at least 40% of the gap in exposure to mass media family planning information, 30% in modern contraceptive use, 24% of adequate antenatal care visits, 47% of the difference in facility-based childbirths, and 62% in C-section. Lack of information on pregnancy complications, living in rural residence, religion, lack of autonomy in health facility seeking decision, need to pay, and distance explains the disparity in reproductive health care use across all countries. In countries with complete fee exemption policies for specific groups in the population, Ghana, Niger, and Senegal, the inequality gaps between wealth groups in having an adequate number of antenatal care visits and facility-based childbirth are smaller than in countries with partial or no exemption policies. But this is not the case for C-section.ConclusionsThere is evidence that current policies addressing the cost of maternal care services may increase the wealth-based inequality in maternal care use if socio-demographic differences are not addressed. Public health interventions are needed to target socio-demographic disparities and health facility seeking problems that disadvantage women in poor households.

Examining trends in inequality in the use of reproductive health care services in Ghana and Nigeria

BackgroundEquitable use of reproductive health care services is of critical importance since it may affect women’s and children’s health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. We analyzed the magnitude and trends in wealth-related inequalities in the use of family planning, antenatal and delivery care services in Ghana and Nigeria. We also investigate horizontal inequalities in the determinants of reproductive health care service use over the years.MethodsWe use data from Ghana’s (2003, 2008 and 2014) and Nigeria’s (2003, 2008 and 2013) Demographic and Health Surveys. We use concentration curves and concentration indices to measure the magnitude of socioeconomic-related inequalities and horizontal inequality in the use of reproductive health care services.ResultsExposure to family planning information via mass media, antenatal care at private facilities are more often used by women in wealthier households. Health worker’s assistance during pregnancy outside a facility, antenatal care at government facilities, childbirth at home are more prevalent among women in poor households in both Ghana and Nigeria. Caesarean section is unequally spread to the disadvantage of women in poorer households in Ghana and Nigeria. In Nigeria, women in wealthier households have considerably more unmet needs for family planning than in Ghana. Country inequality was persistent over time and women in poorer households in Nigeria experienced changes that are more inequitable over the years.ConclusionWe observe horizontal inequalities among women who use reproductive health care. These inequalities did not reduce substantially over the years. The gains made in reducing inequality in use of reproductive health care services are short-lived and erode over time, usually before the poorest population group can benefit. To reduce inequality in reproductive health care use, interventions should not only be pro-poor oriented, but they should also be sustainable and user-centered.

Reproductive intentions and use of reproductive health care among female survivors of childhood cancer.

Do female childhood cancer survivors (CCSs) express a decreased desire to have children and do they use reproductive health care more often compared to women without a history of cancer? Overall, no difference was found in the desire to have children between CCSs and controls, whereas CCSs consult a fertility specialist more often, at a younger age, and sooner after their first attempt at conceiving. Female CCSs may face a shorter than anticipated reproductive window as a result of their cancer treatment. Little is known about their desire to have children and use of reproductive health care, especially in relation to their former cancer treatment. This study is part of the DCOG LATER-VEVO study, a nationwide retrospective cohort study on female fertility in Dutch CCSs. In total, 1749 CCSs and 1673 controls were invited for the study. Data collection took place between January 2008 and May 2014. Data on the desire to have children and use of reproductive health care were collected by questionnaire. The control group consisted of sisters from CCSs and females from the general population. In total, 1106 (63%) CCSs and 818 (49%) controls completed the questionnaire. Overall, no difference was found in the desire to have children between CCSs and controls (86% and 89%, respectively). However, survivors of a CNS tumour were less likely to desire children and CCSs without biological children at time of study were more likely to report that their desire to have children was unfulfilled because of medical reasons (9%), compared to controls (1%). In total, 12% of CCSs ever consulted a fertility specialist compared to 10% of controls (OR = 1.7, 95% CI: 1.3-2.4). Mean (SD) age at time of their first visit was 27.7 (4.4) years for CCSs and 29.9 (3.9) years for controls (P < 0.01). In total, 43% of CCSs consulted a fertility specialist within 12 months after they had started trying to achieve a pregnancy, compared to 27% of controls. Risk factors for consulting a fertility specialist included a previous diagnosis of renal tumour, leukaemia, lymphoma or a CNS tumour, and treatment with alkylating chemotherapy, gonadotoxic radiotherapy or both. In total, 70% of CCSs reported a female factor as cause of subfertility compared to 34% of controls (OR = 4.5, 95% CI: 2.3-8.7) and in this specific group, CCSs seemed more likely to use fertility treatment (OR = 2.9, 95% CI: 1.0-8.2). Because of the low number of CCSs who used fertility treatment, we were not able to look at specific diagnoses and treatment types associated with using fertility treatment. Nevertheless, we were able to identify diagnostic- and treatment-related risk factors for consulting a fertility specialist. Details regarding consultations with a fertility specialist and fertility treatment were based on self-report and may therefore be subject to recall bias. Decisions about parenthood affect all CCSs. It's important to evaluate reproductive intentions and function timely after cancer treatment, so CCSs can be adequately counselled regarding family planning and fertility treatment. This work was supported by the Dutch Cancer Society (Grant no. VU 2006-3622) and the Children Cancer Free Foundation (Project no. 20). NTR2922.

