Utilization Of Maternal Health Care Services Research Articles

Utilizing maternal healthcare services: are female-headed households faring poorly?

BackgroundUtilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019–2021).MethodsThe outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest.Results24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves.ConclusionThe results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses.Trial RegistrationNot Applicable.JEL ClassificationD10, I12, J16.

Assessment of modern maternal health care usage in Ethiopia

Ethiopia, like many developing nations, has struggled with the problem of low utilization of maternal healthcare services. The main objective of this study is to investigate the awareness and application of modern maternal healthcare usage and to identify the determinant factors that affect the usage of modern maternal healthcare services in Ethiopia. A quantitative approach to the survey questionnaire was employed. A simple random sampling technique was used to select 240 respondents from a sample of women aged between 18 and 49. Using statistical software, the collected data were analyzed using categorical variable tests and binary logistic regression. The findings showed that, from the total of 240 respondents, some of the respondents had not attended Antenatal care, delivery care, and postnatal care. Therefore, from the findings of the study, the researchers have concluded that to increase health care utilization, the concerned bodies should be expanding access to health services, improving the quality of antenatal care services, conducting awareness-raising promotions, and providing training for health workers to increase their skills and professional ethics. Keywords: Health care; maternity; modern health care service; women.

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

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

Appraisal of universal health insurance and maternal health services utilization: pre- and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia.

The Indonesian government introduced universal health insurance through the National Social Security System (JKN) in 2014 to enhance overall healthcare. This study compares maternal health care (MHC) service utilization before and after JKN implementation in Indonesia. Using 2012 and 2017 data from Indonesia Demographic and Health Surveys (DHS), we conducted a two-period cross-sectional design study following the Anderson model. We assessed how the JKN policy and population characteristics influenced healthcare utilization for women aged 15-49 who had given birth in the last 5 years. Multivariable logistic regression models were used to assess the impact of the JKN policy and related factors. In two waves of Indonesia DHS with 14,782 and 15,021 subjects, this study observed a significant increase in maternal healthcare service utilization post-JKN implementation. Women were more likely to have at least four antenatal care visits (adjusted odds ratio, AOR = 1.17), receive skilled antenatal care (AOR = 1.49), obtain skilled birth assistance (AOR = 1.96), and access facility-based delivery (AOR = 2.45) compared with pre-JKN implementation. This study revealed a significant positive impact of JKN on enhancing MHS utilization. The introduction of universal health insurance coverage likely reduced financial barriers for specific demographics, resulting in increased service utilization. Our study may offer valuable insights for Asian countries with similar demographics and health insurance implementations.

Influence of socio-demographic factors on the use of maternal health care among Muslim women in urban slums of Mumbai, India

Background: Low and middle-income countries such as India face significant challenges in improving maternal health and reducing maternal mortality rate. To combat this problem, it is essential to utilize maternal health-care services. Objective: This study aims to assess the utilization of maternal health-care services (Antenatal care [ANC] and skilled attendance at birth) and the determining factors of maternal health-care utilization. Materials and Methods: This study is cross-sectional. The study is carried out in an urban slum in Mumbai, India. The respondents were selected using a multistage sampling procedure, and 300 Muslim women who delivered in the past 2 years in the reproductive age group (15–49 years) were selected. The data were collected using a structured interview schedule. Data were analyzed using logistic regression analysis. Results: The study shows that maternal health-care utilization among respondents was unsatisfactory. Only 43.8% of the respondents utilized full ANC service and 27.3% still delivered at home with unskilled birth attendance (traditional Dai). A medical emergency, high cost, and lack of quality of services were the most common reasons to deliver at home. Respondents’ age at marriage, education (respondents and partners), monthly income, number of children, and type of family are the most important determining factors for the utilization of maternal health-care services. Conclusion: Better utilization of maternal health-care services can be achieved by improving the overall socioeconomic status of Muslim women. To improve maternal healthcare, special attention is required to be paid to the education of women and spouses. Furthermore, policies may address the women’s subordinate position in socioeconomic parameters. Similarly, close monitoring is required by the government through different agencies on the utilization of maternal health-care services.

