Utilization Of Maternal Care Services Research Articles

Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso

To identify determinants of utilisation for antenatal care (ANC) and skilled attendance at birth after a substantial reduction in user fees. The study was conducted in the Nouna Health District in north-western Burkina Faso in early 2009. Data was collected by means of a representative survey on a sample of 435 women who reported a pregnancy in the prior 12 months. Two independent logit models were used to assess the determinants of (a) ANC utilisation (defined as having attended at least 3 visits) and (b) skilled assistance at birth (defined as having delivered in a health facility). 76% of women had attended at least 3 ANC visits and 72% had delivered in a facility. Living within 5 km from a facility was positively associated, while animist religion, some ethnicities, and household wealth were negatively associated with ANC utilisation. Some ethnicities, living within 5 km from a health facility, and having attended at least 3 ANC visits were positively associated with delivering in a facility. User fee alleviation secured equitable access to care across socio-economic groups, but alone did not ensure that all women benefited from ANC and from skilled attendance at birth. Investments in policies to address barriers beyond financial ones are urgently needed.

Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors

BackgroundUtilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality, understanding the factors affecting maternal health use is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. This study examined the determinants of maternal services utilization in Nigeria, with a focus on individual, household, community and state-level factors.MethodsData from the 2005 National HIV/AIDS and Reproductive Health Survey - an interviewer-administered nationally representative survey - were analyzed to identify individual, household and community factors that were significantly associated with utilization of maternal care services among 2148 women who had a baby during the five years preceding the survey. In view of the nested nature of the data, we used multilevel analytic methods and assessed state-level random effects.ResultsApproximately three-fifths (60.3%) of the mothers used antenatal services at least once during their most recent pregnancy, while 43.5% had skilled attendants at delivery and 41.2% received postnatal care. There are commonalities and differences in the predictors of the three indicators of maternal health service utilization. Education is the only individual-level variable that is consistently a significant predictor of service utilization, while socio-economic level is a consistent significant predictor at the household level. At the community level, urban residence and community media saturation are consistently strong predictors. In contrast, some factors are significant in predicting one or more of the indicators of use but not for all. These inconsistent predictors include some individual level variables (the woman's age at the birth of the last child, ethnicity, the notion of ideal family size, and approval of family planning), a community-level variable (prevalence of the small family norm in the community), and a state-level variable (ratio of PHC to the population).ConclusionFactors influencing maternal health services utilization operate at various levels - individual, household, community and state. Depending on the indicator of maternal health services, the relevant determinants vary. Effective interventions to promote maternal health service utilization should target the underlying individual, household, community and policy-level factors. The interventions should reflect the relative roles of the various underlying factors.

Challenges for Utilization of Antenatal and Delivery Care Services in Urban Setting of Bangladesh

ABSTRACT In most developing countries like Bangladesh the health care facilities are not optimally available and usually are underutilized. The study explored the perception of urban poor women regarding pregnancy, childbirth and obstetric care services of the health centers and factors for utilization and/or nonutilization of such services. Focus group discussions were conducted among mothers with a child aged one year or below, their husband and elder female members of the family between May and June 2001 in selected geographical clusters of Dhaka city. It was revealed that women regard pregnancy and child birth as a natural process that needs no medical care unless some dire emergency arises. Taking tetanus toxoid during pregnancy was equated with availing antenatal care. Traditional birth attendant (Dai) was more preferable as birth attendant as they are available at home, like a kin to them, and affordable. Reason for not availing the services were high cost, nonavailability of drugs, hassles to get free bed, ignorance about the complications, negative cultural norm, rude behavior of health care providers, fear of cesarian section and an unfamiliar environment in the hospitals. Utilization of maternity care services can be improved through a combined effort of increasing awareness to avail skilled care and made the services more accessible and with better quality.