Navigating Social Networks, Resources, and Neighborhoods: Facilitators of Sexual and Reproductive Health Care Use among Women Released From Jail

ABSTRACTOur objective was to understand factors that support or undermine sexual and reproductive health care use among women released from jail. We conducted semistructured interviews with 28 women (ages 20–53) on average 6 months after their release from a city jail. Social support networks were the most common factor that supported women's sexual and reproductive health care use; having a medical home, reliable transportation, financial resources, and neighborhood dynamics were other factors mentioned by health care users. Community-based public health efforts should address the social context in which women on the margins of society perceive sexual health risk and use sexual and reproductive health care services.

Associations of women's position in the household and food insecurity with family planning use in Nepal.

BackgroundWomen in Nepal have low status, especially younger women in co-resident households. Nepal also faces high levels of household food insecurity and malnutrition, and stagnation in uptake of modern family planning methods.ObjectiveThis study aims to understand if household structure and food insecurity interact to influence family planning use in Nepal.MethodsUsing data on married, non-pregnant women aged 15–49 with at least one child from the Nepal 2011 Demographic and Health Survey (N = 7,460), we explore the relationship between women’s position in the household, food insecurity as a moderator, and family planning use, using multi-variable logistic regressions. We adjust for household and individual factors, including other status-related variables.ResultsIn adjusted models, living in a food insecure household and co-residing with in-laws either with no other daughter-in-laws or as the eldest or youngest daughter-in-law (compared to not-co-residing with in-laws) are all associated with lower odds of family planning use. In the interaction model, younger-sisters-in-law and women co-residing with no sisters-in-law in food insecure households have the lowest odds of family planning use.ConclusionThis study shows that household position is associated with family planning use in Nepal, and that food insecurity modifies these associations–highlighting the importance of considering both factors in understanding reproductive health care use in Nepal. Policies and programs should focus on the multiple pathways through which food insecurity impacts women’s reproductive health, including focusing on women with the lowest status in households.

The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males

PurposeTo explore perceptions of facilitators/barriers to sexual and reproductive health (SRH) care use among an urban sample of African-American and Hispanic young men aged 15–24 years, including sexual minorities. MethodsFocus groups were conducted between April 2013 and May 2014 in one mid-Atlantic U.S. city. Young men aged 15–24 years were recruited from eight community settings to participate in 12 groups. Moderator guide explored facilitators/barriers to SRH care use. A brief pregroup self-administered survey assessed participants' sociodemographics and SRH information sources. Content analysis was conducted, and three investigators independently verified the themes that emerged. ResultsParticipants included 70 males: 70% were aged 15–19 years, 66% African-American, 34% Hispanic, 83% heterosexual, and 16% gay/bisexual. Results indicated young men's perceptions of facilitators/barriers to their SRH care use come from multiple levels of their socioecology, including cultural, structural, social, and personal contexts, and dynamic inter-relationships existed across contexts. A health care culture focused on women's health and traditional masculinity scripts provided an overall background. Structural level concerns included cost, long visits, and confidentiality; social level concerns included stigma of being seen by community members and needs regarding health care provider interactions; and personal level concerns included self-risk assessments on decisions to seek care and fears/anxieties about sexually transmitted infection/HIV testing. Young men also discussed SRH care help-seeking sometimes involved family and/or other social network members and needs related to patient-provider interactions about SRH care. ConclusionsStudy findings provide a foundation for better understanding young men's SRH care use and considering ways to engage them in care.

Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services

Study Objective, Design, and SettingAdolescents face barriers to accessing youth-friendly family planning services, specifically long-acting reversible contraception (LARC). School-based health centers (SBHCs) can provide youth-friendly care. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services. Participants, Interventions, and Main Outcome MeasuresWe interviewed 18 female adolescents who received LARC services. Two independent reviewers coded deidentified verbatim transcripts; discrepancies were resolved by consensus with a third reviewer. A guide of themes was structured corresponding to Ambresin's domains of youth-friendly services. From these domains, we identified emerging themes using grounded theory, with a focus on practical suggestions for improving LARC services in SBHCs. ResultsInterviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions (12 levonorgestrel intrauterine system (LNG-IUS); Mirena®), 1 copper intrauterine device (Paragard®), 5 contraceptive implant (Nexplanon®). Overall, participants were highly satisfied with SBHC LARC services. Within the domain of communication, 2 key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure “care packages” with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients. ConclusionThis quality improvement project, conducted in a unique setting, gave adolescents a voice. The identified strategies for improving health education, social support, and outreach might be generalizable to other SBHCs. Future research could explore the effect of implementing these suggested strategies on reproductive health care use and outcomes at SBHCs.

Healthcare access and the patterns of maternal health care utilization among poor and non-poor women living in urban areas in Portugal

Introduction: Studies on attitudes and practices are increasingly used but not specifically related to the motivations for the use of reproductive health care among women of fertile age, living in urban areas and in different social contexts. Objectives: The aim of this study was to estimate the associations between the variables of social status (degree of poverty in the studied groups) and the variables of fecundity (representations, tensions, practices and control of fertility) and, in addition, to compare access to health care in the different studied groups, assessing the association between use of maternal health care and poverty in urban areas. Design: A case-control study was conducted in the Municipality of Lisbon, Portugal, with a total sample of 1513 women of fertile age: 499 cases of women considered very poor were selected from the database of beneficiaries of RSI (Social Welfare Payment for Inclusion); 1014 controls (two controls for each selected case), divided as 507 poor women selected from the other beneficiaries of Santa Casa da Misericordia in Lisbon and 507 non-poor women selected from four Health Centers from the Municipality of Lisbon, Portugal. A total of 1054 women answered the questionnaire: 304 cases (response rate of 61%) and 750 (response rate of 74%) controls. The statistical analysis involved descriptive analysis and multinomial logistic regression. Results: The analysis confirms the association between poverty and patterns and representations of fecun dity regarding pregnancy planning. The results of this study thus show the existence of different distributions on several variables and the gradients of poverty. Regarding access to health care, the major impact of poverty on women is limiting access to pharmaceuticals. The incapacity to afford the cost of health care appears as a central aspect of access to health care. Conclusion: A number of factors seem to be associated with poverty in women, such as ethnicity, single motherhood, low household income, low household size, low educational level of women and marital status. The association of poverty with not planning the pregnancy of the last child on one hand and large household size on the other hand points to a vicious circle that sustains poverty and leads to extreme poverty. Limited financial access to health care seems to mediate the association between women’s poverty and low coverage with family planning as well as the lack of access to safe termination of pregnancy.

Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized.

HIV care need not hamper maternity care: a descriptive analysis of integration of services in rural Malawi

To evaluate the use of reproductive health care and incidence of paediatric HIV infection during the expansion of antiretroviral therapy and services for the prevention of mother-to-child transmission in rural Malawi, and the influence of integration of these HIV-related services into general health services. Descriptive analysis. Thyolo District, with a population of 600,000, an HIV prevalence of 21% and a total fertility rate of 5.7 in 2004. Women attending reproductive health services care in 2005 and 2010. Review of facility records and databases for routine monitoring. Use of antenatal, intrapartum, postpartum, family planning and sexually transmitted infection services; incidence of HIV infection in infants born to mothers who received prevention of mother-to-child transmission care. There was a marked increase in the uptake of perinatal care: pregnant women in 2010 were 50% more likely to attend at least one antenatal visit (RR 1.50, 95% CI 1.48-1.51); were twice as likely to deliver at a healthcare facility (RR 2.05, 95% CI 2.01-2.08); and were more than four times as likely to present for postpartum care (RR 4.40, 95% CI 4.25-4.55). Family planning consultations increased by 40% and the number of women receiving treatment for sexually transmitted infections doubled. Between 2007 and 2010, the number of HIV-exposed infants who underwent testing for HIV went up from 421 to 1599/year, and the proportion testing positive decreased from 13.3 to 5.0%; infants were 62% less likely to test HIV positive (RR 0.38, 95% CI 0.27-0.52). During the expansion and integration of HIV care, the use of reproductive health services increased and the outcomes of infants born to HIV-infected mothers improved. HIV care may be successfully integrated into broader reproductive health services.

