Utilization Of Skilled Birth Attendants Research Articles

Prevalence and determinants of utilizing skilled birth attendance during home delivery of pregnant women in India: Evidence from the Indian Demographic and Health Survey 2015-16.

Utilization of skilled birth attendance during home delivery of pregnant women is proven to reduce complications during and after childbirth. Though the utilization of skilled birth attendance (SBA) during home delivery has increased significantly in recent times, the rate of utilizing skilled birth attendance is still low in several regions across India. The objective of this study is to analyze the prevalence and to identify the determinants of the utilization of skilled birth attendance during home delivery of pregnant women in India. To conduct this study, data and information from the Indian Demographic and Health Survey 2015-16 have been utilized. The sample size for this study is a weighted sample of 41,171 women. The sample consisted of women who had given a live birth in the three years preceding the survey. For women with more than one child, only the first live birth was considered. The binary logistic regression model and the log-binary logistic regression analysis have been applied as the adjusted odds ratios (AORs) with 95% confidence intervals for identifying the determinants of home-based skilled birth attendance during delivery. That allows us to select the most appropriate model for our study objective by ensuring that the determinants of skilled birth attendance for home delivery are accurately assessed based on the characteristics of the data. The analyses show that only 18.8% of women had utilized skilled birth attendance during delivery. Women residing in urban areas are more likely to utilize skilled birth attendance during home delivery (AOR: 1.14; 95% CI: 1.08-1.20). Women having higher education levels are associated with increased use of SBA during home delivery (AOR: 1.15; 95% CI: 1.04-1.28). Exposure to media is associated with increased utilization of SBA (AOR: 1.17; 95% CI: 1.11-1.23). Overweight women are also more likely to avail the SBA during home delivery (AOR: 1.11; 95% CI: 1.03-1.19). Women belonging to affluent households have higher odds of utilizing skilled birth attendance (AOR: 1.41; 95% CI: 1.33-1.49). Having 3+ tetanus injections is associated with the utilization of SBA (AOR: 1.56; 95% CI: 1.43-1.69). Women having 4+ antenatal care visits were more likely to utilize SBA (AOR: 1.81; 95% CI: 1.71-1.92). Women belonging to the Hindu religion were 1.12 times more likely to utilize SBA (AOR: 1.12; 95% CI: 1.07-1.18). Women with 1 to 3 birth orders were 1.40 times more likely to utilize skilled birth attendance during home delivery (AOR: 1.40; 95% CI: 1.30-1.51). The percentage of women utilizing skilled birth attendance during home delivery is still very low which is a matter of serious concern. Several factors have been found to be associated with the utilization of SBA during home delivery in India. As skilled birth attendance has significant positive health outcomes for pregnant women and newborns, efforts to increase the rate of SBA utilization during home delivery should be undertaken.

Facilitators of Skilled Birth Attendants’ Utilization in Government and Christian Health Association of Malawi Hospitals: A Cross-Section Study of Lilongwe Rural

Background: Every woman must have access to a Skilled Birth Attendant (SBA) for routine care and management of complications during labour, childbirth, and early postnatal period. SBA utilization has been identified as an essential approach of reducing maternal morbidity and mortality among reproductive age group of 15-49. Malawi as a developing country is also utilizing skilled birth attendants in an effort to reduce maternal death by 70 per 100,000 births. Report of 2020 from Demographic and Health Survey (DHS) on skilled birth attendants (SBA) revealed that Malawi was 89.8% by 2018, while Lilongwe District, the study area, was 67% of SBA utilization against a target of skilled birth attendant utilization of 95% by the year 2022. Purpose: To evaluate the facilitators of skilled birth attendants’ utilization in government and CHAM hospitals and their relationship to hospital delivery. Methods: This research used logistic regression test and quantitative cross-sectional approach. Questionnaires were used to collect data from December 2021 to February 2022 in 390 participants. The sampling techniques used were cluster and random sampling. Results: Based on logistic regression marital status (p=0.001, OR 14.56), pregnancy complication (p=0.000, OR 12.21), and ANC three times (p=0.010, OR 2.11) and four times (p=0.000 OR 0.76) were found to be significantly associated with hospital delivery. On the other hand ANC once (p=0.005, OR -2.33) and twice (P=0.008, OR -1.94) did not significantly influence utilization skilled birth attendants by pregnant mothers Conclusion: Based on the results, it is concluded that age from 15 to 30 and employment, marital status, education, complication, antenatal clinic, are the facilitators for pregnant mothers to utilize skilled birth attendant. These facilitators might be of importance for policy makers to consider when coming up with programs to increase skilled birth attendants utilization at rural area of Lilongwe District.

