Association between child marriage and institutional delivery care services use in Bangladesh: intersections between education and place of residence

Abstract Background: The importance of antenatal visits in safe motherhood and childbirth is well documented. However, less is known how social determinants of health interact with antenatal care (ANC) visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the association of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.Methods: We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,581 women of reproductive age (15-49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results: Regression analyses adjusted for socioeconomic and demographic covariates suggest that women who had 4 or more ANC visits were 5.7 times (95% CI= 4.78, 7.11, P<0.001) more likely to use delivery care at a health facility and 6.5 times (95% CI= 5.23, 8.03; P<0.001) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions between ANC, education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion: Our findings suggest that the association of ANC visit with institutional delivery care services is stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

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Practices and Women’s Perceptions of Childbirth in Western Nepal: A Qualitative Study

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i1.2413 ◽

2020 ◽

Vol 18 (1) ◽

pp. 64-69

Author(s):

Tulsi Ram Bhandari ◽

Shreejana Wagle ◽

Ganesh Dangal

Keyword(s):

Institutional Delivery ◽

Health Workers ◽

Cultural Beliefs ◽

Home Delivery ◽

Labor Pain ◽

Delivery Care ◽

Local Health ◽

Care Services ◽

Study Results ◽

Women’S Perceptions

Background: Despite continuous efforts to increase the utilization of institutional delivery care services nearly two-fifths women deliver their babies at home without the assistance of skilled birth attendants (SBA) in Nepal. The skilled care at birth can reduce the high maternal and neonatal mortality. This study explored childbirth practices and women’s perceptions of childbirth and its associated factors.Methods: An exploratory study was conducted in three purposively selected remote villages of Kapilvastu district, from March to May 2017. Face-to-face in-depth interviews were conducted with women who had an under-one year child. We performed a thematic analysis to draw the findings of the study. Results: Women sought institutional delivery care either for long labor-pain or obstructed-delivery. Despite various incentives, people still preferred home for normal deliveries. There was also practiced skilled birth attendant (SBA) assisted home delivery care. Some of the local health workers also advised pregnant-women for assisted home delivery care. People considered childbirth as a normal process. Due to cultural beliefs and norms, people were also reluctant to pursue institutional delivery care services. Financial constraints, poor access to services and expensive transportation services were other underlining causes of home delivery practices. Conclusions: Despite various incentives for institutional delivery care; the study did not spectacle an encouraging reaction. It pointed to the very basic and strong relationship between women’s position in the household and the society and education with childbirth practices. There were limits to how far financial incentives can overcome these obstacles. So, the improvement of the socio-economic conditions of the women would be the viable way-out of the problem.Keywords: Childbirth practices; home delivery; institutional delivery; women’s perception

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A qualitative study of factors impacting accessing of institutional delivery care in the context of India's cash incentive program

Social Science & Medicine ◽

10.1016/j.socscimed.2017.01.059 ◽

2017 ◽

Vol 178 ◽

pp. 55-65 ◽

Cited By ~ 24

Author(s):

Sukumar Vellakkal ◽

Hanimi Reddy ◽

Adyya Gupta ◽

Anil Chandran ◽

Jasmine Fledderjohann ◽

...

Keyword(s):

Qualitative Study ◽

Institutional Delivery ◽

Delivery Care ◽

Incentive Program ◽

Cash Incentive

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Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽

10.1542/peds.106.s3.937 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 937-941

Author(s):

Kenneth D. Mandl ◽

Charles J. Homer ◽

Oren Harary ◽

Jonathan A. Finkelstein

Keyword(s):

Primary Care ◽

Length Of Stay ◽

Early Discharge ◽

Urgent Care ◽

Care Utilization ◽

Care Services ◽

Primary Care Services ◽

Ambulatory Services ◽

The Impact ◽

Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

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Utilization pattern and associated factors of maternal health care services in Haryana, India: a study based on district level household survey data

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180910 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1154 ◽

Cited By ~ 2

Author(s):

Shinjini Ray ◽

Pravat Bhandari ◽

Jang Bahadur Prasad

Keyword(s):

Health Care ◽

Maternal Health ◽

Antenatal Care ◽

Health Care Services ◽

Institutional Delivery ◽

Maternal Mortality Ratio ◽

Maternal Health Care ◽

District Level ◽

Care Services ◽

Maternal Health Care Services

Background: Maternal health was one of the most important millennium development goals (MDGs), India didn’t achieve by the year 2015. Since, India is a multicultural, social and multiregional country, where some of the regions have good social and demographic achievement while some are poor. Haryana is one of them, which has 146 maternal mortality ratio. The level of receiving antenatal care (ANC) in Haryana is quite low as compared to other states of India. Objective of present study was to Understand the extent of use of maternal health care services in Haryana as well as examining the role of antenatal care and other socio-economic factors on the utilization of maternal health services.Methods: Bivariate analysis, chi-square test, and binary logistic regression have been used based on district level household and facility survey-4 data.Results: The utilization of ANC (any and full), institutional delivery and post-delivery treatment seeking varies among women by literacy, age at first marriage, age at women and place of residence. Literate women are two times more likely to access ANC [odds ratio (OR)=1.97 (any ANC), 1.95 (full ANC), p<0.01] and 1.52 times more likely to prefer institutional delivery [OR=1.52, p<0.01].Conclusions: Empowering women through the encouragement of mother’s education should be one of the most fundamental strategies to promote maternal health care services and reduce inequalities.

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Health Insurance Cards and Health Care Services Utilization: Evidence From Children in Mountainous Regions of Vietnam

Global Pediatric Health ◽

10.1177/2333794x19843917 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1984391 ◽

Cited By ~ 1

Author(s):

Nhu Van Ha ◽

Van Thi Anh Nguyen ◽

Bui Thi My Anh ◽

Thanh Duc Nguyen

Keyword(s):

Health Care ◽

Health Insurance ◽

Associated Factors ◽

Health Care Services ◽

Health Care Policy ◽

Care Policy ◽

Insurance Reform ◽

Care Services ◽

Free Health Care ◽

Services Use

Health insurance reform for children younger than 6 years of age was implemented in 2005. The study aimed to describe the health insurance card status, health care services use, and associated factors. The cross-sectional study was conducted with 210 Hmong mothers of children younger than 6 years of age, and of those, 118 mothers having an ill child in the previous 4 weeks were selected in this study. Descriptive statistics and multiple logistic regression were applied to predict the associated factors. In all, 42.9% of children had health insurance cards and 45.8% ill children accessed public health facilities. The factors included children’s age, mothers’ knowledge of the free health care policy, mothers’ knowledge about one sign of lung infection of their children associated with health insurance status, and health care services use. In conclusion, the 2005 reform of child health insurance policy has brought a modest impact on insurance coverage of children younger than 6 years of age and health care services use. Mothers’ knowledge of free health care policy should be improved.

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