Utilization Of Maternal Services Research Articles

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.

Health insurance support on maternal health care: evidence from survey data in India.

Maternal health care financing is key to the smooth functioning of health systems in a country. In India, maternal health care still persists as a major public health issue. Adequate health insurance could transform the utilization of maternal health care services. Therefore, we aim to examine the health insurance policies that cover maternal health and their performance in India. The unit-level data of social consumption on health by the National Sample Survey Organizations, conducted in India (2017-18), are used. Bivariate analysis, logistic regression and propensity scoring matching are applied. About 14.1% women are covered by health insurance support at the national level. Uninsured women are less likely to receive full antenatal care (ANC) services and institutional delivery. Socio-economic characteristics play a significant role in utilizing maternal health care benefits through health insurance support. Our study concludes that the health insurance coverage is the most significant contributor to the better utilization of full ANC and institutional delivery at the national level and hindrances in accessing them. There is a need for proactive and inclusive policy development by the Government of India to incentivize public financing through health insurance, which can shrink the challenges of public health burden and reduce the health risk.

Utilization of Maternal Health Services in Slum Area of Butwal Sub-Metropolitian City

Background: High maternal morbidity and mortality has been a major public health problem in Nepal which may be due to the low utilization of maternal health services in Nepal. Utilization of maternal services is found very low in slum areas as compared to upscale areas. This study aims to find out the prevalence of utilization of maternal health services and its associated factors in slum areas of Butwal sub-Metropolitan city.
 Methods: A community based cross sectionalstudy was conducted among 202 women who had given birth to baby within 1 year. Semi-structured questionnaire and face to face interview was done to collect the data. Descriptive as well as inferential statistics were used to analyze the data.
 Results:The results showed thatabout 81.18% women had taken complete ANC and 34.65% had taken complete PNC services as per protocol of WHO. Multivariate logistic regression showed that respondent education, monthly income, nearest to health care facilities, knowledge level, and women’s autonomy was found to be associated significantly with complete utilization of ANC services. Similarly, Respondent occupation and nearest to health care facilities were found to be associated significantly with complete utilization of PNC.
 Conclusion: Though ANC utilization was found to be satisfactory but PNC utilization was found very low so more focused should be given to increase the utilization of PNC services in slum area.

Challenges and Suggestions to Promote Maternal Service Provision and Utilization Under the Free Maternal Health Policy in Ghana: Perspectives of Health Directors and Facility Managers

INTRODUCTIONTo promote service uptake and reduce maternal deaths, a policy was implemented under Ghana’s National Health Insurance Scheme in 2008. This study explored the benefits and limitations of the policy, health system challenges, and community-level challenges resulting in suggestions to mitigate the challenges.METHODSThe study design was cross-sectional, utilizing qualitative data collection. It was carried out in the Kassena-Nankana East Municipality, Ghana, involving in-depth interviews (IDIs) with directors of Ghana Health Service and facility managers. A total of eight IDIs were conducted. Data were transcribed, read, and analyzed based on themes which were presented using key quotes.RESULTSThe policy promoted the use of services. Nonetheless, challenges existed as a result of limited service coverage, inadequate human resources and infrastructure, lack of medications and equipment, lack of transport, and the influence of religion, culture, and family members. There was a need to strategize so that women with a low socioeconomic status would receive service over those of a high socioeconomic status. Other suggestions included the inclusion of family planning services, accreditation of private facilities, provision of a shift system for specialists to move to rural areas, and provision of incentives for health personnel in rural areas. It was also suggested that health personnel make known their challenges as well as to provide education on women’s rights and service expectations. The provision of transport vouchers to women as well as alternative arrangements to be made with private transport owners were also suggested.CONCLUSIONImplementing the suggestions may improve service provision and utilization leading to the reduction of maternal deaths and contributing towards achieving universal health coverage.

Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: A multilevel analysis.