A multilevel analysis of social determinants of skilled birth attendant utilisation among married and cohabiting women of Madagascar.

Maternal mortality ratio (MMR) in Madagascar is 392 deaths per 100000 live births, and this is a major public health concern. One of the strategies for reducing MMR and achieving target 3.1 of the Sustainable Development Goals (i.e. reducing the global MMR below 70 per 100000 live births) is the utilisation of skilled birth attendants (SBAs). This analysis examined the prevalence and social determinants of SBA utilisation among married and cohabiting women of Madagascar. Data from the 2021 Madagascar Demographic and Health Surveys was analysed on a weighted sample of 6997 married and cohabiting women. A multilevel regression was carried out to determine the social determinants of utilising SBAs. The results are presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and a p-value <0.05 to determine the significant associations. The prevalence of SBAs among married and cohabiting women of Madagascar was 64.4% (95% CI 0.62 to 0.68). In model 3 of the multilevel regression, women 35-39y of age (adjusted OR [aOR] 1.86 [95% CI 1.30 to 2.60]), women with secondary/higher education (aOR 1.67 [95% CI 1.32 to 2.10]), women whose partners had secondary/higher education (aOR 1.58 [95% CI 1.25 to 1.99]), cohabiting women (aOR 1.33 [95% CI 1.07 to 1.65]), women who had four or more antenatal care visits (aOR 2.05 [95% CI 1.79 to 2.35]), female household head (aOR 1.44 [95% CI 1.06 to 1.95]), Muslims (aOR 1.58 [95% CI 0.71 to 3.53]), those of the richest wealth index (aOR 4.32 [95% CI 2.93 to 6.36]) and women who lived in communities with high literacy levels (aOR 2.17 [95% CI 1.57 to 3.00]) had higher odds of utilisation of SBA. This current analysis revealed low SBA utilisation among married and cohabiting women in Madagascar. The analysis points to the fact that understaffing and inaccessibility of health facilities remain major contributors to the low utilisation of SBAs. The findings call on the government and stakeholders in Madagascar to consider implementing programs that will empower women and focus on disadvantaged groups. These programs could include providing free maternal healthcare services to all pregnant women and intensifying health education programs that target women and their partners with no formal education.

Factors associated with maternal health services utilization in Pakistan: Evidence from Pakistan maternal mortality survey, 2019.

This study investigates the factors associated with maternal health services utilization in Pakistan using two outcome indicators, ideal antenatal care (IANC), defined as the pregnant woman receiving all the essential services included in standard antenatal care, and skilled birth attendance (SBA). This study used the Pakistan Maternal Mortality Survey 2019 data. The study utilized binary logistic regression models to investigate the adjusted association between the outcome variables, separately for IANC and SBA, and the independent variables, education, wealth, parity, and residence. Wealth showed a positive association with utilization of IANC (adjusted odds ratio [AOR] = 11.48, 95% CI = 7.76, 16.99) and SBA (AOR = 4.37, 95% CI = 3.30,5. 80). Maternal age was associated only with IANC for women aged 35 or more years (AOR = 1.31, 95% CI = 1.06, 1.62). Increased likelihood of utilization of IANC and SBA services was also observed for women with formal education. Women who had 3-5 previous live births had higher odds of using IANC and SBA than women who had 1-2 or more than five previous live births. Urban residency was not correlated with either IANC or SBA. When compared to the wealthy and educated quintile, women in the lower wealth quintile and those without any formal education were less likely to utilize ANC and SBA services. A comprehensive and multipronged approach from the health and education sectors is needed to improve maternal health in Pakistan.

