Maternal health outcomes of socially marginalized groups in India

2020 ◽  
Vol 33 (2) ◽  
pp. 172-188 ◽  
Author(s):  
Arvind Kumar Yadav ◽  
Pabitra Kumar Jena
Keyword(s):  
Maternal Health ◽  
Health Inequalities ◽  
Postnatal Care ◽  
Decomposition Method ◽  
Institutional Delivery ◽  
Healthcare Services ◽  
Rural India ◽  
Maternal Healthcare ◽  
Content Type ◽  
Marginalized Groups

PurposeThe present study delves into the health inequalities between the two most socially deprived groups namely Scheduled Tribes (STs) and Scheduled Castes (SCs) in rural India.Design/methodology/approachThis study used health-specific three rounds of National Sample Survey Office (NSSO) unit-level data for analyses. Probit model has been used to predict the differences in access to maternal healthcare services. Blinder–Oaxaca decomposition method is used to explore the inequality in health of rural population in India and assess the estimated relative contribution of socioeconomic and demographic factors to inequalities in maternal health.FindingsThe study establishes that STs women often perform poorly compared to SCs in terms of maternal health such as antenatal care, postnatal care and institutional delivery. Blinder–Oaxaca decomposition method shows that there exist health inequalities between STs and SCs women. Difference in household income contributes 21–34 percent and women's education 19–24 percent in the gap of utilization of maternal healthcare services between SCs and STs women. A substantial part of this difference is contributed by availability of water at home and geographical region. Finally, the study offers some policy suggestions in order to mitigate the health inequalities among socially marginalized groups of SCs and STs women in rural areas.Originality/valueThis study measures and explains inequalities in maternal health variables such as antenatal care, postnatal care and institutional delivery in rural India. Research on access to maternal healthcare facilities is needed to improve the health of deprived sections such as STs and SCs in India. The results of this study pinpoint the need for public health decision-makers in India to concentrate on the most deprived and vulnerable sections of the society. This study thus makes a detailed and tangible contribution to the current knowledge of health inequalities between the two most deprived social groups, i.e., SCs and STs.

scholarly journals Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Umar Haruna ◽  
Gordon Dandeebo ◽  
Sylvester Z. Galaa
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Health Outcomes ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Transportation Systems ◽  
Successful Implementation ◽  
Maternal Healthcare ◽  
Focused Antenatal Care

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

The practice of complementary feeding and associated factors among mothers of children 6-23 months of age in Enemay district, Northwest Ethiopia

2014 ◽  
Vol 44 (3) ◽  
pp. 230-240 ◽  
Author(s):  
Dessalew Gessese ◽  
Habte Bolka ◽  
Amanuel Alemu Abajobir ◽  
Desalegn Tegabu
Keyword(s):  
Complementary Feeding ◽  
Dietary Diversity ◽  
Healthcare Services ◽  
Northwest Ethiopia ◽  
Original Research ◽  
Feeding Practice ◽  
Meal Frequency ◽  
Maternal Healthcare ◽  
Content Type ◽  
Services Utilization

Purpose – The aim of this study was to assess complementary feeding practice and identify factors associated with it among mothers of children 6-23 months of age in Enemay district, Northwest Ethiopia. Design/methodology/approach – A community-based cross-sectional study design with a multi-stage sampling technique was undertaken from March to April 2013. Pre-tested structured interviewer-administered questionnaire were used to collect the data. Epi data were used for data entry and cleaning and SPSS for descriptive and logistic regression analysis. Findings – Timely complementary feeding, minimum acceptable meal frequency and minimum dietary diversity were 56.4, 60.6 and 8.5 percent among the respondents, respectively. The practice of optimal complementary feeding was 40.5 percent. Occupation, knowledge of complementary feeding and family income of the mother, and maternal healthcare services utilization were associated with optimal complementary feeding practice (OCFP). Originality/value – The proportion of mothers who practiced timely complementary feeding, acceptable meal frequency and dietary diversity, and the overall OCFP were found to be low. Therefore, maternal healthcare services utilization and health information dissemination should be strengthened to all expectant mothers. Type of paper: Original research.

scholarly journals The Extent of Universal Health Coverage for Maternal Health Services in Eastern Uganda: A Cross Sectional Study

2021 ◽  
Author(s):  
Clara Lindberg ◽  
Tryphena Nareeba ◽  
Dan Kajungu ◽  
Atsumi Hirose
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Postnatal Care ◽  
Institutional Delivery ◽  
Skilled Birth Attendance ◽  
Health Coverage ◽  
Birth Attendance ◽  
Out Of Pocket Payments ◽  
Eastern Uganda