The continuum of care for maternal and newborn health is a systematic approach for delivery of an integrated effective package of life-saving interventions throughout pregnancy, childbirth, and postpartum as well as across levels of service delivery to women and newborns. Nonetheless, in low-income countries, coverage of these interventions across the life cycle continuum is low. This study examined the predictors of utilization of maternal and newborn health care services along the continuum of care in Ethiopia. This was a cross-sectional population-based study. We measured maternal and newborn health care utilization practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. We fitted multilevel random-effects logistic regression models to examine the predictors of the continuum of care accounting for the survey design, and individual, and contextual characteristics of the respondents. Our analysis revealed that only one-fifth of women utilized maternal and newborn health services across the antepartum, intrapartum, and postpartum continuum; most women discontinued at the postpartum stage. Continued use of services varied significantly across wealth, model family, prenatal stay at maternity waiting homes, antenatal care in the first trimester, complete antenatal care service, and the administrative region at all antepartum, intrapartum, and postpartum stages. Moreover, family conversation during pregnancy [AOR: 2.12; 95% CI: 1.56-2.88], delivery by cesarean [AOR: 2.70; 95% CI: 1.82-4.02] and birth notified to health extension workers [AOR: 1.95; 95% CI: 1.56-2.43] were found to be predictors of the continuum of care at the postpartum stage. In Ethiopia, despite good access to antepartum care, compliance with continuity of care across the pathway decreased with significant inequitable distributions, the poorest segment of the population being at most disadvantage. The main modifiable program factors connected to the continued uptake of maternal health services include family conversation, pregnant women conference, complete antenatal care, antenatal care in the first trimester, and birth notification.

Factors Influencing the Utilisation of Maternal Health Care Services Among Women of Reproductive Age in Lagos Island LGA, Lagos State

Nigeria has one of the highest rates of maternal deaths during pregnancy, childbirth and after childbirth among the developing countries. Therefore, it is important to identify the factors influencing the utilization of maternal health care services among women of reproductive age. This study was conducted to assess the level of utilization of maternal health care services and it examined factors influencing the utilization of the maternal health care services among women of reproductive age. This study was a cross-sectional descriptive design. Proportionate stratified sampling technique was used to select the markets, while convenience sampling technique was used to select 297 participants. The instrument used for data collection was a self-structured questionnaire that was divided into three sections (sections A-C). The validity and reliability of the instrument was established before used. The descriptive statistics was employed to answer the research questions, while Pearson correlation and chi-square analysis were employed to test the hypotheses at 0.05 level of significant. Findings showed that the level of utilization of maternal health care services was low. There was a significant relationship between factors influencing the utilization of maternal services and the level of utilization of the services among the women of reproductive age (r = .516, p = <0.05). Conversely, the socio-demographic factors were not significantly related to the level of utilization of maternal health services among participants. It was recommended among others that there should be education in form of orientation for women on the need for them to utilize MHCS during pregnancy and delivery and after childbirth.

Geospatial differences among natural regions in the utilization of maternal health care services in India

BackgroundThe chances of a woman dying or becoming disabled during childbirth are closely connected to her socioeconomic status, cultural norms and values, and her home's geographical remoteness. Most of the studies were undertaken to address the issue of accessibility of the hospital's location and its impact on utilization of maternal healthcare utilization. Some studies also attempted to understand the pattern of utilization of healthcare utilization according to administrative and political regions. ObjectivesThis study aims to identify the Geographical differences in the utilization of maternal health services in India according to geographical regions, caste, religion, wealth status, and place of residence. Data and methodsData for analysis was taken from the National Family Health Survey-4 (2015–16). Data management and analysis were performed using statistical software Stata 13.0. To identify the regional differences in the use of maternal healthcare services, study used the 75 th round of NSS's classification of India into 88 natural regions. Regional variations in the usage of maternal health care were plotted using ArcGIS 10.5, and the bivariate method. ResultsResults shows that the utilization of partial ANC ranges from 33.8% to 91.9%. Utilization is lowest in the Northern Kerala region (33.8%) and, in ascending order, higher in Lakshadweep (34.4%), Goa (36.2%), Puducherry (43.1%), Southern Kerala (43.4%), Inland Tamil Nadu (44.5%), and Andaman and Nicobar Island (46.2%), the mountainous region of Jammu and Kashmir (46.7%), Coastal northern Tamil Nadu (49.9%) and Eastern Maharashtra (51.6%). Institutional delivery was the highest in Northern Kerala (100%) and lowest in the Nagaland (35.7%). Near-universal institutional delivery was also found in Southern Kerala (99.9%), Puducherry (99.9%), Coastal Northern Tamil Nadu (99.6%) and Lakshadweep (99.2%). ConclusionsDifferences in the utilization of MCHS by women can be seen among India's natural regions. Utilization is lagging in the Himalayan Mountain ranges, areas with dense forest cover, the Ganga and Brahmaputra plains, and the Desert region of Rajasthan.