Pregnant Women’s Preferred Birthing Positions In A Tertiary Health Facility In Cross River State, Nigeria

Objective: In recent times, there have been a shift in the focus of health sector towards respectful maternity care. The concept of respectful maternity care is inclined towards client centred care with the right of women to make informed decisions concerning birth choices. The right of a woman to decide which position to adopt during childbirth has been limited the supine position in most maternity service centres and hospital settings. This study sought to investigate pregnant women’s preferred birthing positions in a tertiary health care facility in Calabar, Cross River State, Nigeria&#x0D; Materials and methods This study utilized the descriptive cross-sectional design to recruit 169 pregnant women using the purposive sampling techniques. The instrument for data collection was a structured and validated questionnaire.&#x0D; Results: Finding showed that 89.3% had good knowledge on birthing positions. Also, a good number of participants preferred the squatting position and position change as they deem comfortable during childbirth. Supine positions where the least preferred. Additionally, most participants agreed that level of education, age, previous childbirth familiarities, place of birth and support from midwives were factors that could influenced their choice of birthing positions.&#x0D; Conclusion: Based on these findings, the researchers recommended that midwives update their knowledge on the different birthing positions in order to educate and assist pregnant women who may desire these positions during childbirth. This will encourage the utilization of Skilled Birth Attendants (SBAs) which will help reduce maternal morbidity and mortality that would occur during childbirth on the overall.

Skilled birth attendant utilization trends, determinant and inequality gaps in Ethiopia

BackgroundGlobally over half a million women die every year from potentially preventable and treatable pregnancy and childbirth complications; of which 99% occur in low-and middle-income countries (LMICs). The utilization of skilled birth attendants can timely identify treatable birth complications and save lives. However, utilization of services remained low in LMICs. This study aimed to examine the trends in the utilization of skilled birth attendants and the inequality gaps in Ethiopia using data from the Demographic and Health Surveys.MethodsWe used data from five rounds of Ethiopian Demographic and Health Surveys conducted in the period 2000–2019. Respondents were women in the reproductive age group who had a live birth within five years preceding the surveys. We used the concentration curve and concentration index to identify the inequalities using the World Health Organization recommended Health Equity Analysis Toolkit software. We did a logistic regression analysis to examine factors associated with skilled birth attendant utilization using STATA version 14.0.ResultThe skilled birth attendant coverage trend showed an increment from 5.7% in 2005 to 49.8% in 2019. The inequality gaps within the wealth, residence and education categories also showed a reduction over time. The odds of utilizing SBA were higher among those having primary, secondary, and above education status [AOR = 1.61 95%CI (1.33, 1.95)], being in the upper wealth quintile [AOR = 3.46 95%CI (1.8, 4.31)] and living in urban areas [AOR = 3.53 95%CI (1.88, 6.64)].ConclusionThe skilled birth attendant coverage trend showed a steady increase from 2005 to 2019 but if we continue with the current pace, it will be difficult to achieve the national target. The inequality gaps in household wealth status and residency area remain high. Efforts like strengthening the health system and engaging multisectoral agents need to be given priority to further reach the poorest and those living in rural areas to achieve national and international targets.