Maternal Healthcare Services Utilization and Associated Factors among Childbearing Age of Women in Liben District, East Borena Zone, Oromia Regional Health Bureau, Ethiopia

Background: Utilization of maternal healthcare services is a fundamental health intervention for preventing maternal morbidity and mortality. Despite its importance, the utilization of maternal healthcare services in Ethiopia is low, especially in rural pastoralist communities. Thus, this study aimed to assess maternal healthcare services utilizations and its associated factors in the Liben district of Guji zone, Oromia region, Southern Ethiopia. Methods: A community-based cross-sectional study was conducted with 416 randomly identified mothers in Liben in September, 2020. The respondents were mothers who had given birth 12 months prior to the survey. The data were collected using interviewer administered questionnaires. The data were entered into Epi-data version 4.1 and analyzed using SPSS version 20. Descriptive, bivariate and multivariate logistic regression analyses were also performed. Result: Sixty percent of mothers had received antenatal care at least once. In this study, only 21.2% and 17.5% of women had delivered their babies at health institutions and utilized early postnatal care services respectively. Maternal education [AOR=2.43(95%CI: 1.22–4.89)], decision making power [AOR=2.40(95% CI: 1.3–23.3)], perceived compassionate & respectful care [AOR=0.30(95%CI: 0.18–0.50)], and planned current pregnancy [AOR=0.22(95% CI: 0.12–0.37)] were significantly associated with utilization of antenatal care. Mother’s age [AOR=3.73(95% CI: 1.53–6.04)], time to travel to health facilities [AOR=1.74(95% CI:1.02– 3.08)], knowledge of danger signs [AOR=3.77(95% CI:2.16–6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery, whereas recent antenatal care utilization[AOR=5.34(95%CI:1.96–8.65)], planned current pregnancy and knowledge of danger signs [AOR=2.93(95%CI:1.59–5.41)] were found to be significantly associated with postnatal care utilization. Conclusion: Overall, the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Therefore, considering the identified associated factors and providing information and training on these issues to the community could improve and sustain maternal healthcare services utilization.

Determinants of short birth interval among married multiparous women in Chinaksen district, eastern Ethiopia: a case-control study.

The short birth interval is a common public health issue that affects women's and children's health in sub-Saharan Africa. Despite a higher burden of short birth intervals reported in Ethiopia, there is limited evidence to indicate the primary risk factors, particularly in rural eastern Ethiopia. Therefore, this study assessed the determinants of the short birth interval among married multiparous women in Chinaksen district, Eastern Ethiopia. A community-based case-control study was conducted among randomly selected 210 cases and 210 controls from April 01 to June 30, 2019. The total sample size (219 cases and 219 controls) were calculated using Epi-Info software version 7.2. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27, and multivariable logistic regression analyses conducted to identify the determinants of short birth intervals. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the strength of association and statistical significance declared at p-value < 0.05. The women in the young age group (AOR = 2.33, 95% CI: 1.03, 5.26), missed their antenatal care visits (AOR = 2.23, 95% CI: 1.18, 4.21), failed to utilize postpartum contraceptives (AOR = 5.98, 95% CI: 3.62, 9.89), did not attend postnatal care visit (AOR = 1.86, 95% CI: 1.13, 3.05), nonexclusive breastfed (AOR = 4.05, 95% CI: 2.18, 7.52), short and medium period of breastfeeding (AOR = 4.00, 95% CI: 1.34, 12.10) and (AOR = 3.56, 95% CI: 1.62, 7.82), respectively and female sex of preceding child (AOR = 1.92, 95% CI: 1.18, 3.12) were the important risk factors of short birth interval. Women's age, antenatal care visits, postnatal care attendance, utilization of postpartum contraceptives, exclusive breastfeeding practice, duration of breastfeeding, and sex of the preceding child were the primary predictors of short birth intervals. Improving the utilization of maternal healthcare services in health facilities would be imperative to prevent and reduce short birth intervals, and its negative consequences.