Pattern of maternal mortality in a tertiary care hospital of Patna, Bihar

Sir, In India, women of child-bearing age constitute approximately 19% of the population.(1) Major portions of these women posses factors that are conducive to increased maternal mortality. Bihar along with UP, MP, Rajasthan, and Punjab have a maternal mortality rate (MMR) over 450 per 100,000 live births.(2) This study was undertaken to find out the root causes of such deaths. During the study period of 2 years from August 2003 to July 2005 in three settings of a Medical College Hospital, all the women who died due to complications of pregnancy and childbirth within 42 days of delivery were selected. The relevant facts and history were noted from case records, attendants, and missing information was collected later by home visits. Data on a total of 329 maternal deaths were recorded. The total number of live births was 8422 during the study period. In the first and second years of the study, maternal deaths were 180 and 149, respectively. The MMR was 4159.93 and 3638.58 per 100,000 live births, respectively making the overall MMR 3906.44/100,000 live births. Among 329 total maternal deaths, the maximum were in the age group of 21 to 30 years old (56.54%) followed by 31 to 40 years old (22.49%). The death rate for mothers from rural areas was higher (67.17%). Maternal deaths were observed more among illiterate women (57.75%). The highest number of maternal deaths occurred among those who were second or third gravida (48.94%) followed by fourth gravida and above (26.14%) [Table 1]. A total of 85.11% of maternal deaths happened among those who had not received adequate antenatal care services. Toxemia of pregnancy (24.01%) was observed as the major cause of maternal death followed by sepsis (17.93%) [Table 2]. Anemia accounted for 15.81% of maternal deaths. In the majority of cases (58.36%), the women went to the hospital more than 24 hours to less than 1 week after the onset of complications and 12.16% of the women went to the hospital more than 1 week after the onset of complications. Table 1 Gravida, utilization of maternal care services, and maternal mortality Table 2 Causes of maternal deaths This study has shown a higher maternal mortality rate (3906.44/100,000 live births) and may be due to being a tertiary care hospital based study, where more complicated cases are admitted. The majority of deaths were in the age group of 21 to 30 years old (56.54%). Baul, et al.(3) had a similar observation of 51.8%. Women from rural areas contributed to a major share of maternal mortality (67.17%). Chi, et al.(4) also reported higher maternal mortality among women of rural areas. The highest rate of deaths was among illiterate women. This is in conformity with Rajaraman, et al.(5) The majority of deaths were among 2nd and 3rd gravida (48.94%) and among those who had not received adequate antenatal care services (84.11%). Baul, et al.(3) and Rajaraman, et al.(5) had similar observations. The direct obstetric causes accounted for 66.56% of maternal deaths; toxemia (24.01%), sepsis (17.93%), and hemorrhage (16.11%) were the major causes. Anemia accounted for another 15.81% of deaths. These findings are in conformity with the findings of Rajaraman, et al.(5) and Ramteke, et al.(6) This study has found the root causes of very high maternal mortality rate to be illiteracy, inadequate antenatal care services, and a delay in the initiation of treatment.

Do individual and program factors matter in the utilization of maternal care services in rural India? A theoretical approach

Current studies on the utilization of maternal care services in India focus on individual factors. In the present study, we use the theoretical model developed by Andersen and Newman [1973. Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly, 51(1), 95–124] to understand the utilization of maternal care services in rural areas of India. This theoretical model uses individual and welfare program—or system factors—to study health care utilization. Data collected through the National Family Health Survey-2 are used in the present study. The results suggest that in addition to individual characteristics, program and system factors influence the utilization of maternal care in rural areas. Program factors, particularly educational activities promoting the benefits of maternal care services carried out through mahila mandal and anganwadi centers, are important in increasing the use of maternal care services in rural areas. Additionally, the results indicate that the mere presence of a private health care facility need not necessarily improve utilization. Increase in utilization is observed among households if the health worker visited these households during pregnancy. More state-specific studies incorporating both program and individual characteristics are recommended to further strengthen our understanding of the utilization of health care services in general and maternal care services specifically.