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

BackgroundWithin Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone.MethodsWe used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25.ResultsOut of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC.ConclusionFactors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

\u201cEven though they insult us, the delivery they give us is the greatest thing\u201d: a qualitative study contextualizing women\u2019s experiences with facility-based maternal health care in Ethiopia

BackgroundGlobally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women’s experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women’s care experience and what women mean by satisfaction in two Ethiopian regions.MethodsHealth center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women’s experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction.ResultsMaternal and newborn survival and safety were central to women’s descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as ‘satisfactory’. The texture behind this ‘satisfaction’, however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider’s interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility’s amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women’s experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women’s overall satisfaction, even in the context of poor-quality facilities and limited resources.ConclusionOur findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women’s satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women’s care experience.

Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review.

Mobile health (mHealth) technology is being used predominantly in low- and middle-income countries. Developing countries with low level of investment in health infrastructure can augment existing capacity by adopting low-cost affordable technology. The aim of the review was to summarize the available evidence on mHealth interventions that aimed at increasing the utilization of Maternal and Child Health (MCH) care services. Further, this review investigated the barriers which prevent the use of mHealth among both health care workers as well as beneficiaries. A scoping review of literature was undertaken using the five-stage framework developed by Arksey and O'Malley. The articles published between 1990 and 2021 were retrieved from three databases (PubMed, Cochrane Reviews, and Google Scholar) and grey literature for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was followed to present the findings. A total of 573 studies were identified. After removing duplicates, studies not related to mHealth and MCH and publications of systematic reviews and protocols for studies, a total of 28 studies were selected for review. The study design of the research articles which appeared during the search process were mostly observational, cross-sectional, and randomized controlled trials (RCTs). We have classified the studies into four categories based on the outcomes for which the mHealth intervention was implemented: MCH care services, child immunization, nutrition services, and perceptions of stakeholders toward using technology for improving MCH outcomes. This brief review concludes that mHealth interventions can improve access to MCH services. However, further studies based on large sample size and strong research design are recommended.

An observational study on maternal mortality and maternal near miss in a selected facility of West Bengal.

An observational study was performed at Purba Medinipur District Hospital, West Bengal, from April 1, 2018, to December 31, 2020, with an aim to find out the magnitude of maternal mortality and near miss cases and to assess the utilization of available maternal health care services by the deceased women and near miss cases. Result showed 4.5% women developed potentially life-threatening condition (PLTC) of which 21% women developed LTC. Maternal Near Miss (MNM) ratio was 9.46/1000 live birth and the MNM-to-Maternal Mortality ratio was 8.3:1 and the leading causes of MNM and maternal death were hemorrhage, pregnancy induced hypertension/eclampsia. The utilization of maternal health-care services revealed that there is a scope to increase the service delivery. Study finding indicates that health-care programs need to enhance the existing efforts to improve timely health seeking behavior of women.

Situational Analysis of Access to Essential Healthcare Services in Nigeria: Implication for Trans-Sectorial Policy Considerations in Addressing Health Inequities

Background: Socioeconomic factors influence health outcomes and the distribution of health resources within and between countries globally. In Nigeria, there are various socio-economic factors that have been reported to be responsible for health inequities across the different geopolitical zones. Objective: To assess health inequities in relation to socio-economic factors that affect access to essential health care services in Nigeria, using family planning, maternal care, and childcare as indicators. Method: The study involved a cross-sectional secondary analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) and a literature review of transdisciplinary approaches to addressing health inequities. Result: The overall result from the findings suggests a strong influence of geographical and socioeconomic factors in the distribution of healthcare services. Specifically, family planning services were more readily available and accessible in the Southern zones of Nigeria than in the Northern zone of Nigeria, which could be attributed to socio-cultural, religious, and access-related barriers. Results also showed that access to most maternal and child health care services was often skewed towards the southern zones, which could be due to the presence of more healthcare workers who provide these services coupled with higher access to maternal care, hence a higher uptake and utilization of maternal care services. Also, children in the northern zones had lesser odds of receiving basic and age-appropriate vaccination than those in other regions, which could be attributed to the supply-side disparities that exist between the northern and southern regions. Conclusion: This study concludes that level of educational attainment, wealth quintiles, as well as financial barriers, are the major socio-economic factors that influence access to maternal and childcare services.