Exploring Antenatal Health Care Service Utilization in Nepal: A Comprehensive Analysis

The utilization of maternal health care is one of the important factors in reducing the incidence of maternal mortality. Studies in Nepal and in developing countries shows that various demographic, socio-economic and economic factors are associated with ANC service utilization. The main objective of this study is to identify and examine socio-demographic and economic factors affecting antenatal healthcare service utilization in Nepal. This study used data from the Nepal Demographic and Health Survey 2016 and analyzed the data using logistic regression analysis. This research analyzes ANC (antenatal care) concerning dependent variables: age, birth order, religion, ethnicity, educational attainment, province, residence, and wealth indices. Maternal health has been receiving increased attention in the global health, development, and human rights agenda, representing a priority area for accelerating progress on the SDGs and sustaining the gains of the MDGs. Bivariate analysis was conducted for all variables, and some of them were statistically significant at the 5 percent significance level (since p &lt; 0.05). The dichotomous use of modern maternal healthcare utilization, namely whether a woman utilized maternal health care or not, employed dichotomous logistic regression to determine which factors best explain and predict the outcome of maternal health care utilization during pregnancy. A positive estimated value indicates that the odds favor the event and the event is likely to occur, while a negative value indicates that the event is not likely to occur. ANC visits of women decrease with birth order. Based on empirical results, the major factors for ANC services were income, awareness, access to health care services, and birth order attended. The level of awareness among women about the utilization of maternal healthcare in the study area was low. Maternal healthcare service utilization differed across various components of maternity. It would be better to increase awareness about the utilization of modern maternal healthcare for mothers and improve access to healthcare services in their villages to minimize transportation costs and waiting times from the government's side, thus increasing the utilization of maternal health care services in Nepal.

Determinants of maternal health care utilization at urban slums in Northeast India: a cross-sectional study

Background: Factors affecting maternal health care utilization determine maternal mortality rate (MMR). Therefore this study has been carried out to out to assess the level and determinants of maternal health care service utilization in an urban slum of north-east India. Methods: A cross-sectional study design was used. The study area comprised of four municipal wards with well-defined geographical boundaries. All married women in the age group 18-45 years who were either pregnant and/ or had at least one child under 3 years of age on the day of survey residing in that area for a minimum of one year were the study population. Data collection was done by house-to-house visit. Descriptive analysis and chi-square test was used for data analysis. Results: Adequate utilization of IFA and TT was 86.3% and 84.4%, respectively. Adequate utilization of maternal health care was found to be 79.8% and 20.2% respectively. Age, educational status, income of the participants and birth order of the relevant child was found to be significantly associated with the maternal health care utilization. Conclusions: The study concludes that maternal health care utilization was found adequate among 79.8% of study participants, out of which antenatal care, intranatal care and postnatal care utilization rate was found in 85.4%, 89.8% and 82.5% respectively. Age, education, income of the women and birth order of their children were significantly associated with maternal health care utilization.

Knowledge and Perception of Women of Reproductive Age on Utilization of Maternal Health Care Services in Akure South Local Government Area of Ondo State: A Quantitative Approach

