scholarly journals Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242325
Author(s):  
Mohammad Habibullah Pulok ◽  
Gowokani Chijere Chirwa ◽  
Jacob Novignon ◽  
Toshiaki Aizawa ◽  
Marshall Makate
Keyword(s):  
Health Facility ◽  
Socioeconomic Inequality ◽  
Care Service ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Facility Delivery ◽  
Delivery Care ◽  
Health Facility Delivery ◽  
Care Services ◽  
Birth Attendance

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

scholarly journals Utilization of health facility delivery services in the Jomoro District of the Western Region of Ghana

2021 ◽  
Vol 2 (1) ◽  
pp. 173-180
Author(s):  
Samuel Nyarko ◽  
Anthony Kusi ◽  
Kwabena Opoku - Mensah
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Health Facility ◽  
Facility Delivery ◽  
Delivery Care ◽  
Western Region ◽  
Health Facility Delivery ◽  
Skilled Delivery ◽  
Care Services ◽  
Delivery Services

Background: In the year 2000, member states of the United Nations pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio by 2015 in line with Millenium. Development Goal 5, but this could not be achieved. This pledge became imperative given the high maternal mortality being recorded, especially among developing countries. The high maternal deaths in developing countries have been attributed partly to the lack of access to skilled birth attendants during delivery. Objective: This study aimed to investigate factors that influence the utilization of health facility delivery services among pregnant women in the Jomoro District of the Western Region of Ghana. Methods: The study used data from a cross-sectional survey among women aged 18 - 49 yr. living in the Jomoro District of Ghana and had given birth between 2012 and 2016 (n = 374). The study participants were randomly selected from women who attended child welfare clinics on clinic days with their babies in eighteen communities. The study used a structured questionnaire to solicit for information about the women’s demographic and socio-economic characteristics, community characteristics and health systems factors likely to influence their decision to seek skilled delivery care as well as their experiences relating to their last delivery. Bivariate analyses were performed between the primary dependent variable and background characteristics of the respondents. Factors influencing the choice of place of delivery were estimated by multiple logistic regression analysis. Data analysis was performed using STATA Statistical Software, Release 14. Results: About 61.0% (n= 228/374) of the women had their last delivery at a health facility while the remaining 38.8% (n= 145/374) delivered at home without skilled assistance. In multivariate analysis, women aged 25 – 29 yr. were less likely to have a skilled delivery (aOR, 0.40; 95% CI: 0.17 - 0.93). Also, professional women had 4.77 odds of having skilled delivery (aOR, 4.77; 95% CI: 1.53 - 14.93). Distance to the nearest health facility also had a statistically significant association with skilled delivery. Women living at 10 – 19 km to a health facility were less likely to have a skilled delivery (aOR, 0.56; 95% CI: 0.32 - 0.97). In addition, the presence of a midwife at a health facility increased the odds of skilled delivery among women (aOR, 4.59; 95% CI: 2.47 - 8.55). Conclusion: Interventions aimed at increasing the uptake of delivery care services to achieve the SDG’s target on maternal mortality must consider improving the socio-economic wellbeing of women in addition to removing the physical and health system barriers impeding access and utilisation of delivery care services.

scholarly journals “If there are no female nurses to attend to me, I will just go and deliver at home”: a qualitative study in Garissa, Kenya

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Coralie N’Gbichi ◽  
Abdhalah Kasiira Ziraba ◽  
David Wainaina Wambui ◽  
Pauline Bakibinga ◽  
Isaac Kisiangani ◽  
...  
Keyword(s):  
Health Facility ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Facility Delivery ◽  
Maternal And Newborn Health ◽  
Health Facility Delivery ◽  
Community Members ◽  
Birth Attendance ◽  
Female Nurses ◽  
Maternal And Newborn

Abstract Background The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. Methods The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. Results Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. Conclusion To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.

scholarly journals Impact of Free Delivery Care on Health Facility Delivery and Insurance Coverage in Ghana’s Brong Ahafo Region

