Utilization Of Maternal Services Research Articles

Retrospective analysis of causes of death in severe PIH, Preeclampsia & Eclampsia cases in a tertiary medical care centre from January 2015 to December 2016

: PIH, preeclampsia and eclampsia cases are one of the leading cause of maternal death especially in underdeveloped countries. Substandard maternity care is thought to be the reason behind it. Hypertensive disorders in pregnancy is a multi-organ involving disease of unknown etiology. Early detection, timely intervention, strict vigilance and intensive monitoring is needed to prevent maternal mortality and morbidity.: Our aim was to detect the cause of death among pregnant women admitted with hypertensive disorders so that measures can be taken to improve the maternity service.: It was a Retrospective analytical study of causes of maternal death among hypertensive disorders in pregnancy cases admitted in our institution from 1 January 2015 to 31 December 2016.Data were collected from case sheets, death certificates and review report on maternal death cases and were analysed and presented. It was found that pulmonary oedema was the most common (75%) cause of maternal death in PIH cases. Improper antepartum care and delay in seeking medical help, moreover, lack of proper utilization of maternity services was the main cause behind the high maternal mortality in PIH cases (89.6%).: Substandard maternity care was found to be responsible for so high maternal death in PIH cases. This result was similar to the other studies in this context. These deaths are preventable to a large extent.

Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study

BackgroundReducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China.MethodsA cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson’s model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization.ResultsPlace of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC.ConclusionsInequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization.We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women’s health literacy.

Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis.

The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia. Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14. After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic. This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services. PROSPERO CRD42021293681.

Family Decision Making in Utilization of Pregnancy and Maternity Services

Efforts to improve maternal and child health in Indonesia have been carried out for a long time, namely with quality maternal health services starting from the time of pregnancy, delivery assistance by trained health personnel, postpartum care for mothers and babies, special care and referrals if complications occur, obtaining leave pregnancy and childbirth, and access to family planning. Maternal health service is a place used to carry out service efforts. Health services for pregnant women are realized through the provision of antenatal care at least six times during pregnancy. Objective: This study was to determine the factors of family decision making in the utilization of pregnancy and delivery services. Methods This research will use an analytic type using a cross-sectional design. The number of samples in this study were 40 people with a duration of 7 months. Total sampling technique. Data analysis consisted of univariate analysis and bivariate analysis with the chi-square test. Results: The results of the study showed that the majority of the factors of good knowledge were 20 people, the majority of the high economic factors were 21 people and the mileage factor was 21 people. Conclusion: There is a relationship between knowledge, economics and distance traveled with the utilization of pregnancy and delivery services with a p value of 0.000. This research is expected to be an input for pregnancy and delivery services so that they can be maximized. Abstrak: Upaya untuk meningkatkan kesehatan ibu dan anak di Indonesia telah lama dilakukan, yaitu dengan pelayanan kesehatan ibu yang berkualitas mulai dari saat hamil, pertolongan persalinan oleh tenaga kesehatan terlatih, perawatan pasca persalinan bagi ibu dan bayi, perawatan khusus dan rujukan jika terjadi komplikasi, memperoleh cuti hamil dan melahirkan, serta akses terhadap keluarga berencana. Pelayanan kesehatan ibu adalah tempat yang digunakan untuk menyelenggarakan upaya pelayanan. Pelayanan kesehatan ibu hamil diwujudkan melalui pemberian pelayanan antenatal sekurang-kurangnya enam kali selama masa kehamilan. Tujuan: Penelitian ini untuk mengetahui Faktor-faktor pengambilan keputusan keluarga dalam pemanfaatan pelayanan kehamilan dan bersalin. Metode Penelitian ini akan menggunakan jenis analitik dengan menggunakan desain cross-sectional. Jumlah sampel dalam penelitian ini adalah 40 orang dengan lama penelitian 7 bulan. Teknik pengambilan total sampling. Analisis data terdiri dari analisis univariat dan analisis bivariat dengan uji chi square. Hasil: Hasil penelitian mayoritas factor pengetahuan baik sebanyak 20 orang, mayoritas factor ekonomi tinggi 21 orang dan faktor jarak tempuh 21 orang. Kesimpulan: Terdapat hubungan antara factor pengetahuan, ekonomi dan jarak tempuh dengan pemanfaatan pelayanan kehamilan dan bersalin dengan p value 0.000. Penelitian ini diharapkan dapat menjadi masukan bagi pelayanan kehamilan dan persalinan agar dapat lebih maksimal.

