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.

Non-citizens and maternal mortality in Botswana: a rights perspective

2014 ◽  
Vol 10 (4) ◽  
pp. 220-230
Author(s):  
Keitshokile Dintle Mogobe ◽  
Sunanda Ray ◽  
Farai Madzimbamuto ◽  
Mpho Motana ◽  
Doreen Ramogola-Masire ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Health Professionals ◽  
Maternal Health Services ◽  
Free Access ◽  
Maternal Deaths ◽  
Case Record ◽  
Content Type ◽  
Obstetric Emergencies

Purpose – The purpose of this paper is to identify organisational, technical and individual factors leading to maternal deaths in non-citizen women in Botswana. Design/methodology/approach – A sub-analysis was conducted comparing non-citizen women to citizens in a case record review of maternal deaths in 2010. Feedback on the results to health professionals was provided and their comments were noted. Findings – In total, 19.6 per cent of 56 case notes reviewed to establish contributory factors to maternal deaths were in non-citizens. This is lower than health professionals perceptions that most maternal deaths are in non-citizens. Non-citizens were significantly less likely to have been tested for HIV and less likely to have received antenatal care, so did not receive interventions to prevent transmission of HIV to their infants or anti-retroviral therapy. They were more likely than citizens to have miscarried or delivered before 28 weeks gestational age at death. Delays in seeking health care were a major contributory factor to death. Research limitations/implications – Incomplete record keeping and missing details, with 30 per cent of the notes of maternal deaths missing, a common problem with retrospective case-note studies. Practical implications – Botswana is unlikely to meet Millennium Development Goal five target to reduce the maternal mortality ratio by 75 per cent. To make progress non-citizens must be given the same rights to access maternal health services as citizens. Rationing healthcare for non-citizens is a false economy since treatment of subsequent obstetric emergencies in this group is expensive. Originality/value – Discrimination against non-citizen women in Botswana, by denying them free access to maternal health services, extends into loss of life because of delays in seeking healthcare especially for obstetric emergencies.

scholarly journals Utilization of maternal health services in rural Thawang, Rolpa district of Nepal: a community-based cross-sectional study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jahirul Hushen ◽  
Arpaporn Powwattana ◽  
Chockchai Munsawaengsub ◽  
Sukhontha Siri
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Local Level ◽  
Maternal Health Services ◽  
Cross Sectional Study ◽  
Local Context ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Content Type

PurposeThis study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.Design/methodology/approachThis was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.FindingsThe results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.Research limitations/implicationsThis is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.Practical implicationsThis research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.Originality/valueUnderutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

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 Intimate partner violence and utilization of reproductive and maternal health services in Cambodia

2019 ◽  
Vol 34 (2) ◽  
pp. 100-111
Author(s):  
Vanthy Mai ◽  
Win Ei Phyu
Keyword(s):  
Decision Making ◽  
Intimate Partner Violence ◽  
Maternal Health ◽  
Health Services ◽  
Partner Violence ◽  
Maternal Health Services ◽  
Intimate Partner ◽  
Modern Contraceptive ◽  
Significant Finding ◽  
Content Type

Purpose The purpose of this paper is to explore an association between women experience lifetime intimate partner violence (IPV) and women decision making with utilization of reproductive and maternal health services in Cambodia. Design/methodology/approach An analysis of secondary data of Cambodia Demographic and Health Survey (CDHS) 2014. The total number of sample size was 1,539 married women who had birth in the last five years prior to the time of interview and completed the domestic violence module in the CDHS 2014 questionnaire. χ² test and binary logistic regression were performed in this study. Findings Results give an evidence that emotional violence had significant impact on receiving sufficient antenatal care (ANC) (OR: 0.7, 95%CI: 0.43–0.86) while physical violence had significant association with deliver with skilled birth attendance (SBA) (OR: 0.5, 95%CI: 0.27–0.79). Further, women’s participation in household decision making played as important factor in enabling women revive sufficient ANC (OR: 1.7, 95%CI: 1.19–2.29), and utilization of modern contraceptive method (OR: 1.5, 95%CI: 1.09–1.97). Originality/value This study provides significant finding on the impact of IPV and women’s decision making on reproductive and maternal health in Cambodia. Result has drawn an attention to policy makers, related ministries and stakeholder to promulgate and effectiveness of policies and program implementation within the country.

scholarly journals Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001–2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vishnu Prasad Sapkota ◽  
Umesh Prasad Bhusal ◽  
Kiran Acharya
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Concentration Index ◽  
Institutional Delivery ◽  
National Level ◽  
Wealth Index ◽  
Maternal Health Services ◽  
Demographic And Health Surveys ◽  
Cesarean Section Delivery ◽  
The Government

Abstract Background Maternal health affects the lives of many women and children globally every year and it is one of the high priority programs of the Government of Nepal (GoN). Different evidence articulate that the equity gap in accessing and using maternal health services at national level is decreasing over 2001–2016. This study aimed to assess whether the equity gap in using maternal health services is also decreasing at subnational level over this period given the geography of Nepal has already been identified as one of the predictors of accessibility and utilization of maternal health services. Methods The study used wealth index scores for each household and calculated the concentration curves and indexes in their relative formulation, with no corrections. Concentration curve was used to identify whether socioeconomic inequality in maternity services exists and whether it was more pronounced at one point in time than another or in one province than another. The changes between 2001 and 2016 were also disaggregated across the provinces. Test of significance of changes in Concentration Index was performed by calculating pooled standard errors. We used R software for statistical analysis. Results The study observed a progressive and statistically significant decrease in concentration index for at least four antenatal care (ANC) visit and institutional delivery at national level over 2001–2016. The changes were not statistically significant for Cesarean Section delivery. Regarding inequality in four-ANC all provinces except Karnali showed significant decreases at least between 2011 and 2016. Similarly, all provinces, except Karnali, showed a statistically significant decrease in concentration index for institutional delivery between 2011 and 2016. Conclusion Despite appreciable progress at national level, the study found that the progress in reducing equity gap in use of maternal health services is not uniform across seven provinces. Tailored investment to address barriers in utilization of maternal health services across provinces is urgent to make further progress in achieving equitable distribution in use of maternal health services. There is an opportunity now that the country is federalized, and provincial governments can make a need-based improvement by addressing specific barriers.

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.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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