Utilization of Maternal Care Services and Level of Satisfaction Among Clients in a Teaching Hospital in Ghana

The study investigates the extent to which mothers are satisfied with the maternity services they receive at Tamale Teaching Hospital. The study adopted a descriptive research design. Primary and secondary sources of data were used for the research. Likert scale questionnaires were used in the collection of the data. A quantitative approach was adopted to analyze the data. From the study, respondents agreed that they are provided with access to high-quality care throughout the phases of pregnancy, labour and delivery. They also averred that they receive screening at the maternal and child health to ensure safe delivery. Again, it emerged that respondents get education on proper diet during pregnancy and lactation and the benefits of physical exercises. Additionally, it came up that respondents do not receive considerate and respectful care at all times and under all circumstances, without recognition of their dignity, values and beliefs, respect the rights of the patient. Respondents do not know the name and professional status of those providing services to them. Respondents do know refusing treatment to the extent permitted by law and are informed of the medical consequences of that refusal in the Tamale Teaching Hospital. Thus, it is recommended that the management of Tamale Teaching Hospital should organize training for health providers to encourage them to communicate client information to them during the provider-client interaction. Management should work to improve on the waiting time and contact time for their clients to be satisfied with their service provision. Management of Tamale Teaching Hospital should carry out client satisfaction surveys routinely to improve the quality of Anti-Natal Care. The primary health care authorities should make adequate provision of maternal and child health services a priority given its importance in minimizing maternal and infant morbidity and mortality.

Utilization of free maternity services among mothers aged 18-49 years in Nakuru County, Kenya

Background: In Kenya, the hope of free maternity services (FMS) is to increase the demand for maternity health care services offered by certified health professionals. Thus, this study aimed to determine and understand the utilization level of FMS among mothers aged 18-49 years living in Naivasha Sub-County, Kenya.Methods: A mixed-methods approach collected quantitative and qualitative data through structured questionnaires, health records reviews, focus group discussions, and key informant interviews. The quantitative and qualitative data were analyzed by use of Statistical package for social sciences (SPSS) 20 and content analysis, respectively. The quantitative data results were further subjected to multiple regression analysis.Results: The findings showed that over 80% utilized antenatal care, facility deliveries and postnatal care, but 68% of respondents used family planning. The mothers were found active in their first, second and third pregnancies in utilizing FMS, followed by a sudden decline. The mothers preferred the public health facilities to the private, mission and Non-Governmental Organizations (NGOs). The significant findings influencing the utilization of FMS among the mothers were age (p=0.004), the number of children (p=0.000), age at first birth (p=0.025), household income (p=0.008) and residential area (p=000). The mothers' level of knowledge on FMS had an average score of 80%, obtained by use of the Linkert scale. The radio, television, health facility and community sources were significant with (p=0.000).Conclusions: The decision-makers consider age, the number of children, age at first birth, household income and residential area in the formulation of FMS policies. Further, utilize relevant sources of information on FMS in the community.

Factors Associated with Intimate Partner Violence and the Utilization of Maternal Health Services: Findings from Nepal Demographic Health Survey 2016.