Utilization of Maternal Health Care Services and Home or Hospital Delivery of Child Birth Among Women of Deupurkot VDC of Parbat District in Nepal

Background Nepal has made significant improvement in meeting the maternal and child health care services also progress newborn, infant and under mortality over the past two decades. The stark disparities on utilization of health services due to women with lower education, low wealth quintile household, disadvantage cast/ethnic groups and women in remote areas. The utilization of available maternal health care services from public and private service is remarkable to reduce maternal morbidity and mortality in Nepal. Methods The community base descriptive cross sectional study was conducted in 509 households through door to door home visit in Deupurkot VDC covering all first to nine wards. The information was obtained using pretested questionnaire of Pokhara University by Bachelor level students of Public Health. The data was entered into Microsoft excel and analyzed. The data was collected from 19th November to 18th December 2014. Results The nuclear family size was (74.3%). Majority (80%) of the household have their pakka house, (95.7%) household used sanitary latrine and (86.7%) household heads were literate. The major occupation was agriculture (52.55%). The age of marriage before 18 yrs was (25.30%). Majority of women (81%) women used Injection Depo-Provera and less used device was Norplant/Implant user was (3.7%) World Health Organization (WHO) recommended almost (41%) had antenatal care (ANC) visit. Majority (96.70%) had gone for ANC visit and (67%) of them give birth their children at health institution. More than half (51.60%) women had knowledge of postnatal care (PNC) but (32.60%) used this service either in Health post, primary health care center (PHCC) or Hospital. Conclusion The antenatal care (ANC) visit were high in conclusion is high even up to WHO recommendation mark. There is a gap between knowledge of postnatal care (PNC) and its utilization, we need to improve this NPC visit gap utilizing available health services.

Prevalence of stillbirth and associated factors among deliveries attended in health facilities in Southern Ethiopia.

Stillbirth is an unfavorable outcome of pregnancy, which is still prevalent in many countries despite remarkable efforts made to improve the care of pregnant women. While producing estimates consistent with other national reports, all are hindered by limited data and important causes of death are likely to be missed. However; there is a scarcity of data on stillbirth in Ethiopia particularly in the Wolaita zone. To assess the prevalence and associated factors of stillbirth among women giving birth at public hospitals in the Wolaita zone, southern Ethiopia. A facility-based cross-sectional study was conducted in public hospitals in the Wolaita zone. A stratified sampling technique was used to select 737 women. A pre-tested interviewer-administered questionnaire was used for data collection. Data were entered using Epidata version 3.1 and analyzed using SPSS version 20. Bivariate and multiple logistic regression analysis were used and the crude and adjusted odds ratios at a 95% confidence interval with P-value <0.05 were considered to declare the result as statistically significant. This study reported an 8.7% [95% CI: 6.5-10.8] prevalence of stillbirth. Women who lived in rural areas, had pregnancy and labor complications, a high number of pregnancies, a prior history of stillbirth, and a complicated delivery were associated with stillbirth. When compared to urban residents, being a rural resident increased the risk of stillbirth by 2.57 fold [adjusted OR = 2.57, 95% CI: 1.23, 5.40]. When compared to their counterparts, women who experienced complications during pregnancy and labor increased 6.23 fold [AOR = 6.23, 95% CI: 2.67-14.58], having a previous history of stillbirth increased 6.89 fold [AOR = 6.89, 95% CI: 2.57-13.57], and the type of delivery increased 7.13 fold the risk of stillbirth [AOR = 7.13, 95% CI: 2.71-18.73]. The prevalence of stillbirth among women who gave birth in public hospitals in the Wolaita zone was found to be high compared to national and regional figures. Therefore, the federal and regional governments should strengthen inter-sectoral collaboration with health facilities to promote the maternal and health care services utilization. The zonal health department and other concerned bodies should focus on the implementation of the strategies and policies that address and reduce the causes of stillbirth.

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019–2020 Rwanda demographic health survey

BackgroundAccess to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda.MethodsWe analyzed weighted secondary data from the 2019–2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression.ResultsOf the 6,302 women, 2,131 (33.8%) (95% CI: 32.8–35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11–1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01–1.52), southern region (AOR): 1.26, 95% CI: 1.04–1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30–1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15–1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07–1.46), those who were married (AOR): 1.35, 95% CI: 1.11–1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05–2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07–1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18–1.95).ConclusionWe have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.

Association between frequency of mass media exposure and maternal health care service utilization among women in sub-Saharan Africa: Implications for tailored health communication and education.

IntroductionAwareness creation through mass media has the potential to promoted positive behaviors and discourage negative health-related behaviors through direct and indirect pathways. In this study, we examined the association between exposure to mass media and maternal health care services utilization among women in sub-Saharan Africa.MethodsWe used data from the recent Demographic and Health Surveys (DHS) conducted between 2010 and 2020. A total of 28 countries with a survey dataset within 2010–2020 were included in our study. We included 199,146 women who had ever had a pregnancy in the last five years preceding the survey. Weighting was applied. Multilevel mixed-effect models were considered to account for cluster-level variations and correct inferences. Fixed and random effects estimates were reported. Adjusted odds ratio (aOR) with their 95% confidence intervals (CIs) were used to present the results. Also, we presented the random intercept variations, intraclass correlation coefficient, and model fitness.ResultsWomen who listened to radio at least once every week (aOR = 1.11, 95% CI = 1.07,1.15) were more likely to attend ANC as against those who did not listen to radio at all. Also, women who watched television at least once a week (aOR = 1.39, 95% CI = 1.33,1.46) were more likely to attend ANC compared to those who did not watch television at all. Women who read newspaper/magazine at least once a week (aOR = 1.27, 95% CI = 1.14,1.41); listened to radio at least once a week (aOR = 1.12, 95% CI = 1.07,1.17); and watched television at least once a week (aOR = 1.32, 95% CI = 1.24,1.40), were more likely to utilize SBA than those who did not read newspaper/magazine; listen to radio; and watch television at all. Women who read newspaper/magazine at least once a week (aOR = 1.35, 95% CI = 1.27,1.45); listened to radio at least once a week (aOR = 1.37, 95% CI = 1.32,1.42); and watched television at least once a week (aOR = 1.39, 95% CI = 1.32,1.47) were more likely to utilize PNC compared to those who did not.ConclusionsThe study identified a strong positive relationship between mass media exposure and maternal health care services utilization. Specifically, exposure to radio and television were positively associated with ANC visitations. Moreover, exposure to mass media (newspaper/magazine, radio and television) were positively associated with SBA and PNC utilization. Policymakers and other non-governmental organizations should continuously invest resources in the design and implementation of maternal health service utilization educational programs through all the mass media channels to scale up women’s maternal health service services utilization uptake in sub-Saharan Africa.

Determinants of Health Facilities Influencing Utilization of Free Maternity Services Among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County

Free maternity services is the offering of medical and obstetric care to pregnant women without any financial cost. Complications related to pregnancy were a major reproductive health problem that lead to disability and increased maternal deaths. Free maternity was introduced in Kenya in 2013 with a focus of achieving 100% utilization of the service and reducing high mortality rate. Homa-Bay County had a low percentage of 54% deliveries taking place in health facilities within the county. The main objective of this study was to establish Determinants of Health facilities Influencing Utilization of Free Maternity Services among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County. Descriptive cross-sectional study design was applied to establish the main objective of this study. A probability and non-probability sampling techniques was used to select 420 respondents. The study utilized quantitative and qualitative methods of data collection. Data analysis was conducted with aid of Statistical Package for Social Scientists (SPSS) version 23. Analysis methods used were; factor analysis and regression analyses methods for quantitative data to determine the relationship and associations among the variables. Qualitative data was analyzed through content analysis by conducting thematic analysis. A total of 396 that was 94% response rate established 54% (213/396) mothers were interviewed and were aged between 20 years and 29years. Results showed that; age of the mothers was insignificant in utilization of free maternity services. Further analysis using logistics regression revealed that the respondents who agreed with the need for a well-equipped health facility with good sanitation system were 63% (OR 0.37, p = 0.03) more likely to reuse FMS. Distance was insignificant in utilization as long as the facility was well-equipped and adequately staffed as 57% (228/396).This study concluded that there was significant association between staff respect, and honesty of the staff with utilization of free maternity service. This study recommended that the County Government of Homa-Bay should increase awareness to women of reproductive age at the community level about FMS through Community health promotion officers in order to improve FMS uptake in Homa-Bay County.

