An ex-ante economic evaluation of the Maternal and Child Health Voucher Scheme as a decision-making tool in Myanmar

Abstract Background Nigeria is experiencing a high level of urbanization and urban poverty. Within Nigeria maternal and child health and family planning outcomes may differ by residence (capital city, urban/non-capital city and rural) as well as by measures of women’s empowerment and wealth. This paper presents a detailed analysis of maternal and child health and family planning outcomes in Plateau State, Nigeria. Methods Data came from the 2017 Nigerian Urban Reproductive Health Initiative Sustainability Study. Multivariable logistic regression was used to study the associations between the key independent variables of residence, women’s empowerment and wealth with having a skilled birth attendant at childbirth and childhood preventative visits. The women’s empowerment variables included perceptions about household decision-making, financial decision-making, views on wife beating and having a prohibition, defined as a restriction on specific activities imposed by a woman’s husband. Multinomial regression was used to study the association of the same factors with the family planning outcome which had three categories – no use, traditional method use and modern method use. Regressions were also run separately for urban and rural populations. Results Women in the capital city of Jos were significantly more likely to have a skilled birth attendant at childbirth, take a child to a preventative visit and use family planning than women in rural areas of Plateau State. Three of the four measures of empowerment (household decision-making, financial decision-making and having a prohibition) were significantly associated with the family planning outcome, while having a prohibition was negatively associated with having a skilled birth attendant at childbirth. In rural areas, women involved in financial decisions were significantly less likely to use a modern method compared to a traditional method. Wealth was a significant factor for all outcomes. Discussion State-level analyses can provide valuable information to inform programs and policies at a local level. Efforts to improve use of maternal and child health and family planning services in Plateau state, Nigeria, should consider women’s empowerment, residence and poverty. Community education on the effectiveness of modern versus traditional methods and potential side effects of specific modern methods, may help women make informed decisions about contraception.

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Healthcare Providers Experiences of Comprehensive Emergency Obstetric Care in Somaliland: An Explorative Study with Focus on Cesarean Deliveries

10.21203/rs.3.rs-139048/v1 ◽

2021 ◽

Author(s):

Jonah Kiruja ◽

Birgitta Essén ◽

Kerstin Erlandsson ◽

Marie Klingberg-Allvin ◽

Fatumo Osman

Keyword(s):

Decision Making ◽

Child Health ◽

Maternal And Child Health ◽

Healthcare Providers ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Health Centers ◽

Family Ties ◽

And Child Health ◽

Child Health Centers

Abstract Background: Severe obstetric morbidity and mortality remain a serious challenge in developing countries such as Somaliland. Despite the wide implementation of comprehensive emergency obstetric care in Sub-Saharan Africa, including Somaliland, the reduction of severe maternal morbidity and mortality has been slow. Aim: This study aims to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care in a referral hospital and four maternal and child health centers in Somaliland. Method: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight healthcare providers were divided into groups of 6-8 for 1 to 2-hour discussions. HCPs included in the study had experiences in providing care to women with severe maternal complications. Data were analyzed using thematic analysis. Results: Collectivistic decision making through family ties was identified by HCPs to act as a barrier to provision of life saving obstetric interventions. This tradition of decision making at a group level rather than at the individual level was perceived as time-consuming and delayed HCPs from obtaining informed consent to provide lifesaving obstetric care. Low socioeconomic status, poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal care affecting provision of emergency obstetric care at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure. Conclusion: HCPs experiences provided vital insights into the care provided to women with severe obstetric complications in Somaliland. To ensure smooth and timely decision-making processes, the antenatal period can be used to prepare families for potential obstetric emergencies and to obtain signed consents. Key Words: Maternal, Somaliland, Healthcare providers, Family ties, Emergency obstetric care, Cesarean section

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Intimate-partner violence and reproductive decision-making by women attending Victorian Maternal- and Child-Health services: a cross-sectional study