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam

BackgroundWith health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level.MethodsThis study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services.ResultsEighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS.ConclusionsWomen choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

Women's autonomy and reproductive health care utilisation: Empirical evidence from Tajikistan

Objective Women's autonomy is widely considered to be a key to improving maternal health in developing countries, whereas there is no consistent empirical evidence to support this claim. This paper examines whether or not and how women's autonomy within the household affects the use of reproductive health care, using a household survey data from Tajikistan. Methods Estimation is performed by the bivariate probit model whereby woman's use of health services and the level of women's autonomy are recursively and simultaneously determined. The data is from a sample of women aged 15–49 from the Tajikistan Living Standard Measurement Survey 2007. Results Women's autonomy as measured by women's decision-making on household financial matters increase the likelihood that a woman receives antenatal and delivery care, whilst it has a negative effect on the probability of attending to four or more antenatal consultations. The hypothesis that women's autonomy and reproductive health care utilisation are independently determined is rejected for most of the estimation specifications, indicating the importance of taking into account the endogenous nature of women's autonomy when assessing its effect on health care use. Conclusions The empirical results reconfirm the assertion that women's status within the household is closely linked to reproductive health care utilisation in developing countries. Policymakers therefore need not only to implement not only direct health interventions but also to focus on broader social policies which address women's empowerment.

Representações de mulheres em idade fértil e profissionais de saúde sobre utilização de cuidados de saúde reprodutiva

Ascertaining poor and not poor women's representations about fecundity and verifying how this affectedreproductive health care use (maternal health care and family planning), as well ashealthcare professionals'representationsabout "poor" women-fecundity patternsand reproductive healthcare use.A qualitative study was carried out through interviews and focus groups. Specifically, eight interviews were held and two focus groups were run, giving a total of eighteen women from various socioeconomic backgrounds (living in poverty and not living in poverty). Both focus groups were run with healthcare professionals (nurses and doctors), giving a total of fifteen participants. Data was analysed by using content analysis identifying significant themes.Similarities were found between women from different social backgrounds, although some differences were also found, particularly about male partners'rolein family planning and planning pregnancies. Health professionals' attributedstandard featuresto "poor" individuals,i.e. immediacy, conditioning family planning practice and maternal health care use patterns.The women and health professionals' representationsregarding fecundity, needs and ways of using reproductive health care (maternal health care and family planning) did not always coincide. Decision-makers'importance in realizing this fact must be emphasizedso that healthcare policies can be adaptedto vulnerable populations'texpectations and perceptions of need, thereby leading to the suitable use of reproductive healthcare and ultimately promoting equity in health.

Access to reproductive healthcare for adolescents: establishing healthy behaviors at a critical juncture in the lifecourse

This review summarizes recent research on the topic of adolescents' access to reproductive healthcare, including an overview of recommended reproductive health services, access to the healthcare system and reproductive health specifically, and barriers and emerging service delivery and policy issues in the field. Recent research confirms the need for diverse healthcare points of access to the reproductive healthcare system for adolescents. It also highlights key policy and service delivery strategies that can improve access to and use of reproductive healthcare among adolescents. Access to high quality, confidential, and comprehensive reproductive healthcare is critical to ensuring the overall health of adolescents. Most adolescents are sexually active, and as a result require a wide range of counseling, clinical, and preventive care. The current healthcare system is not adequately structured to meet the diverse needs of adolescents, in particular for reproductive health needs. Continued attention to removing common barriers to care, such as concerns about confidentiality and cost, as well as promoting new screening and delivery strategies, are critical to reducing the incidence of unintended pregnancy and sexually transmitted infections among youth.

Do Women Increase Their Use of Reproductive Health Care When It Becomes More Available? Evidence from Indonesia

Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health-care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery--changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.

Inequalities in Reproductive Healthcare Utilization: Evidence from Bangladesh Demographic and Health Survey 2004

Utilization of reproductive healthcare services such as antenatal care (ANC), delivery place facilities and postnatal care (PNC) is essential and a basic need for mothers around the globe. However, in Bangladesh inequalities in many forms affect the use of these facilities. These inequalities include socio-economic status, age, education, household size, existence of living children, occupation and household location. Using the database from the Bangladesh Demographic and Health Survey (BDHS) 2004, this study investigated the inequalities and implications of receiving facility-based maternity care such as ANC, delivery place and PNC in Bangladesh. Based on our findings, it is assumed that with the current inequalities in wealth and education, less attention to mothers with bigger family size and to mothers those existing children, lack of facilities and awareness, in rural areas, increased use of reproductive healthcare is unlikely without a change in wealth inequalities and attention to more equity in the health sector. Bivariate and multivariate analyses were done for the study, including tests of significance. Overall, findings revealed significant socio-economic inequalities in the use of reproductive healthcare services. Use of services was much lower among the poor than the rich. These socio-economic inequalities may be reduced by expanding outreach health programs and bringing services closer to the disadvantaged (poor people). The study concluded that many of these inequalities are social constructs that can be reduced by prioritizing the needs of the poor and disadvantaged and adopting appropriate policy change options.