Mothers’ Perspectives on Utilization of Maternal Health Services in Rural Health Units in Luzon: A Qualitative Study

Introduction. Despite implementing various maternal health care programs and integrating these into Service Delivery Networks, the Philippines continues to have high maternal mortality. Identifying factors that impede the utilization of available maternal care services may help reduce maternal morbidity and mortality and bridge the gap between the need and actual use of such services among mothers in the community.Objectives. This study identified barriers, hindrances, and other factors influencing mothers in availing maternal health services in Luzon, the largest island in the country and the area that accounted for more than half of total maternal mortality.Methods. Eight focus group discussions participated in by a total of 78 pregnant women and mothers were conducted across all of the eight regions of Luzon. In each session, the participants were asked to answer questions based on a semi-structured interview guide. The interviews were recorded, translated and back-translated, transcribed, and compiled before analysis by the deductive-dominant approach using NVivo12.Results. Factors affecting maternal health service utilization center on the capacity of health facilities to provideservices like evaluation of the progress of pregnancy, laboratory examinations, free medicines, and immunizations; and on region-bound individual factors. The availability of skilled health personnel and lack of financial resources were the most common subthemes.Conclusion. This study identified some key factors that deter patients from availing of existing maternal healthservices in Luzon. Eliminating these barriers will not only help strengthen local health infrastructure and improve service delivery but also promote the utilization of such services, leading to better maternal outcomes.

Assess the effectiveness of structured teaching program on knowledge and attitude of birth preparedness among primigravida mothers

Background: Birth preparedness is a safe motherhood initiative with the objective of planning for normal birth and anticipating actions needed in the case of emergency. The pregnant mother and their families are encouraged to effectively plan for births and deal with anticipated complication, if they occur it ensures that the readiness and timely utilization of skilled maternal and unit health care services. Aim: To assess the effectiveness of structured teaching program on knowledge and attitude of birth preparedness among Primigravida mothers. Design: Quasi Experimental one group pretest and posttest design was used.Setting: The study was conducted in Government Medical College and Hospital, Thiruvallur, Tamilnadu in Maternal and Child Health Center. Sample: Primigravida mothers in their third trimester who visited the antenatal OPD at Thiruvallur GH served as study participants.Tools: Demographic Variables, Self-structured knowledge questionnaire, self-structured 5 point Likert Scale to assess the attitude. Results: The study results showed that knowledge level in the pretest was 42(42%) of Primigravida mothers had moderately adequate knowledge, 41(41%) had inadequate knowledge and 17(17%) had adequate knowledge on birth preparedness whereas in the post test, 79(79%) had adequate knowledge and 21(21%) had moderate adequate knowledge on birth preparedness among Primigravida mothers. The attitude level in the pretest was 79(79%) of Primigravida mothers had moderately favourable attitude, 17(17%) had favourable attitude and 4(4%) had unfavourable attitude on birth preparedness whereas in the post test, 78(78%) had favourable attitude and 22(22%) had moderate favourable attitude on birth preparedness among Primigravida mothers. There was a significant ix difference between the pretest and post test score of knowledge and attitude which clearly infers that structured teaching programme on birth preparedness administered to the Primigravida mothers was found to be effective in improving their level of knowledge and attitude in the post test.

Factors affecting the utilization of maternal and child health care services in North Gujarat

The present study intended to examine the factors affecting the utilization of maternal health care services in the north Gujarat region of India. The study used Data collected from various hospitals of different districts of North Gujarat. Both bivariate and multivariate techniques have been applied for data analysis. Logistic regression techniques and concentration curve and index have been used. Findings of the study indicate that there were wider socio-economic differential exits in the utilization of MCH services (full ANC, Safe delivery and post-natal care) in all the district under study. The result shows that the farther population from healthcare centre is less likely to utilize maternal and child health care services. The economic inequality in accessing the all three components of maternal health care utilization was higher in the urban area. As the educational level, wealth index, employment, atonomy and exposure to mass media of women increases the utilization of these services increases significantly.

Facilitators and barriers influencing utilization of services provided by community midwives in district Thatta, Pakistan: a qualitative exploratory study

BackgroundTo address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives’ services utilization in district Thatta.MethodsA qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with district officials of the Health department (Thatta), Maternal and Newborn Child Health Program, and Midwifery Association of Pakistan (MAP). In-depth Interviews (IDIs) were conducted with midwifery students who were currently enrolled in the midwifery program of the district; trained community midwives providing services in district Thatta, and trained community midwives not continuing their profession. IDIs were also conducted with community women to explore their views about the scope of midwifery practice and the factors influencing the utilization of community midwives’ services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis.ResultsA total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives’ skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives’ service utilization included deficiencies in community midwives’ training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body.ConclusionThe study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries.