Even though Maternal health care services utilization is very important for further improvement of maternal health, limited evidence exists on the utilization of Maternal health care services among women of reproductive age in Nigeria. This has resulted into high rate of maternal mortality. Thus, this study aims to assess the knowledge and perception of women of reproductive age on utilization of Maternal health care services in Akure south local government area of Ondo State, south western Nigeria using a qualitative research methodology. Data were primarily sourced from 384 women of child-bearing age who were purposively selected across the communities in Akure south local government area through a multi-purpose sampling technique. Secondary Data were obtained from journals, hospital, records, government’s publications, newspapers, and some internet materials that are relevant to this study. Analyses of Data were carried out with the aids of descriptive and inferential statistics. The findings revealed that majority of the respondents have good knowledge but poor perception of the Maternal health care services. Majority of the respondents opined that education and religion contributed to the utilization of Maternal health care services in the local government area. The study further revealed that there is a significant association between respondents knowledge and utilization of Maternal health care services (R= 12.29, p&lt; 0.000). There is also a significant association between respondents religion and the utilization of Maternal health care services ( R = 8.44, P &lt; 0.01). Significant association also exists between the respondent level of education and the use of maternal healthcare service (r =16.20, p&lt; 0.01). But here is no significant association between the perception of the respondent and utilization of maternal healthcare service ( R =10.25, p&gt;0.777) . The study, however, concluded that women of reproductive age in Akure South Local Government area have good knowledge and poor perception maternal healthcare service which utilization is influenced by their education especially in rural communities within the study areas and their religious affiliations. Against this background, the study recommends increased enlightenment among child- bearing women on the importance of maternal healthcare services, subsidization of cost of accessing healthcare services by the governments and NGOs, strengthening the National Health Insurance scheme to incorporate family planning into its benefit package, upgrade of the existing health facilities and establishment of more health centres in rural and semi-urban areas with explosive populations.

Retracted: Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018

Retracted: Bayesian Analysis of Trends in Utilization of Maternal Healthcare Services in Pakistan during 2006-2018

Evaluating Usability of IRAIVI Pregnancy Prediction Model Using System Usability Scale

Background: Barriers to utilize maternal healthcare services amongst pregnant women at community level differs substantial variation among slums and urban areas which is essential to recognize and resolve these issues within framework of district-level policy planning. IRAIVI pregnancy prediction model is developed to enhance optimal utilization of maternal healthcare services. The study was conducted to evaluate usability of IRAIVI using System Usability Scale amongst healthcare workforce. Methods: This model was developed with a set of predictors based on data collected during baseline and follow up visits from currently pregnant women as per study protocol. For evaluating efficiency of this model, System Usability Scale (SUS) was adopted and shared with 25 randomly selected experts in the field of public health. The questionnaire was shared via google form and responses recorded on Likert’s scale were then analysed using SPSS. Results: IRAIVI model's usability assessed using SUS found to be user-friendly, best learning curve, adaptable to new system and highly acceptance by healthcare workforce. The SUS score averaging at 84 demonstrates favourable usability of the model. Conclusion: This model has capability to accentuate maternal health services which in-turn can contribute for better ANC services in resource-constrained settings. Additionally, future opportunities can be explored through field studies in different settings.

Utilization of Maternal Health Care Services in Himachal Pradesh: An Empirical Analysis

More than 500,000 maternal deaths during pregnancy, childbirth, or within a few weeks of delivery occur as a result of poor maternal health delivery in developing countries. Along with many other socioeconomic determinants, the persistent lack of accessibility and underuse of antenatal and other healthcare services continues to be a significant contributor to the high rates of maternal death. The main objective of the present study is to examine the utilization of maternal healthcare services, such as antenatal care (ANC), intranatal care (INC), and postnatal care (PNC), in Himachal Pradesh and what are the determinants which influence the utilization of maternal health care services. The cross-sectional design and multistage stratified random sample used in the study covered three administrative zones within Himachal Pradesh. 576 respondents participated in the study sample, and data were gathered using structured questionnaire. The result of the study showed that majority of the respondents had utilized at least one of the maternal healthcare services. A generous percentage of respondents chose public hospitals for ANC, with Mandi having the most significant consumption of ANC services. Normal delivery was predominant and most of the deliveries took place in public hospitals. The rate of PNC service utilization was relatively low. It was concluded from the study that the importance of education and income in improving maternal healthcare outcomes requires focused interventions to raise PNC service utilization.

Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts

ObjectiveTo report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. MethodsCross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). ResultsOnly 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother’s education, health worker’s home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. ConclusionPVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health.

Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey

BackgroundThe government-subsidized health insurance scheme Seguro Integral de Salud (“SIS”) was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal – “PEAS” (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages.MethodsRelying on the 2021 round of the nationally-representative survey “ENDES” (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15–49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum.ResultsOnly 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the “SIS” group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14–1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17–1.48), ANC education (aOR = 1.59; 95% CI 1.41–1.80) and ANC screening (aOR = 1.46; 95% CI 1.27–1.69) during pregnancy, compared with women in the “Standard Insurance” group [aOR = 1.35 (95% CI 1.13–1.62), 1.22 (95% CI 1.04–1.42), 1.34 (95% CI 1.18–1.51) and 1.31(95% CI 1.15–1.49)] respectively. In addition, women in the “Standard Insurance” group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33–3.55) compared with the women in the “SIS” insurance group (aOR = 2.12; 95% CI 1.41–3.17).ConclusionsOur findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under “Standard Insurance” or “SIS”. Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.

Does Empowering Women Influence Maternal Healthcare Service Utilization?: Evidence from National Family Health Survey-5, India.

Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. DATA ANDMETHODS: The study uses data from the fifth round of the National Family Health Survey conducted in 2019-2021 and analyzed 26,552 (15-49 aged)currently married women who had a live birth in the last 5years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality.

Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study.

The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

Maternal Health Care Service Utilization in the Post-Conflict Democratic Republic of Congo: An Analysis of Health Inequalities over Time.

This study assessed inequality in maternal healthcare service utilization in the Democratic Republic of the Congo, using the Demographic and Health Surveys of 2007 and 2013-2014. We assessed the magnitude of inequality using logistical regressions, analyzed the distribution of inequality using the Gini coefficient and the Lorenz curve, and used the Wagstaff method to assess inequality trends. Women were less likely to have their first antenatal care visit within the first trimester and to attend more antenatal care visits when living in eastern Congo. Women in rural areas were less likely to deliver by cesarean section and to receive postnatal care. Women with middle, richer, and richest wealth indexes were more likely to complete more antenatal care visits, to deliver by cesarean section, and to receive postnatal care. Over time, inequality in utilization decreased for antenatal and postnatal care but increased for delivery by cesarean sections, suggesting that innovative strategies are needed to improve utilization among poorer, rural, and underserved women.

Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa.

Maintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda. We used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined. Declines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced. Varying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.

Optimizing the utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings

IntroductionQuality care delivery is an essential lifesaving interventions for maternal healthcare and reduction in mortality from preventable reproductive conditions. In African countries like Nigeria, numerous perceptions and militating factors present unique challenges in optimizing the utilization of maternal and reproductive healthcare services. As women continuously evolve away from the utilization of healthcare services, achieving universal health coverage for all emerges as a matter of concern.MethodA phenomenological and descriptive research design was used. The study participants comprised a total of 38 women selected from primary and tertiary healthcare institutions. They were purposively selected from four healthcare institutions in Nsukka, Enugu State, Nigeria.ResultFindings revealed that most rural women at the prenatal stage, utilize maternal healthcare services, but at the postnatal stage, they reject reproductive healthcare services owing to certain perceptions. Concerns about sub-optimal utilization of maternal and reproductive healthcare services were found under enabling, predisposing and need factors. Evidence-based interventions included instituting health insurance policies, improving the healthcare sector, personnel, collaboration among stakeholders, and grass-roots community education. Participants showed little knowledge of social workers’ engagement in healthcare institutions.ConclusionFunctional network of care between private and public healthcare system is the key to optimizing maternal and reproductive healthcare utilization. The study recommends stakeholder and community engagement in achieving functional networks of care, strengthening relational linkages between frontline health workers and equip rural women with better knowledge. All these are geared toward achieving optimal utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings.