scholarly journals Inequalities in access to birth by caesarean section in the context of user fee exemption for maternal health services in southwest and north central Nigeria

2020 ◽  
Author(s):  
Anthony Idowu Ajayi
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Positive Impact ◽  
Binary Logistic Regression ◽  
Healthcare Services ◽  
Maternal Health Services ◽  
Maternal Healthcare ◽  
Logistic Regression Models ◽  
Fee Exemption ◽  
User Fee

Abstract Background User fee exemption for maternal healthcare services was introduced with a focus on providing free maternal health services, including caesarean sections (CS), in Nigeria. This policy has had a positive impact on access to facility-based delivery; however, the extent to which inequality in access to CS exists in the context of user fee exemption is unclear. The objective of this study was to examine inequalities in access to birth by CS 5 y after the implementation of the user fee exemption policy. Methods Data were obtained from 1227 women who gave birth between 2011 and 2015 and were selected using cluster random sampling between May and August 2016 from two of the six main regions of the country. Adjusted and unadjusted binary logistic regression models were performed. Results An overall CS rate of 6.1% was found, but varied by income, education and place of residence. Women who earned a monthly income of ≤20 000 naira (US$150) were 50% less likely to have a birth by CS compared with those who earned more. Compared with women who were educated to the tertiary level, women who had a secondary education or less were 51% less likely to give birth by CS. Conclusions This study shows that inequality in access to CS persists despite the implementation of free maternal healthcare services.

scholarly journals Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hanyu Wang ◽  
Eric Frasco ◽  
Rie Takesue ◽  
Kun Tang
Keyword(s):  
Maternal Health ◽  
Prenatal Care ◽  
Health Services ◽  
Primary School ◽  
Postnatal Care ◽  
Maternal Education ◽  
Maternal Health Services ◽  
Education Level ◽  
Cesarean Sections ◽  
Maternal Healthcare

Abstract Background Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization. Methods The MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods. Results Of all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations. Conclusions Mothers’ education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women’s empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.

scholarly journals Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District

2016 ◽  
Vol 4 (1) ◽  
pp. 81
Author(s):  
Alokananda Ghosh ◽  
Biswaranjan Mistri
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Distribution System ◽  
Healthcare Services ◽  
P Value ◽  
Theoretic Model ◽  
Access To Health Services ◽  
Maternal Healthcare ◽  
Risk Pregnancy ◽  
Birbhum District

The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5). Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs) depends on both the availability and accessibility of services along with accountability.This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75) between accessibility index and accountability score with p-value = <0.05, where the direct connectivity index seem to have no direct influence on the accountability score (as the ‘r’ is 0.56 and p-value= >0.05). Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC) have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA), explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services.Drawing on empirical observations of operation of public distribution system in different states of India, the paper constructs a preliminary game theoretic model. It argues that an effective public distribution must be as universal as possible, delivery mechanism of fair price shops should be reformed, they should be make them commercially viable and that special attention should be paid to PDS at times of high food inflation.

scholarly journals Assessment of Knowledge, Attitude and Practice of skilled assistance seeking for maternal healthcare services and associated factors among Women in West shoa zone, Oromia, Region, Ethiopia, 2017

2019 ◽  
Author(s):  
Eden Girmaye Tefera ◽  
Fikadu Wondimu Abdisa ◽  
Maru Mossisa Erena
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Healthcare Services ◽  
Health Facilities ◽  
P Value ◽  
Care Seeking ◽  
Maternal Healthcare ◽  
Attitude And Practice ◽  
Skilled Assistance ◽  
Knowledge Attitude And Practice

Abstract Background: Access to skilled health services during pregnancy, childbirth and postpartum is crucial element which promotes the health and wellbeing of the mother and new born. The aim of the study was to assess women’s knowledge, attitude and practice of skilled assistance seeking for maternal healthcare services in West Shoa zone. Methods: A community based cross sectional quantitative design was conducted in West Shoa zone, Oromia, Ethiopia in 2017. A multistage, random sampling technique was used to select women who had birth in the past one year preceding the study. Interviewed administered structured questionnaire were used to collect the data. A total of 654 women were involved in this study. Data was analysed using SPSS version 20 statistical software package. Pre-tested and structured questionnaires were used to collect the data by trained data collectors. Logistic regression model was used to control the confounding variables at p-value< 0.05. Results: Out of 654 respondents, 416 (63.6%) delivered at health facilities and 268 (36.4%) at home. Skilled assistance seeking for maternal health services was significantly associated with mother’s education (AOR=3.0, 95%CI=1.18-7.84), mother’s access to maternal health information (AOR=3.1, 95% CI=1.13-8.41). Women’s awareness was significantly associated with antenatal‐care attendance (AOR 1.9) and institutional delivery (AOR 3.1). Women who had experience obstetric problems were twice seek skilled provider than those who had not had complications (AOR=2.3, 95%CI=1.39-3.75. P-value=0.001). Women who experiences complications seek a skilled postnatal care more likely compared with those who did not have such characters (AOR=2.2, 95%CI=1.35-3.66. P-value=0.002). Conclusion: The study revealed that low practice of sought care from skilled providers. Hence, it is highly recommended to improve the socioeconomic factors such as maternal literacy, availability of transport facility in case of emergency referral and service availability may increase care seeking from health facilities. Keywords: Skilled assistance, Seeking and Maternal healthcare services.