BackgroundIntimate partner violence (IPV) adversely affects women’s reproductive health outcomes but to what extent women’s justification of IPV affects maternal health care service utilization is unexplored.MethodsThe secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women’s justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT).ResultsA total of 26,029 women aged 15–49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94).ConclusionsWomen’s justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women’s condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women’s utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12905-022-01780-4.

Utilization of maternal health care services and ownership and use of mobile phones among Indian women

Background: Even with years of maternal and child health programmes and interventions, maternal and child health issues persist in India. Given the expansion in the ownership and use of mobile phones, mobile health (mHealth) interventions have been designed and implemented to facilitate MCH services. This study aims to assess whether ownership and use of mobile phones by Indian women are associated with the utilization of maternal health indicators such as antenatal carevand institutional delivery services.Methods: This study used the latest publically available data on mobile phone use from a nationally representative household survey (n=12047) to examine the association between mobile phone ownership and use, such as access to the Internet or not, texting facility available on the phone or not with having at least four ANC visits or an institutional delivery. The data fitted survey-adjusted logistic regression models adjusted for women’s autonomy, access to mass media, and other sociodemographic covariates.Results: Household ownership of a mobile phone was positively associated with receiving ANC (OR=1.21; CI=1.08-1.36) in fully adjusted models. Women with access to the Internet and SMS facility also had higher odds (OR=2.87; CI=1.54-5.34) of reporting an institutional delivery and receiving an ideal ANC (OR=1.25; CI=1.01-1.64) in the fully adjusted models Conclusions: Patriarchal social norms potentially affect women’s use of mobile phones. mHealth based maternal and child health (MCH) interventions in India, particularly those targeting underprivileged/disadvantaged women, are unlikely to be effective unless measures are made to increase access to, and autonomy in, mobile phone use. Partnering with social scientists in designing such interventions and other policy-relevant implications are discussed.

Barriers for health care access affects maternal continuum of care utilization in Ethiopia; spatial analysis and generalized estimating equation.

Although Ethiopia had made a significant change in maternal morbidity and mortality over the past decades, it remains a major public health concern. World Health Organization designed maternal continuum of care to reduce maternal morbidity and mortality. However, majority of the mothers didn't utilize the maternal continuum of care. Therefore, this study aimed to assess the spatial distribution of incomplete utilization of maternal continuum of care and its associated factors in Ethiopia. This study was based on 2016 Demographic and Health Survey data of Ethiopia. A total weighted sample of 4,772 reproductive aged women were included. The study used ArcGIS and SaTScan software to explore the spatial distribution of incomplete utilization of maternal continuum of care. Besides, multivariable Generalized Estimating Equation was fitted to identify the associated factors of incomplete utilization of maternal continuum of care using STATA software. Model comparison was made based on Quasi Information Criteria. An adjusted odds ratio with 95% confidence interval of the selected model was reported to identify significantly associated factors of incomplete utilization of maternal continuum of care. The spatial analysis revealed that incomplete utilization of maternal continuum of care had significant spatial variation across the country. Primary clusters were detected at Somali, North-Eastern part of Oromia, and East part of Southern Nation Nationalities while secondary clusters were detected in the Central Amhara region. In multivariate GEE, rural residency, secondary education, higher education, Protestant religious follower's, Muslim religious follower's, poorer wealth index, richer wealth index, richest wealth index, currently working, having barriers for accessing health care, and exposure for mass media were significantly associated with incomplete utilization maternal continuum of care. Incomplete utilization of maternal continuum of care had significant spatial variations in Ethiopia. Residence, wealth index, education, religion, and barriers for health care access, mass media exposure, and currently working were significantly associated with incomplete utilization of maternal continuum of care. Therefore, public health interventions targeted to enhance maternal service utilization and women empowerment in hotspot areas of incomplete utilization of maternal continuum of care are crucial for reducing maternal morbidity and mortality.