Background: Intimate partner violence (IPV)is a public health problem globally and is most common in developing countries. IPV affects more than one-fourth of all women of reproductive age [WRA]. It is most critical during pregnancy. IPV not only affects physical and mental well-being but also leads to negative consequences with birth outcomes. The paper aims to find out the association between background characteristics of participants, IPV, and utilization of maternal health services. Methods: We conducted a secondary data analysis of the Nepal Demographic and Health Survey 2016 to assess the association between IPV and maternal service utilization: ANC visits and institutional delivery. Altogether 1374 WRA were randomly selected. Background characteristics of the WRA and those who experienced IPV were the independent variables and ANC visits and institutional delivery were the dependent variables. Results: Data showed that 26 percent of the WRA had faced at least one form of IPV, 68 percent had visited health facilities at least four times for ANC check-ups during pregnancy, and the rate of institutional delivery was 61 percent. There were associations among IPV with ANC visits and institutional delivery (p<0.001). Age group, educational level, ethnicity, number of children, residence setting, and wealth status of the WRA were significantly associated with ANC visits and institutional delivery (p<0.001). Conclusions: IPV, educational level, and socio-economic status of WRA were significant predictors for maternal health service utilization. Policymakers should incorporate these significant predictors during planning and intervention programs as well.

Women Empowerment and Utilization of Maternal Health Care in Pakistan

The impact of women's empowerment is examined on the utilization of maternal health care services in Pakistan. The empirical analysis based on logistic regression shows that women's education is the most important factor to improve maternal health among women. Other predisposing factors like parity and health belief are also contributing factors. Household wealth status turned out to be the most significant factor among other enabling factors like ease of access and source of information. Death of the child in previous pregnancies is the only need factor and we have found it statistically significant in the case of postnatal care.

Predictors and Utilization of Health Institution Services for Childbirth among Mothers in a Southern Nigerian City.

Background Poor maternal health indices, including high maternal mortality, are among Nigeria's major public health problems. Most of these deaths can be prevented by timely access and utilization of maternity healthcare services by women. Aim/Objective. This study seeks to identify factors affecting the utilization of health facilities for the delivery of babies among mothers in Calabar, Cross River State, Nigeria. Methodology. The study was a community-based cross-sectional study. A structured questionnaire was administered to 422 women of reproductive age residents in the study area who had given birth at least once within the last five years prior to the survey using a multistage random sampling technique. Data generated were entered, coded, and analyzed using Statistical Packages for Social Sciences (SPSS version 22.0), and results were presented in tables and charts. Chi-squared tests and multiple logistic regression were used for the identification of variables associated with health facility-based delivery. Result The mean age of respondents was 27.3 years (SD = 8.4). Fifty-two percent of the respondents utilized the health facility for delivery, 89.6% attended at least one antenatal clinic (ANC), and 18.9% completed at least 3 ANC sessions. There was a statistically significant association between health facility delivery and marital status (P=0.007), education (P=0.042), and family size (P=0.002). Older women (OR = 0.7, CI = 0.169–3.714), Christians (OR = 1.9, CI = 0.093–41.1), divorcees (OR = 3.7, CI = 0.00–0.00), and respondents who registered early (first trimester) for ANC (OR = 4.9, CI = 0.78–31.48) were found to be higher users of delivery services at the health facility. Conclusion Community health intervention focusing on improving the knowledge and awareness of the significance of utilizing available delivery services at the healthcare facility should be developed and implemented.

Decomposing the urban\u2013rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa

BackgroundThere has been a substantial improvement in reducing maternal mortality in the Sub-Saharan African region. The vast rural-urban gap in maternal health outcomes, however, is obscured by this average achievement. This study attempts to measure the contribution of identified risk factors to describe the average rural-urban difference in the use of antenatal care, health facilities for delivery, and health professional assistance at delivery.MethodTo achieve this objective, we used descriptive analysis and Fairlie non-linear decomposition method to quantify covariates’ contribution in explaining the urban–rural difference in maternal healthcare services utilisation.ResultThe study’s finding shows much difference between urban and rural areas in the use of maternal healthcare services. Socio-economic factors such as household wealth index, exposure to media, and educational level of women and their husbands/partners contributed the most in explaining the gap between urban and rural areas in healthcare services utilisation.ConclusionsInterventions to bridge the gap between urban and rural areas in maternal healthcare services utilisation in Sub-Saharan Africa should be centred towards socio-economic empowerment. Government can enforce targeted awareness campaigns to encourage women in rural communities in Sub-Sharan Africa to take the opportunity and use the available maternal health care services to be at par with their counterparts in urban areas.