scholarly journals Socio-economic Determinants of Maternal Healthcare Utilization in Addis Ababa

2020 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Peter Sandy
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Service Use ◽  
Tertiary Education ◽  
Addis Ababa ◽  
Maternal Health Services ◽  
Public Hospitals ◽  
Health Coverage ◽  
Maternal Healthcare ◽  
The Right

Abstract Background Despite progresses over the last two decades, Ethiopia is one of the countries in the world with significant number of maternal deaths and service use for antenatal, labour and childbirth is low. This study intended to identify the underlying causes of low coverage of maternal health services in Addis Ababa. Methods We conducted a comparative cross-sectional study in Addis Ababa in July 2017. A three stage sampling technique was applied to select the study population. The first step was to select study Ketenas using simple random sampling. The villages within the Ketenas were then identified, which led to the second stage of the sampling process. In the third stage, a fixed number of 20 households per village were selected with an equal probability random selection from the newly created household listing. All women aged 18–49 years who gave birth one year preceding the date of data collection were then invited to a face-to-face interview. Both multiple linear regression and logistic regression were applied to estimate crude and adjusted associations. Results Less than 45.0% of women from the poorest households received all the recommended ANC contacts at the right time, while 71.4% of women from richest households received all the recommended contacts at the right time. The majority of women from poorest households gave birth at health centres (66.2%), followed by public hospitals (30.9%). The largest proportion of women from richest households gave birth at private hospitals (46.1%), followed by public hospitals (16.1%). Meanwhile, only 52.5% of women with primary education had all the recommended ANC contacts, while 78.5% of women who completed tertiary education had all the recommended ANC contacts (p < 0.001). Women from richest households were less likely to face multiple barriers to use maternal health services as compared to women from poorest households (OR = 0.57, p = 0.032). Conclusion There is a huge inequality in maternal healthcare coverage in Addis Ababa. To achieve universal maternal health coverage, affordability of the service is not adequate although it is one of the requirements. Other underlining social determinants deserve the attention of policy makers and program designers.

Maternal health services: an equal or framed territory?

2017 ◽  
Vol 10 (2) ◽  
pp. 110-122 ◽  
Author(s):  
Joana Bessa Topa ◽  
Conceição Oliveira Nogueira ◽  
Sofia Antunes Neves
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Immigrant Women ◽  
National Level ◽  
Healthcare Services ◽  
Maternal Health Services ◽  
Legal Rights ◽  
Free Access ◽  
Medical Specialties ◽  
Content Type

Purpose Despite the high prevalence of immigrant women at the national level, studies on migration have been indifferent to the gender perspective. The purpose of this paper is to discuss the engagement of Ukrainian immigrant women, one of the most expressive nationalities of female immigration in Portugal, on maternal and child healthcare services, exploring their perceptions and experiences in these contexts. Design/methodology/approach On the basis of critical and social constructionism assumptions, this research focusses on discourse. Assuming that immigrant women have access to different resources, as well as different competences to interpret and intervene within the context they are in (Topa et al., 2010; UNFPA, 2006), the best method to deeply understand their experiences was to analyse how discourse is organized and how it creates and produces meanings that become practices (Nogueira, 2001a). The present study adopted a qualitative methodology for collecting (semi-structured interviews) and analysing the data (thematic analysis) and was based on discourses of ten Ukrainian women, living in the metropolitan area of Oporto, who were pregnant or were mothers in Portugal. Findings Ukrainian women were misinformed about their legal rights and free access to maternal health services. Some dissatisfaction emerges among them with regard to the quality of information provided by health professionals and their communication skills. Their opinion is that they are given limited access to medical specialties, especially in primary care and that their doubts are inappropriately clarified during medical appointments. Originality/value This research also argues that cultural and intersectional considerations are fundamental to promote inclusive health policies for immigrants.

