scholarly journals Disability, Caste and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

2021 ◽  
Author(s):  
Hridaya Raj Devkota ◽  
Andrew Clarke ◽  
Emily Murray ◽  
Maria Kett ◽  
Nora Groce
Keyword(s):  
Service Utilization ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Household Wealth ◽  
Service Development ◽  
Maternal Healthcare ◽  
Women With Disabilities ◽  
Disabled Women ◽  
Dalit Women ◽  
Natal Care

Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by the inclusion of disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30 – 0.84) and PNC (OR 0.47, CI 0.25 – 0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05 – 0.74). Conclusions: Disabled women – whether Dalit or non-Dalit - had lower rates of utilizing all maternal healthcare services than non-disabled women. However, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention to be re-examined and more nuanced interventions considered to ensure improved access and outcome among all vulnerable groups.

scholarly journals Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

Disabilities ◽  
2021 ◽  
Vol 1 (3) ◽  
pp. 218-232
Author(s):  
Hridaya Raj Devkota ◽  
Andrew Clarke ◽  
Emily Murray ◽  
Maria Kett ◽  
Nora Groce
Keyword(s):  
Service Utilization ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Household Wealth ◽  
Vulnerable Groups ◽  
Service Development ◽  
Maternal Healthcare ◽  
Women With Disabilities ◽  
Disabled Women ◽  
Dalit Women

Background: Disability and caste are two different forms of oppression; however, people of the Dalit caste in Nepal and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15–49 years. Maternal healthcare service utilization was assessed by antenatal care (ANC), health facility (HF) delivery, and postnatal care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by inclusion of a disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery, and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30–0.84) and PNC (OR 0.47, CI 0.25–0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste, and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05–0.74). Conclusions: Disabled women—whether Dalit or non-Dalit—had lower rates of utilizing all maternal healthcare services than non-disabled women. Interestingly, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention be re-examined and more nuanced interventions considered to ensure improved access and outcomes among all vulnerable groups.

scholarly journals Optimum maternal healthcare service utilization and infant mortality in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Girmay Tsegay Kiross ◽  
Catherine Chojenta ◽  
Daniel Barker ◽  
Deborah Loxton
Keyword(s):  
Infant Mortality ◽  
Service Utilization ◽  
Healthcare Service ◽  
Healthcare Services ◽  
World Health ◽  
Maternal Healthcare ◽  
Sampling Weights ◽  
The World ◽  
Optimum Utilization ◽  
The Relationship

Abstract Background Ethiopia has one of the highest rates of infant mortality in the world. Utilization of maternal healthcare during pregnancy, at delivery, and after delivery is critical to reducing the risk of infant mortality. Studies in Ethiopia have shown how infant survival is affected by utilization of maternal healthcare services, however, no studies to date have investigated the relationship between optimum utilization of maternal healthcare services utilization and infant mortality. Therefore, this study examined the effect of optimum utilization of maternal healthcare service on infant mortality in Ethiopia based on the World Health Organization (WHO, 2010) guidelines. Methods We used nationally representative cross-sectional data from the Ethiopian Demographic and Health Survey (EDHS). Sampling weights were applied to adjust for the non-proportional allocation of the sample to the nine regions and two city administrations as well as the sample difference across urban and rural areas. A total of 7193 most recent births from mothers who had provided complete information on infant mortality, ANC visits, tetanus injections, place of delivery and skilled birth attendance during pregnancy were included. The EDHS was conducted from January to June 2016. We applied a multivariate logistic regression analysis to estimate the relationship between optimum maternal healthcare service utilization and infant mortality in Ethiopia. Results The findings from this study showed that optimum maternal healthcare service utilization had a significant association with infant mortality after adjusting for other socioeconomic characteristics. This implies that increased maternal healthcare service utilization decreases the rate of infant mortality in Ethiopia. The main finding from this study indicated that infant mortality was reduced by approximately 66% among mothers who had high utilization of maternal healthcare services compared to mothers who had not utilized maternal healthcare services (AOR = 0.34; 95%CI: 0.16–0.75; p-value = 0.007). Furthermore, infant mortality was reduced by approximately 46% among mothers who had low utilization of maternal healthcare services compared to mothers who had not utilized any maternal healthcare services (AOR = 0.54; 95%CI: 0.31–0.97; p-value = 0.040). Conclusions From this study, we concluded that optimum utilization of maternal healthcare services during pregnancy, at delivery and after delivery might reduce the rate of infant mortality in Ethiopia.

scholarly journals Optimum Maternal Healthcare Service Utilization and Infant Mortality in Ethiopia

2020 ◽  
Author(s):  
Girmay Kiross ◽  
Catherine Chojenta ◽  
Daniel Barker ◽  
Deborah Loxton
Keyword(s):  
Infant Mortality ◽  
Service Utilization ◽  
Healthcare Service ◽  
Healthcare Services ◽  
World Health ◽  
P Value ◽  
Maternal Healthcare ◽  
Sampling Weights ◽  
The World ◽  
Optimum Utilization

