Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Background Equitable maternal healthcare service access and it’s optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen’s behavior model of health service use as the theoretical framework. Methods The 2017–18 Bangladesh Demographic Health Survey (2017–18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. Results Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30–20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband’s education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69–42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child’s birth order, administrative regions, and area of residence (rural vs. urban). Conclusions Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.

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Changes in North Carolina Maternal Health Service Use and Outcomes Among Medicaid-Enrolled Pregnant Women During State Budget Cuts

Journal of Public Health Management and Practice ◽

10.1097/phh.0000000000000118 ◽

2015 ◽

Vol 21 (2) ◽

pp. 208-213 ◽

Cited By ~ 3

Author(s):

Dorothy Cilenti ◽

Hye-Chung Kum ◽

Rebecca Wells ◽

J. Timothy Whitmire ◽

Ravi K. Goyal ◽

...

Keyword(s):

North Carolina ◽

Maternal Health ◽

Health Service ◽

Pregnant Women ◽

Service Use ◽

Maternal Health Service ◽

Health Service Use ◽

Budget Cuts ◽

State Budget

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Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2021-007247 ◽

2022 ◽

Vol 7 (1) ◽

pp. e007247

Author(s):

Zeus Aranda ◽

Thierry Binde ◽

Katherine Tashman ◽

Ananya Tadikonda ◽

Bill Mawindo ◽

...

Keyword(s):

Maternal Health ◽

Health Service ◽

Health Services ◽

Sierra Leone ◽

Service Use ◽

Maternal Health Services ◽

Health Facilities ◽

Maternal Health Service ◽

Health Service Use ◽

The Impact

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

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