ICTs and maternal healthcare utilization. Evidence from Ghana

2014 ◽  
Vol 41 (7) ◽  
pp. 518-541 ◽  
Author(s):  
Gordon Abekah-Nkrumah ◽  
Marta Guerriero ◽  
Purnima Purohit
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Information And Communication Technologies ◽  
Healthcare Utilization ◽  
Maternal Health Services ◽  
Demographic And Health Surveys ◽  
Supply Side ◽  
Demand Side ◽  
Maternal Healthcare ◽  
Content Type

Purpose – Traditionally, the role of technology on health services has been argued from the supply side. The purpose of this paper is to use a demand side perspective to examine the effect of Information and Communication Technologies (ICTs) on the use of maternal health services in Ghana. Design/methodology/approach – Study used data from the 2008 Ghana Demographic and Health Surveys and binary response regression models to examine the effect of women's access to ICTs on maternal healthcare utilization in Ghana. Three variables on maternal healthcare utilization were employed: use of contraception, antenatal care and place of delivery. Findings – Results from the study show that the effect of the use of technology is both positive and significant. In particular, among the other ICTs (i.e. landline phone, listening to radio, watch television, color television in household, computer in household), the coefficients of mobile phone ownership tends to be consistently significant across all four reproductive health services. Therefore, ICTs have a good capacity to influence women's demand of health information. This needs to be taken into account when designing maternal health policies and interventions. Originality/value – This is one of the few papers examining the effect of ICTs on utilization of maternal health services from the demand side compared to the popular supply side argument often found in the literature.

scholarly journals Assessment of Knowledge, Attitude, and Practice of Skilled Assistance Seeking Maternal Healthcare Services and Associated Factors among Women in West Shoa Zone, Oromia Region, Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Eden Girmaye ◽  
Kassa Mamo ◽  
Birhanu Ejara ◽  
Fikadu Wondimu ◽  
Maru Mossisa
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Healthcare Services ◽  
Maternal Health Services ◽  
Care Utilization ◽  
Skilled Delivery ◽  
Attitude And Practice ◽  
Skilled Assistance ◽  
Study Participants ◽  
Knowledge Attitude And Practice

Background. This study aimed to assess women’s knowledge, attitude, and practice towards skilled assistance seeking maternal healthcare services in West Shoa Zone, Oromia Region, Ethiopia. Methods. Cross-sectional survey design was conducted from 1 February to 23 March 2018 in West Shoa Zone, Oromia, Ethiopia. A simple random sampling technique was used to select the participants. The data were collected using a pretested and structured questionnaire. Data were entered using EpiData version 3.1, and descriptive analysis and bivariate and multivariate logistic regression analyses were carried out using SPSS version 20 statistical software package. Results. The study revealed that the knowledge, attitude, and practice towards skilled maternal health services were found such that 473.3 (72.4%) of the study participants had good knowledge, 180.7 (27.6%) had poor knowledge, and 400 (61.3%) had positive attitude, 254 (38.84%) had negative attitude, 460.3 (70.4%) had good practice, and 193.7 (29.6%) had poor practice towards skilled maternal health services. Factors that had a significant association with antenatal care utilization were planned pregnancy (AOR = 8.2, 95% CI = 3.39-19.78-0.87) and access to transport (AOR = 3.1, 95% CI = 1.46–6.61). Attending ANC at least once (AOR = 3.1, 95% CI = 1.13–8.41), women’s education (AOR = 3.0, 95% CI = 1.18–7.84), and unplanned pregnancy (AOR = 0.3, 95% CI = 0.21–0.75) were factors associated with skilled delivery service utilization. Attending ANC at least once (AOR = 2.1, 95% CI = 1.1–4.2), birth complications (AOR = 2.2, 95% CI = 1.35–3.66), unplanned pregnancies (AOR = 0.3, 95% CI = 0.22–0.68), and awareness about skilled obstetric care (AOR = 3.7, 95% CI = 1.68–12.79) were factors associated with postnatal care utilization. Conclusions. This study found that the knowledge, attitude, and practice of skilled maternal health services among the study participants are low, showing less than three-quarters of the total sample size. Therefore, this study implied that interventions are required to improve women’s knowledge, attitude, and practice of skilled maternal health services in the study area. Furthermore, women’s education is significantly associated with skilled delivery service utilization. Accordingly, this study recommends that improving equity among the marginalized population is needed to increase maternal health service coverage.

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