Australian Journal of Primary Health ◽

10.1071/py17183 ◽

2018 ◽

Vol 24 (5) ◽

pp. 422 ◽

Cited By ~ 5

Author(s):

Esther M. Bauleni ◽

Leesa Hooker ◽

Hassan P. Vally ◽

Angela Taft

Keyword(s):

Decision Making ◽

Intimate Partner Violence ◽

Child Health ◽

Maternal And Child Health ◽

Partner Violence ◽

Intimate Partner ◽

Postpartum Women ◽

Reproductive Decision ◽

Reproductive Decision Making ◽

And Child Health

The reproductive years are a critical period where women experience greater risk of intimate-partner violence (IPV). Most studies investigating the association between IPV and reproductive health have been completed in low- and middle-income countries. This study aimed to examine the relationship between IPV and women’s reproductive decision-making in Victoria, Australia. We analysed secondary data from a cluster-randomised trial of IPV screening that surveyed new mothers attending Maternal- and Child-Health centres in Melbourne. Survey measures included the experience of partner abuse in the past 12 months using the Composite Abuse Scale and four reproductive decision-making indicators. Results showed that IPV affects reproductive decision-making among postpartum women. Women who reported abuse were less likely to plan for a baby (adjusted Odds Ratio 0.48, 95% CI: 0.31–0.75) than were non-abused women, significantly more likely to have partners make decisions for them about contraception (Risk ratio (RR) 4.09, 95% CI: 1.31–12.75), and whether and when to have a baby (RR 12.35, 95% CI: 4.46–34.16), than they were to make decisions jointly. Pregnant and postpartum women need to be screened for partner violence that compromises women’s decision-making power regarding their reproductive rights.

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Decision Making Capacity and Constraints Faced by Rural Women while Seeking Maternal and Child Health Care Services in Northeastern Bangladesh

Asian Journal of Agricultural Extension Economics & Sociology ◽

10.9734/ajaees/2019/v35i430228 ◽

2019 ◽

pp. 1-11

Author(s):

Eshita Deb ◽

Mitu Chowdhury ◽

Indrajit Kundu ◽

Modhumita Bhattachirjee Pia ◽

Kanij Fatema

Keyword(s):

Health Care ◽

Decision Making ◽

Child Health ◽

Maternal And Child Health ◽

Rural Women ◽

Health Care Services ◽

Child Health Care ◽

Care Services ◽

Study Results ◽

And Child Health

The aim of the study was to determine the association between rural women’s decision-making power and the constraints faced by them while seeking Maternal and Child Health care services in northeastern Bangladesh. The study sample consisted of 150 mothers living in northeastern Bangladesh who had accessed institutional MCH care services during their pregnancy, childbirth and the postpartum period. Data were collected through a structured questionnaire using simple random sampling technique from January-April, 2018 and analyzed using descriptive statistics, decision making index and constraints facing indexing method through SPSS and Microsoft Excel. The study results showed that, decisions about treatment-seeking, consultation with the doctor during the prenatal and postnatal period, institutional birth preference and use/not use of contraceptives was always taken by the husband because the index was closer to the weighted value 200. But while making decisions about purchasing household daily needs, medicines, taking the first child or having more than two children, both husband and wife participated equally. On the other hands, constraint facing index showed that lack of medicine and vaccination, unhealthy environment and unprofessional behavior of the clinic’s people with CFI 651, 316 and 304 respectively, were the most commonly faced constraints by the rural women which discouraged them to seek institutional MCH care services. Though rural women were not completely suppressed in the northeastern region of Bangladesh, healthcare-seeking decisions were completely under the supervision of the men of families. Along with the socio-economic barriers, unprofessionalism, unavailability and mismanagement of the offered services also discouraged them to access institutional MCH care services. Awareness building among the rural people, especially in the recipients of this service along with Government and policy maker’s intervention to ensure a better quality of MCH care services can change the scenario of MCH care-seeking attitude of rural women in northeastern Bangladesh.

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