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.

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.

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.

Chronic diseases raise global risks to maternal health

2015 ◽  
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Millennium Development Goals ◽  
Significant Loss ◽  
Maternal Deaths ◽  
Content Type ◽  
Global Rate ◽  
Development Goals ◽  
Developed World ◽  
Public Health Provision

Subject Progress in ending Maternal Mortality Rates globally. Significance The global rate of maternal deaths since 1990 has dropped significantly. However, with the Millennium Development Goals (MDG) expiring this year, only 16 countries are on track to achieve MDG 5: to reduce the maternal mortality rate (MMR) by 75%. Reduction rates in developing countries have also slowed, while rates in the developed world are rising. Such uneven progress in maternal health suggests that the current models for public health provision are inadequate. Impacts The economies of countries with high MMR are disrupted by the significant loss of productive young women. The loss of the mother stilts the development of surviving children, perpetuating cycles of poverty. Health systems that fail to provide maternity care will also be profoundly crippled in their capacity to serve the wider population.

Geographic access and maternal health services utilization in Sélingué Health District, Mali.

2020 ◽  
Author(s):  
Moctar TOUNKARA ◽  
Oumar Sangho ◽  
Madeleine Beebe ◽  
Lillian Joyce Whiting-Collins ◽  
Rebecca R. Goins ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Health Facility ◽  
Health Services Utilization ◽  
Maternal Health Services ◽  
Health District ◽  
Geographic Access ◽  
Services Utilization ◽  
The Impact

Abstract Introduction. Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in high geographic-access regions. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality and denotes a lack of equity in the Malian health system.Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within moderate geographic access districts in Mali. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.Methods. We conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.Results. The majority of the participants were 20 to 24 years old. Over 68% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district impede the other roughly 40% of our sample from utilizing maternal healthcare. The concentration index demonstrated the impact of inequity in geographic access comparing women residing near and far from the referral care facility.Conclusion. Maternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

scholarly journals Contraceptive use and maternal mortality in Indonesia: a community-level ecological analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Riznawaty Imma Aryanty ◽  
NohanArum Romadlona ◽  
Besral Besral ◽  
Elvi Debora P. Panggabean ◽  
Budi Utomo ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Protective Factors ◽  
Contraceptive Use ◽  
Risk And Protective Factors ◽  
Maternal Health Services ◽  
Household Wealth ◽  
Community Level ◽  
Contraceptive Prevalence

Abstract Background Prior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood. Methods Data from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions. Results Higher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality. Conclusions Community contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010–2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal.

scholarly journals Predictors of the Timing and Number of Antenatal Care Visits among Unmarried Compared To Married Youth in Uganda Between 1995 And 2011

2020 ◽  
Author(s):  
Peninah Agaba ◽  
Cyprian Misinde
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
First Trimester ◽  
Maternal Health Services ◽  
Demographic And Health Surveys ◽  
Enabling Factors ◽  
Maternal Deaths ◽  
Early Use ◽  
Late Start

Abstract Introduction Inadequate use of maternal health services among the youth remains a serious health challenge in Uganda. The low use of maternal health services among youth partly explains the persistence high maternal mortality rate in the country. Yet, improved use of maternal health services by the youth would help reduce maternal deaths in the country. Therefore, this study examines predisposing and enabling factors associated with the timing and the number of antenatal care visits among unmarried compared to married youth aged 15-24 years between 1995 and 2011 in Uganda. Methodology Two-level binary logistic and linear regression models with district as a second level of analysis were conducted on pooled data of the 1995, 2000/01, 2006 and 2011 Uganda Demographic and Health Surveys. This analysis was among 581 unmarried, compared to 5,437 married youth, aged 15-24 years. Results Only 16% of unmarried youth and 18% of married youth had ANC in the first trimester. Education was the only factor that was significantly associated with early use of antenatal care among unmarried youth. Whereas high education was associated with higher odds of using antenatal care in the first trimester among married youth (OR=1.30, 95%CI=1.08-1.57), it was associated with late start among unmarried youth (OR=0.56, 95%CI=0.31-0.98). Higher parity, protestant membership and residence in eastern region were associated with late start of antenatal care, while access to radio and television, and education level of the husband were associated with higher odds of early use of antenatal care among married youth. Overall, married youth were more likely to have more frequent antenatal care visits than unmarried youth. Among both groups, higher educational attainment and greater access to radio were associated with frequent antenatal care use. Residing in western region was associated with fewer antenatal care visits among both married and unmarried youth. Access to newspaper was associated with more antenatal care visits among married youth only. Conclusion This study presents the individual level predisposing and enabling factors that are important predictors of the use of antenatal health care services among youth that will guide policy to reduce maternal deaths among youth in Uganda.

scholarly journals Reducing Maternal Mortality: A Qualitative Study of Health Workers’ Expectation in Urban Area, Indonesia

2021 ◽  
Vol 9 (T4) ◽  
pp. 18-26
Author(s):  
Arlina Dewi ◽  
Sri Sundari ◽  
Nursetiawan Nursetiawan ◽  
Supriyatiningsih Supriyatiningsih ◽  
Dianita Sugiyo ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Urban Area ◽  
Urban Areas ◽  
Health Workers ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Integrated System

BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality. AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas. METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising. RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity. CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.

Antenatal Care in Sudan: A Qualitative Study Into Accessibility and Quality of Maternal Health Services in Khartoum

2018 ◽  
Vol 8 (2) ◽  
pp. 77-86
Author(s):  
Rayan Mohamed-Ahmed ◽  
Muna Abdel Aziz ◽  
Richard Walker
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Cost Effective ◽  
Maternal Health Services ◽  
Modern Medicine ◽  
Group Discussions ◽  
Maternal Deaths ◽  
Physical Barriers

Antenatal care is shown to be a cost-effective intervention for reducing rates of maternal mortality. However, utilization of maternal health services in Sudan remains low and maternal deaths high. This study aims to investigate why Sudanese women do not attend antenatal care, satisfaction with services and views on improving uptake. Focus group discussions took place, with 30 women who had delivered in the past year, in five areas in Khartoum. Themes in transcripts were identified. Factors that can affect a woman’s choice to attend antenatal care extend beyond physical barriers and include misconceptions of it’s use, conflict between faith and modern medicine and dissatisfaction with previously used services. The care provider’s perceived lack of empathy, unpunctuality and lack of health promotion can also contribute to underutilization.

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