Abstract Objective Monitoring essential health services coverage is important to inform resource allocation for the attainment of the Sustainable Development Goal 3. The objective was to assess service, effective and financial coverages of maternal healthcare services and their equity, using health and demographic surveillance site data in eastern Uganda. Methods Between Nov 2018 and Feb 2019, 638 resident women giving birth in 2017 were surveyed. Among them, 386 were randomly sampled in a follow-up survey (Feb 2019) on pregnancy and delivery payments and contents of care. Service coverage (antenatal care visits, skilled birth attendance, institutional delivery and one postnatal visit), effective coverage (antenatal and postnatal care content) and financial coverage (out-of-pocket payments for antenatal and delivery care and health insurance coverage) were measured, stratified by socio-economic status, education level and place of residence. Results Coverage of skilled birth attendance and institutional delivery was both high (88%), while coverage of postnatal visit was low (51%). Effective antenatal care was lower than effective postnatal care (38% vs 76%). Financial coverage was low: 91% of women made out-of-pocket payments for delivery services. Equity analysis showed coverage of institutional delivery was higher for wealthier and peri-urban women and these women made higher out-of-pocket payments. In contrast, coverage of a postnatal visit was higher for rural women and poorest women. Conclusion Maternal health coverage in eastern Uganda is not universal and particularly low for postnatal visit, effective antenatal care and financial coverage. Analysing healthcare payments and quality by healthcare provider sector is potential future research.

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 Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246237
Author(s):  
Berhan Tsegaye ◽  
Elsabet Shudura ◽  
Amanuel Yoseph ◽  
Alemu Tamiso
Keyword(s):  
Regression Analysis ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Postnatal Care ◽  
Institutional Delivery ◽  
Care Service ◽  
Maternal Health Services ◽  
P Value ◽  
Services Utilization

Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.

scholarly journals Spurring the Uptake of Maternal Healthcare Services in Culturally Endowed Communities in Elgeyo Marakwet, Kenya

2020 ◽  
Vol 30 (2) ◽  
Author(s):  
Cheboi Solomon Kemoi ◽  
Kimeu Anastasiah Nyamilu Mailu ◽  
Rucha Kenneth Kibaara
Keyword(s):  
Maternal Health ◽  
Cultural Values ◽  
Cultural Practices ◽  
Well Being ◽  
Healthcare Services ◽  
Educational Outreach ◽  
Health Seeking ◽  
Maternal Healthcare ◽  
Patient Centered ◽  
Social Construct

BACKGROUND: Enhancing the well-being of the mother and newborn is an explicit goal in health. Of the most legendary neglected influencer is patient centered requirement. The hope for people-oriented maternal health interventions in societies is hinged on cultural differentials therefore, contextualizing beliefs, values and expectations is important. A study to identify maternal healthcare services needs amongst women in Marakwet communities was undertaken.MATERIALS AND METHODS: This was an explorative qualitative study. A stratified list of cultural subgroups was developed and used to purposively select study participants. Twelve focus group discussions (FGDs) and fourteen key informant interviews (KIIs) were undertaken. Data was collected using semi-structured FGD and KII guides. The data was analyzed using five steps of conventional content analysis.RESULTS: The finding of the study revealed that support and care during pregnancy, labour, childbirth and postpartum are systematic defined informational, instrumental and emotional processes pivoted by individual and society pathways. Social-cultural needs include continuous pregnancy and labor care, companionship, elective delivery methods, placenta interpretation, placenta disposal, newborn celebration, privacy and mother-child welfare services. Choice of delivery assistant is a dynamic social construct informed by cultural values such as initiation, age, gender and experience. Health behavior dynamics is therefore context-dependent, embodied by social network and social support as well as psychological and physiological expectation.CONCLUSION: Women maternity needs are multiple and diverse. Adapting care to meet the contextualized individual and community needs may spur positive maternal health seeking behaviour among women and assist healthcare workers to provide culturally competent care to improve health outcomes. Educational outreach and behaviour change communications to demystify and tackle retrogressive cultural practices should be increased. 

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.

Socioeconomic inequalities in maternal healthcare utilization in Zambia: 1997-2014

2020 ◽  
Author(s):  
Zhifei He ◽  
Ghose Bishwajit ◽  
Sanni Yaya ◽  
Zhaohui Cheng ◽  
Guo Shuyan ◽  
...  
Keyword(s):  
Postnatal Care ◽  
Multivariate Regression ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Socioeconomic Inequalities ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Maternal Healthcare ◽  
Regression Methods ◽  
Care Services

Abstract Background Exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilisation between 1997 and 2014. Methods Data were analyzed using descriptive and multivariate regression methods. Results Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate ANC visit was comparatively higher among those in the lower wealth quintiles. Conclusion Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilisation of these services.

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.

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