PLoS ONE ◽  
2012 ◽  
Vol 7 (11) ◽  
pp. e49430 ◽  
Author(s):  
Susie Dzakpasu ◽  
Seyi Soremekun ◽  
Alexander Manu ◽  
Guus ten Asbroek ◽  
Charlotte Tawiah ◽  
...  
Keyword(s):  
Health Facility ◽  
Insurance Coverage ◽  
Facility Delivery ◽  
Delivery Care ◽  
Health Facility Delivery ◽  
Brong Ahafo Region ◽  
Brong Ahafo

scholarly journals Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Augustine Tanle ◽  
Kwaku Kissah-Korsah ◽  
Joshua Amo-Adjei
Keyword(s):  
Decision Making ◽  
Women’S Health ◽  
Women's Health ◽  
Health Facility ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Wealth Status ◽  
Health Decision Making ◽  
Birth Attendance ◽  
Health Decision

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery.

scholarly journals Expanding Access to Health Facility Delivery in Nigeria: Progress, Challenges and Opportunities

2021 ◽  
Author(s):  
Anthony Idowu Ajayi ◽  
Oluwafemi Emmanuel Awopegba ◽  
Matthew Tobiloba Obisesan ◽  
Charlotte Nwogwugwu ◽  
Eyitayo Omolara Owolabi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Facility ◽  
Health Care Services ◽  
Facility Delivery ◽  
Maternal Health Care ◽  
Health Facility Delivery ◽  
Care Services ◽  
Access To Health ◽  
Challenges And Opportunities

Abstract Background Nigeria has the highest maternal deaths counts globally, and this reflects poor access to quality maternal health care services. Previous research on access to health facility delivery has not sufficiently probed the within-country inequalities in access to and progress in expanding maternal health care services in Nigeria. Our study fills this gap by examining the progress, challenges, and opportunities in expanding access to health facility delivery in Nigeria. Methods Data of 37,928 and 40,567 live births in the 2013 and 2018 Nigeria Demographic and Health surveys (NDHS) respectively were analysed in this study. NDHS employs a multistage sampling and is representative of both the country and each of the 36 states and Federal Capital Territory (FCT). We used descriptive statistics to examine the trend in health facility delivery in Nigerian states and presented the results using maps. Also, we used logistic regression analysis to examine progress in expanding access to health facility delivery across Nigerian states. Results The proportion of births delivered in health facilities increased from 35.8% in 2013 to 39.4% in 2018, representing a 3.6% increment. After adjusting for relevant covariates, women were 17% more likely to deliver in health facilities in 2018 than in 2013 surveys. However, progress in expanding access to health facility delivery was uneven across the country. While the odds of delivering in a health facility significantly increased for women living in 13 of the 36 states and FCT, the odds reduced significantly in seven states and no progress was recorded in 17 states. Conclusion There was a slight improvement in access to health facility delivery in Nigeria between 2013 and 2018. However, progress remains uneven across the states with only 13 states recording some progress. Four states stood out, recording over a three-fold relative increase in odds of health facility deliveries. These states implemented maternal health care policies that not only made services free but also improved infrastructure and human resources for health. Thus, providing examples of what works in improving access to services for other states to follow.

scholarly journals Factors associated with antenatal and health facility delivery care in selected areas of Subornochor upazila, Noakhali, Bangladesh

2020 ◽  
Vol 8 (3) ◽  
pp. 983-988
Author(s):  
Md. Ruhul Kabir ◽  
Susmita Ghosh ◽  
Md Abdullah Al Mamun ◽  
Homayra Islam ◽  
Ruhina Binta A Ghani
Keyword(s):  
Health Facility ◽  
Facility Delivery ◽  
Delivery Care ◽  
Health Facility Delivery ◽  
Factors Associated

scholarly journals What is the Impact of Ante Natal Care (ANC) Attendance on the Subsequent Maternal Health Care Services Utilization in Conflict Affected Area

2021 ◽  
Author(s):  
Temesgen Bocher ◽  
Adam A Abdulkadir ◽  
Mashaka Lewela ◽  
Judy Korir ◽  
Ali Mohamed Magan
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Services ◽  
Care Service ◽  
Health Care Service ◽  
Skilled Birth Attendance ◽  
Maternal Health Care ◽  
Care Services ◽  
Birth Attendance ◽  
The Impact