Utilization of Maternal and Child Health Care Services among Pregnant Women in Slum Population of West Delhi

Utilization of maternal and child health (MCH) services remains poor in India. This study aimed to assess the utilization of MCH care services among pregnant women residing in an urban slum area of West Delhi. A household survey was conducted using questionnaire cum interview method for collection of sociodemographic information, obstetric history, and information on utilization of MCH care services. Pregnant women were followed within 72 h of delivery for obtaining information regarding delivery conditions. Although 96.6% of pregnant women have attended at least one antenatal care (ANC), whereas complete four ANC were attended by only one-fourth (25.3%) pregnant women. Nearly three-fourth (73.3%) pregnant women received; ANC from a government doctor and coverage for ANC components was highest in ANC provided by government doctor. Utilization of full ANC was reported by less than one-fifth pregnant women (19.18%). Only one-fifth of pregnant women (19.7%) received supplementary nutrition. Postnatal care (PNC) was received by 73.2% of women who had institutional deliveries during their stay in health facility only. Coverage of ANC components, number of ANC visits, utilization of full ANC, and PNC was found unsatisfactory. Participation in supplementary nutrition program was also poor. Intervention programs are needed for enhancing community awareness and improving the competence, confidence, and motivation of grass root health workers.

Socio-economic determinants of maternal health care utilization in Kailahun District, Sierra Leone, 2020

BackgroundAscertaining the key determinants of maternal healthcare service utilization and their relative importance is critical to priority setting in policy development. Sierra Leone has one of the world’s highest maternal death ratios in the context of a weak health system. The objectives of this study were to determine; the level of utilization of Antenatal Care (ANC), Skilled Delivery Attendants (SDA), Postnatal Care (PNC) services, and factors that influence the utilization of these services.MethodsWe conducted a community-based cross-sectional study involving 554 women of reproductive age (15–49 years) who had at least one delivery in the last 3 years and lived in the Kailahun District, Sierra Leone from November 2019 to October 2020. Data were analysed using analysed using bivariate, multivariate and multinomial logistic regression models.ResultsThe median age of respondents was 25 years (Q1 = 17 years, Q3 = 30 years). Eighty-nine percent (89%) had 4 or more ANC visits. Only 35.9% of women were delivered by SDA. Women residing in urban areas had over six-fold increased odds of utilizing SDA as compared to women residing in rural areas (AOR = 6.20, 95% CI = 3.61–10.63). Women whose husbands had a primary level of education had 2.38 times increased odds of utilizing SDA than women whose husbands had no education (AOR = 2.38, 95% CI = 1.30–4.35). Women that walked longer distances (30–60 min) to seek healthcare had 2.98 times increased odds of utilizing SBA than those that walked shorter distances (< 30 min) (AOR = 2.98, 95% CI = 1.67–5.33). Women who had a secondary/vocational level of education had 2.35 times increased odds of utilizing the standard PNC category as compared to those with no education (OR = 2.35, 95% CI = 1.19–4.63).ConclusionThe majority of women had 4 or more ANC visits yet the use of skilled birth attendants was low. Urban residence and education were significantly associated with the use of the standard PNC category. To improve the utilization of maternal health care services, national healthcare policies should target the advancement of education, train skilled Maternal Healthcare (MHC) attendants, rural infrastructure, and the empowerment of women.

Assessment of Knowledge and Utilization of Maternal and Neonatal Health services in Public Hospitals of district Dera Ghazi Khan

Background: Poor utilization of healthcare services during pregnancy, child delivery, and postpartum is a significant cause of maternal and child mortality. Antenatal and postnatal care is the most effective intervention for maternal and infant mortality and morbidity, especially in areas where women's general health is poor. Objectives: This study was conducted to find out the mother's knowledge about maternal and neonatal services to determine the utilization of maternal and neonatal services in public hospitals of District Dera Ghazi Khan. Methodology: A cross-sectional study was conducted in a public hospital in Dera Ghazi Khan. A structured questionnaire was used to collect data about the knowledge and utilization of antenatal care services among pregnant women. Results:The findings of the present study showed that 58.4% of respondents have good knowledge of antenatal care, while 41.6% showed poor ability. Among total respondents, 46.32% showed positive utilization of ANC services, while 53.68% showed poor utilization. A statistically significant difference has been found between respondents' income and ANC knowledge (p=0.02). A statistically significant difference was found between respondents' education and ANC knowledge (p=0.01). Among respondents who have their first pregnancy, 45(72.58%) have good ANC service utilization (p=0.002). Among respondents who were satisfied with the ANC services, 81(89.01%) were utilizing early ANC, whereas 10 (10.98%) were utilizing late ANC services (p=0.01). Conclusion: Overall findings of this research have shown that respondents' knowledge and utilization of ANC were not satisfactory. For more improvement, there is a need to educate women and provide them with adequate facilities to utilize maternal and neonatal care services.