The Underlying Gendered Factors Influencing Access to and Utilization of Skilled Birth Attendance (Sba): A Case Study in Ghana

Maternal mortality continues to be a major public health concern in Ghana where women still die from preventable maternal deaths. Several factors contribute to the high maternal mortality in the country including delay in seeking skill birth attendance, sociocultural factors among others. Pursuance to the aforesaid, the study aimed at analyzing the role of gender in accessing skilled birth attendance in Ghana. A review of relevant literature was conducted to respond to the role of gender in accessing and utilizing skilled birth attendance. The search was conducted in Web of Science, Medline, PubMed, Academic Search Complete, and Cochrane database of systematic reviews including manual search of relevant literature in articles reference list. The 12 Centre for Evidence Based Management (CEBM) guidelines were used to assess the quality of the studies. The findings revealed a power play and a significant role of gender in accessing skilled birth attendance. Among the 10 studies included in this review, half of them were from northern Ghana whiles the other half in southern Ghana. Significant element discussed among the papers reviewed included male involvement, participation in decision making processes to seek skilled delivery and the effect of women social network. Men although appreciate the importance of skilled birth attendance, they are unable to provide the needed support to their partners during labour. The decision on the place of birth is mostly taken by the elderly women in the families. Gender indeed plays a significant role in determining women access and utilization of skilled birth attendance.

Determinants of Skilled Birth Attendance Utilization Among Mothers Who Gave Birth in The Last 24 Months in Kembata Tembaro Zone

Determinants of Skilled Birth Attendance Utilization Among Mothers Who Gave Birth in The Last 24 Months in Kembata Tembaro Zone

Multivariate decomposition of trends, inequalities and predictors of skilled birth attendants utilisation in Nigeria (1990–2018): a cross-sectional analysis of change drivers

ObjectivesLiterature has assessed skilled birth attendants (SBAs) utilisation, but little is known about what contributes to the changes in SBA use. Multivariate decomposition analysis was thus applied in this study...

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

BackgroundSeveral studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.MethodsThis study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.ResultsOverall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].ConclusionDecomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

Maternal health care service utilization among young married women in India, 1992\u20132016: trends and determinants

BackgroundMaternal deaths among young women (15–24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India.MethodsThe study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15–24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05.ResultsThe use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992–2016. SBA utilization was 88 and 83% during 2015–16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time.ConclusionsIn India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.

Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003\u20132017

BackgroundMaternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017.MethodsThe study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services.ResultsThe RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period.ConclusionWe found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

Determinants of Skilled Birth Attendant Utilization at Chelia District, West Ethiopia.

Background An estimated 303,000 maternal deaths occurred globally in 2015 from which sub-Saharan Africa alone accounted for 201,000 (66%) of the maternal deaths, and most of these are attributed to complications of pregnancy and childbirth due to the absence of institutional delivery by skilled attendants. Objective The aim of this study was to assess institutional delivery utilization and associated factors among mothers who gave birth in the last one year in Chelia District. Methodology. A community-based cross-sectional study design supplemented by a qualitative method was employed from March 15 to 30, 2018. A multistage sampling technique was used to select 475 study participants. Quantitative data were collected using structured questionnaires, and focus group discussions were employed to get qualitative data. The data were entered to EpiData version 3.1 and exported to the statistical package version 21 for analysis. Descriptive statistics and bivariate and multivariate logistic regression analysis were computed to measure the strength of association between dependent and independent variables at a p value of <0.05. Results Among the respondents, 216 (46.2%) utilized institutional delivery service. Monthly income (AOR = 4.465, 95%CI = 1.729, 11.527), antenatal care attendance (AOR = 0.077, 95%CI = 0.008, 0.73), knowledge of mothers about their expected date of delivery (AOR = 0.297, 95%CI = 0.179, 4.93), intended pregnancy (AOR = 0.326, 95%CI = 0.162, 0.654), discussion with health extension workers about the place of delivery at home visit (AOR = 0.11, 95%CI = 0.023, 0.523), knowledge of mothers about the existence of the waiting area in health facilities (AOR = 0.14, 95%CI = 0.023, 0.84), and number of children (AOR = 0.119, 95%CI = 0.029, 0.485) had a significant association with institutional delivery utilization. Conclusion Utilization of institutional delivery was low and far away from the expected country target in the district. The health sector should strive to increase proportion of institutional delivery by reaching pregnant mothers with timely antenatal care service provision and enhancing family planning provision.

Multilevel analysis of skilled birth attendance and associated factors among reproductive age women in Ethiopia: Data from EDHS 2016

IntroductionThe evaluation of factors on the utilization of skilled birth attendance is crucial for Ethiopia where the utilization of skilled birth attendance (SBA) is low. The study was aimed to assess the influence of individual and community-level factors on women's utilization of SBA at delivery in Ethiopia. MethodsData for this study was obtained from the fourth national representative 2016 Ethiopian Demographic and Health Survey (EDHS 2016) sampled from 645 communities of 7193 women age 15–49 who had the most recent childbirth in the survey. In this study, a two-level multilevel logistic regression model was used to identify individual and community-level factors associated with the utilization of SBA. ResultApproximately 37.75% of women were utilized skilled birth attendance by a skilled provider during their delivery of most recent childbirth. Significant heterogeneity was observed among the community in the utilization of SBA at the delivery of their most recent childbirth. At the individual level, factors such as mother’s education, antenatal care, exposure to media, wealth index, wantedness of pregnancy, and birth order were found to be predictors of SBA. At the communal level, place of residence and region were predictors of SBA utilization of mothers. ConclusionThis study found a significant variation in the utilization of skilled birth attendance during delivery at the individual level, with the most prominent factors such as socio-economic status and educational level. Thus, we recommend the concerned body in empowering women economically and educationally through community and individual-based intervention to improve utilization of SBA during delivery.

Can a National Health Insurance Policy Increase Equity in the Utilization of Skilled Birth Attendants in Indonesia? A Secondary Analysis of the 2012 to 2016 National Socio-Economic Survey of Indonesia.

The Indonesian government has been implementing the National Health Insurance (Jaminan Kesehatan Nasional [JKN]) policy since 2014. This study aimed to evaluate JKN based on equity indicators, especially in skilled birth attendants (SBAs) use. The data were obtained from National Socio-Economic Survey of Indonesia during 2012 to 2016. To analyze the data, χ2 and logistic regression tests were applied. The respondents were married mothers from 15 to 49 years who had delivered a baby. Deliveries by SBAs increased at the national level, but this achievement showed significant variation according to geographical location. The coverage of deliveries by SBAs in the eastern areas of Indonesia was still much lower than those in the western areas. All factors determining SBAs utilization (health insurance ownership, education, household economic status, and geography factor) indicated the positive correlation (P < .05). The inequity of SBA use in differences in geographical location and socioeconomic status continues to occur after the implementation of JKN.

Does involving male partners in antenatal care improve healthcare utilisation? Systematic review and meta-analysis of the published literature from low- and middle-income countries.

Although in most low- and middle-income countries (LMICs) men are decision makers and control the household budget, their involvement in maternity care is limited. Reports from high-income countries indicate a beneficial effect of involving men in antenatal and delivery care on birth outcomes. We conducted a systematic review to assess whether similar effects are observed in LMICs. We searched MEDLINE, PubMed, CINAHL, Embase, NCBI, PsycInfo and other relevant databases using a comprehensive search strategy to retrieve relevant articles. A total of 17 articles were included. Meta-analysis of extracted data was performed, using the generic inverse variance method where possible. All studies were conducted in South Asia and Africa. We found that involving a male partner in antenatal care was associated with skilled birth attendance utilization (pooled OR 3.19 [95% CI 1.55 to 6.55]), having institutional delivery (OR 2.76 [95% CI 1.70 to 4.50]) and post-partum visit uptake (OR 2.13 [95% CI 1.45 to 3.13]). Mother's knowledge of danger signs and modern contraception utilization were also positively affected. However, it had no significant impact on the number of antenatal visits. Male involvement in antenatal care had a positive impact on the uptake of maternal health services. Further research needs to investigate whether this translates into improved maternal and newborn health in developing countries.

