Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study

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.

Download Full-text

Addressing social and gender norms to improve uptake of maternal health services in Mali: a descriptive study of CARE’s Project Hope for Mothers and Newborns (PEMN)

Culture Health & Sexuality ◽

10.1080/13691058.2017.1421707 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1273-1286 ◽

Cited By ~ 1

Author(s):

Jennifer Kuzara ◽

Anne Woodriff Sprinkel ◽

Feven Tassew Mekuria ◽

Marcie Rubardt ◽

Fodié Maguiraga ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Gender Norms ◽

Descriptive Study ◽

Maternal Health Services ◽

Project Hope ◽

And Gender

Download Full-text

Implementation Research With the Soliga Indigenous Community in Southern India for Local Action on Improving Maternal Health Services

SSRN Electronic Journal ◽

10.2139/ssrn.3483650 ◽

2019 ◽

Cited By ~ 1

Author(s):

Tanya Seshadri ◽

C Madegowda ◽

Giridhara R Babu ◽

Prashanth Nuggehalli Srinivas

Keyword(s):

Maternal Health ◽

Health Services ◽

Implementation Research ◽

Maternal Health Services ◽

Indigenous Community ◽

Southern India ◽

Local Action

Download Full-text

Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4

Clinical Epidemiology and Global Health ◽

10.1016/j.cegh.2020.11.005 ◽

2021 ◽

Vol 10 ◽

pp. 100672

Author(s):

Balhasan Ali ◽

Paramita Debnath ◽

Tarique Anwar

Keyword(s):

Maternal Health ◽

Health Services ◽

Health Survey ◽

Family Health ◽

Maternal Health Services ◽

National Family Health Survey ◽

Urban India ◽

National Family

Download Full-text

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

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

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.

Download Full-text

Maternal health services in China’s western rural areas: uptake and correlates

China Agricultural Economic Review ◽

10.1108/caer-12-2014-0148 ◽

2016 ◽

Vol 8 (2) ◽

Cited By ~ 5

Author(s):

Chengfang Liu ◽

Linxiu Zhang ◽

Yaojiang Shi ◽

Huan ZHOU ◽

Alexis Medina ◽

...

Keyword(s):

Public Health ◽

Maternal Health ◽

Health Services ◽

Health Systems ◽

Uptake Rate ◽

Rural Areas ◽

Design Methodology ◽

Maternal Health Services ◽

Western China ◽

Public Health Systems

Purpose Many public health systems have struggled with the dual questions of (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it. The objective of this study is to assess the uptake rate of a new set of maternal health services in poor rural areas of China. Design/methodology/approach The analysis is based on the survey responses of women’s representatives and village cadres from almost 1000 villages in June 2012 as part of a wide-scale public health survey in Sichuan, Gansu and Yunnan provinces in the western part of China. Findings We find that the uptake rate of maternal health services (including in-hospital delivery, antenatal care visits and post-partum care visits) in poor rural areas of western China are far below average in China, and that the rates vary across provinces and ethnic groups. Our analyses demonstrate that distance, income, ethnicity and availability appear to be systematically correlated with low uptake rates of all maternal health services. Demand-side factors seem to be by far the most important sources of the differences between subpopulations. We also find that there is potential for creating a Conditional Cash Transfer program to improve the usage of maternal health services. Originality/value We believe that our results will contribute positively to the exploration of answers to the dual questions that many public health systems have struggled with (1) why the uptake rate of maternal health services is low among some subpopulations; and (2) how to raise it.

Download Full-text