Abstract Background: Somalia has registered 732 maternal mortality every 100,000 live birth; the uptake of maternal health care service is lowest in the world. The purpose of study is to understand social and economic factors that hinder or facilitate the uptake of maternal health care service during the pregnancy in Somalia. Methods: Cross-sectional data was collected from 642 mothers of reproductive age in Mogadishu town through a community survey in November 2020. Descriptive data analysis and propensity score matching models were employed to measure association between the determinants of the uptake of required ANC, Skilled birth attendance and confounding factors. In addition, the impact of minimum ANC attendance on the uptake of mother health care services was evaluated Results: The study indicated that ANC is at its lowest level, only 10% women reported attending 4-ANC[1], 23% didn’t attend any ANC, and 61% attending 1 to 3 ANC; moreover, skilled birth attendance is low rate at 30%, against 67% average in Africa; 78% of women are unable to make decision to visit health clinic or hospital autonomously, rather the decision is made by other people, 44% decision is made by the husband and only 30% jointly by the woman and her husband. Contrary to the data on attendance, about 70% of the surveyed women were aware of health benefits of attending ANC. The cost associated with accessing health service at 31%, distance to health centers, 12%, and perception (ANC is not needed), 23% were the major reasons of not delivering at health institutions.Conclusions: Thus, the number of ANC visits has an incremental positive effect on the probability utilization of skilled birth attendance and delivery at health facility. Access related factors are the most hindering barriers for the poor utilization of health care service as evidently indicated by the negative correlation of distance from health center. Improving access to health education, interventions targeting improved income and women empowerment lead to better maternal health outcome.

scholarly journals Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey

2018 ◽  
Author(s):  
Gedefaw Abeje Fekadu ◽  
Fentie Ambaw Getahun ◽  
Seblewongiel Ayenalem Kidanie
Keyword(s):  
Antenatal Care ◽  
Health Facility ◽  
Postnatal Care ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Factors Associated ◽  
Content Of Care ◽  
Care Services ◽  
At Home

AbstractIntroductionIn Ethiopia, many mothers who attend the recommended number of antenatal care visits fail to use facility delivery and postnatal care services. This study identifies factors associated with facility delivery and use of postnatal care among mothers who had four or more antenatal care visits, using data from the 2016 Ethiopian Demographic and Health Survey (EDHS).MethodsTo identify factors associated with facility delivery, we studied background and service-related characteristics among 2,415 mothers who attended four or more antenatal care visits for the most recent birth. In analyzing factors associated with postnatal care within 42 days after delivery, the study included 1,055 mothers who attended four or more antenatal care visits and delivered at home. We focused on women who delivered at home because women who deliver at a health facility are more likely also to receive postnatal care as well. A multivariable logistic regression model was fitted for each outcome to find significant associations between facility delivery and use of postnatal care.ResultsFifty-six percent of women who had four or more antenatal care visits delivered at a health facility, while 44% delivered at home. Mothers with secondary or above level of education, urban residents, women in the richest wealth quintile, and women who were working at the time of interview had higher odds of delivering in a health facility. High birth order was associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Quality of antenatal care as measured by the content of care received during antenatal care visits stood out as an important factor that influences both facility delivery and postnatal care. Among mothers who attended four or more antenatal care visits and delivered at home, the content of care received during ANC visits was the only factor that showed a statistically significant association with receiving postnatal care.ConclusionsThe more antenatal care components a mother receives, the higher her probability of delivering at a health facility and of receiving postnatal care. The health care system needs to increase the quality of antenatal care provided to mothers because receiving more components of antenatal care is associated with increased health facility delivery and postnatal care. Further research is recommended to identify other reasons why many women do not use facility delivery and postnatal care services even after attending four or more antenatal care visits.

scholarly journals Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Dharel ◽  
A Bhattarai ◽  
Y R Paudel ◽  
P Acharya ◽  
K Acharya
Keyword(s):  
Health Facility ◽  
Newborn Care ◽  
Facility Delivery ◽  
Early Initiation ◽  
Health Facility Delivery ◽  
Essential Newborn Care ◽  
Place Of Delivery ◽  
Early Initiation Of Breastfeeding ◽  
Nationally Representative ◽  
Initiation Of Breastfeeding

Abstract Background Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal. Methods We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates. Results The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods. Conclusions Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery. Key messages The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

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