Inequalities in the utilization of maternal health care in the pre- and post-National Health Mission periods in India.

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005-06 and 2015-16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005-06 to 0.08 by 2015-16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.

Knowledge, attitude, and utilization of skilled birth attendants in a rural community in Southern Nigeria: A mixed method survey

Background: The World Health Organization recommends that women be attended by skilled birth attendants (SBAs) during delivery to improve maternal and newborn health and to achieve the maternal mortality target of the sustainable development goals (SDGs). Objectives: The objectives of the study were to assess the knowledge, attitude, and utilization of SBAs among women of reproductive age in a rural community in Edo State, Nigeria. Materials and Methods: A descriptive cross-sectional study design among a total population of women of reproductive age was carried out. Data collection was by mixed methods using a pre-tested, interviewer-administered questionnaire, and focus group discussion (FGD) Guide. Ethical clearance to conduct this study was sought and obtained from the Ethical Committee, University of Benin Teaching Hospital. Quantitative data collected were analyzed using international business machines Statistical Package for the Social Sciences version 21.0 while qualitative data were analyzed thematically using ATLAS.ti software. Logistic regression was applied to calculate crude odds ratios, adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p-values of the quantitative data. The level of significance was set at P < 0.05. Results: A total number of 484 persons (comprising 465 respondents and 19 FGD participants) were surveyed. The study showed good knowledge 421 (92.1%), positive attitude 405 (88.6%), and good utilization 410 (88.2%) of SBAs. The determinants of utilization of SBAs were age (AOR: 1.086 95% CI: 1.020–1.155), knowledge of respondents (AOR: 0.034 95% CI: 0.012–0.098), and cost of services (AOR: 0.348 95% CI: 0.157–0.772). Conclusion: Knowledge, attitude, and utilization of SBAs were found to be good among the studied population. The determinants of utilization should be used as major points for international electrotechnical commission in key intervention programs.

Preference for Utilization of Skilled Birth Attendants (SBA) Services by Expectant Mothers in Mombasa County

Preference for Utilization of Skilled Birth Attendants (SBA) Services by Expectant Mothers in Mombasa County

Trends and drivers of skilled birth attendant use in Nigeria (1990-2013): policy implications for child and maternal health.

IntroductionWhile Nigeria accounts for only 2% of the world population, it regrettably shares 14% of global maternal death burden. Whether its reported increase in antenatal care utilization is accompanied by increased use of skilled birth attendants (SBAs) is not known. This study assessed trends in utilization of SBAs in Nigeria between 1990 and 2013 and identified its determinants.MethodsData from four consecutive Nigerian Demographic and Health Survey reports between 1990 and 2013 were pooled. We used basic descriptive statistics, test of association, and logistic regression to assess the prevalence, relative change, and determinants of SBA use at 5% significance level. Sample weights were applied, and adjustment was made for survey design and sampling errors.ResultsNearly half (46.7%) of the respondents were aged 25–34 years, while half (50.3%) of the respondents had no formal education. The prevalence of SBA use increased only marginally across the years and characteristics studied, from 32.4% in 1990 to 38.5% in 2013, an insignificant 6% increase. Educated women used SBA more than women with no education (92.4% vs 13.1%), and their odds ratio of using SBA were thrice that of uneducated women (odds ratio =3.09, 95% confidence interval =2.17–4.38). Women involved in decisions regarding their use of health facility were 12% more likely to use SBAs than others who do not. Educational attainment, religion, tribe, rural/urban residence, and zone of residence were significant to the use of SBA.ConclusionThe use of SBA was very low throughout the study period, barely at one third usage with insignificant changes over the studied period. Women empowerment, including decision-making power and residence, were the strongest determinants of SBA use. To overturn poor child and maternal health outcomes in Nigeria through SBA use, efforts should be targeted at educating girls, sexual and reproductive health education, and accessible and improved health care facility services.