Factors affecting utilization and satisfaction of maternal health care services among mothers of neonates in Paropakar maternity and women’s hospital

Background: Knowledge and use of maternal health service is an effectual way to reduce the risk of maternal morbidity and mortality which can be influenced by multiple factors. Maternal service utilization thus plays an important role during pregnancy, childbirth, and the postpartum period. The aim of the study was to analyse antenatal services as proxy indicator for study purpose.Methods: A descriptive cross-sectional study was conducted in post-natal ward of Paropakar maternity and women’s hospital after ethical approval from the Ethical Review Board of the Nepal Health Research Council and Institutional Review Committee of Paropakar maternity and women's hospital and 210 samples were collected by a simple random sampling method. Statistical analysis was done using SPSS 16.0.Results: Out of 210 participants, only 100 (47.6%) had antenatal care as per protocol. The median age of the women delivering in hospital was 25 years. Women having household income more than 10,000 (OR=2.125, 95% CI=1.065-4.241, p=0.032), impact of mass media for utilization of antenatal care service (OR=14.261, 95% CI=4.881-41.670, p value<0.001), and women’s taking an hour or less to reach health facility (OR=2.763, 95% CI=1.293-5.903, p value=0.009) were found to be statistically significant.Conclusions: Majority of women in the study didn’t utilized full antenatal care service as per protocol. There is a need for different community based maternal and child health programs targeting the reproductive aged women and adolescent groups.

Exposure to conflicts and the continuum of maternal healthcare: Analyses of pooled cross-sectional data for 452,192 women across 49 countries and 82 surveys.

Violent conflicts are observed in many parts of the world and have profound impacts on the lives of exposed individuals. The limited evidence available from specific country or region contexts suggest that conflict exposure may reduce health service utilization and have adverse affects on health. This study focused on identifying the association between conflict exposure and continuum of care (CoC) services that are crucial for achieving improvements in reproductive, maternal, newborn, and child health and nutrition (RMNCHN). We combined data from 2 sources, the Demographic Health Surveys (DHS) and the Uppsala Conflict Data Program's (UCDP) Georeferenced Event Dataset, for a sample of 452,192 women across 49 countries observed over the period 1997 to 2018. We utilized 2 consistent measures of conflict-incidence and intensity-and analyzed their association with maternal CoC in 4 key components: (i) at least 1 antenatal care (ANC) visit; (ii) 4 or more ANC visits; (iii) 4 or more ANC visits and institutional delivery; and (iv) 4 or more ANC visits, institutional delivery, and receipt of postnatal care (PNC) either for the mother or the child within 48 hours after birth. To identify the association between conflict exposure and components of CoC, we estimated binary logistic regressions, controlling for a large set of individual and household-level characteristics and year-of-survey and country/province fixed-effects. This empirical setup allows us to draw comparisons among observationally similar women residing in the same locality, thereby mitigating the concerns over unobserved heterogeneity. Around 39.6% (95% CI: 39.5% to 39.7%) of the sample was exposed to some form of violent conflict at the time of their pregnancy during the study period (2003 to 2018). Although access to services decreased for each additional component of CoC in maternal healthcare for all women, the dropout rate was significantly higher among women who have been exposed to conflict, relative to those who have not had such exposure. From logistic regression estimates, we observed that relative to those without exposure to conflict, the odds of utilization of each of the components of CoC was lower among those women who were exposed to at least 1 violent conflict. We estimated odds ratios of 0.86 (95% CI: 0.82 to 0.91, p < 0.001) for at least 1 ANC; 0.95 (95% CI: 0.91 to 0.98, p < 0.005) for 4 or more ANC; and 0.92 (95% CI: 0.89 to 0.96, p < 0.001) for 4 or more ANC and institutional delivery. We showed that both the incidence of exposure to conflict as well as its intensity have profound negative implications for CoC. Study limitations include the following: (1) We could not extend the CoC scale beyond PNC due to inconsistent definitions and the lack of availability of data for all 49 countries across time. (2) The measure of conflict intensity used in this study is based on the number of deaths due to the absence of information on other types of conflict-related harms. This study showed that conflict exposure is statistically significantly and negatively associated with utilization of maternal CoC services, in each component of the CoC scale. These findings have highlighted the challenges in achieving the Sustainable Development Goal 3 in conflict settings, and the need for more concerted efforts in ensuring CoC, to mitigate its negative implications on maternal and child health.