Abstract Background: Ethiopia has one of the highest rates of infant mortality in the world. Utilization of maternal healthcare during pregnancy, at delivery, and after delivery is critical to reducing the risk of infant mortality. Studies in Ethiopia have shown how infant survival is affected by utilization of maternal healthcare services; however, no studies to date have investigated the effect of optimum utilization of maternal healthcare services based on the World Health Organization (WHO) guidelines on infant mortality. Therefore, this study examined the effect of optimum utilization of maternal healthcare services on infant mortality in Ethiopia. Methods: We used nationally representative cross-sectional data from the Ethiopian Demographic and Health Survey (EDHS). Sampling weights were applied to adjust for the non-proportional allocation of the sample to the nine regions and two city administrations as well as the sample difference across urban and rural areas. We applied a multivariate logistic regression analysis to estimate the relationship between optimum maternal healthcare service utilization and infant mortality in Ethiopia. Results: The findings from this study showed that optimum maternal healthcare service utilization had a significant association with infant mortality after adjusting for other socioeconomic characteristics. This implies that increased maternal healthcare service utilization decreases the rate of infant mortality in Ethiopia. The main finding from this study indicated that infant mortality was reduced by approximately 66% among mothers who had high utilization of maternal healthcare services compared to mothers who had not utilized maternal healthcare services (AOR=0.34; 95%CI: 0.16-0.75; p-value=0.007). Furthermore, infant mortality was reduced by approximately 46% among mothers who had low utilization of maternal healthcare services compared to mothers who had not utilized any maternal healthcare services (AOR=0.54; 95%CI: 0.31-0.97; p-value=0.040).Conclusions: From this study, we concluded that optimum utilization of maternal healthcare services during pregnancy, at delivery and after delivery might reduce the rate of infant mortality in Ethiopia. The maternal healthcare service intervention packages in Ethiopia should involve a variety of care, spanning pregnancy, childbirth, and post-delivery, which should lead to the improvement of children’s’ survival in their first year of life.

scholarly journals Hardiness and attitudes toward professional healthcare services: Implications for healthcare service utilization among Black American adults

2021 ◽  
Vol 8 (2) ◽  
pp. 205510292110291
Author(s):  
Drexler James
Keyword(s):  
Locus Of Control ◽  
Healthcare Provider ◽  
Service Utilization ◽  
Indirect Effect ◽  
Indirect Effects ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Black American ◽  
Health Value ◽  
Health Domains

This study ( N = 780) examines the indirect effects of hardiness—health locus of control (HLOC), health competence (HC), health value (HV)—on past-year healthcare provider visit via attitudes toward seeking and receiving professional healthcare services (ATSRPHS). Across four health domains (dental, general health, mental, vision), ATSRPHS mediated the indirect effect of (1) HV and (2) internal HLoC on past-year healthcare provider visit. ATSRPHS also mediated the indirect effect of external HLoC on past-year visit to healthcare provider visit for general medical, mental, and vision health. ATSRPHS did not mediate any indirect effect of HC on past-year healthcare provider visit. This research contributes to understanding determinants of healthcare service utilization among Black American adults.

scholarly journals Does gender inequality matter for access to and utilization of maternal healthcare services in Bangladesh?

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257388
Author(s):  
Firoz Ahmed ◽  
Fahmida Akter Oni ◽  
Sk. Sharafat Hossen
Keyword(s):  
Gender Inequality ◽  
Gender Gap ◽  
Partner Violence ◽  
Bargaining Power ◽  
Healthcare Services ◽  
Household Wealth ◽  
Maternal Healthcare ◽  
Intrahousehold Bargaining ◽  
Women’S Autonomy ◽  
Women's Autonomy

There is a high prevalence of gender gap in Bangladesh which might affect women’s likelihood to receive maternal healthcare services. In this backdrop, we aim to investigate how gender inequality measured by intrahousehold bargaining power (or autonomy) of women and their attitudes towards intimate partner violence (IPV) affects accessing and utilizing maternal health care services. We used Bangladesh Demographic and Health Survey (BDHS) data of 2014 covering 5460 women who gave birth at least one child in the last three years preceding the survey. We performed logistic regression to estimate the effect of women’s autonomy and their attitude towards IPV on access to and utilization of maternal healthcare services. Besides, we employed different channels to understand the heterogeneous effect of gender inequality on access to maternal healthcare services. We observed that women having autonomy positively influenced attaining five required antenatal care (ANC) services (AOR: 1.17; 95% CI: 0.98–1.41) and women’s negative attitudes towards IPV were positively associated with five ANC services (AOR: 1.42; 95% CI: 1.02–1.97), sufficient ANC visits (COR: 1.55; CI: 1.19–2.01), skilled birth attendant (SBA) (AOR: 1.43; 95% CI: 1.05–1.94) and postnatal care (PNC) services (AOR: 1.44; 95% CI: 1.12–1.84). Besides, rural residency, religion, household wealth, education of both women and husband were found to have some of the important channels which were making stronger effect of gender inequality on access to maternal healthcare services. The findings of our study indicate a significant association between access to maternal healthcare services and women’s autonomy as well as attitude towards IPV in Bangladesh. We, therefore, recommend to protect women from violence at home and mprove their intrahousehold bargaining power to increase their access to and utilization of required maternal healthcare services.

scholarly journals Are maternal healthcare services accessible to vulnerable group? A study among women with disabilities in rural Nepal

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200370 ◽  
Author(s):  
Hridaya Raj Devkota ◽  
Emily Murray ◽  
Maria Kett ◽  
Nora Groce
Keyword(s):  
Healthcare Services ◽  
Vulnerable Group ◽  
Maternal Healthcare ◽  
Women With Disabilities ◽  
Group A ◽  
Rural Nepal

scholarly journals Determinants of maternal healthcare service utilisation among Indonesian mothers: A population-based study

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1124
Author(s):  
Ridwan Setyo Aji ◽  
Ferry Efendi ◽  
Iqlima Dwi Kurnia ◽  
Santo Imanuel Tonapa ◽  
Chong-Mei Chan
Keyword(s):  
Occupational Status ◽  
Wealth Index ◽  
Healthcare Facility ◽  
Healthcare Services ◽  
Household Wealth ◽  
Population Based ◽  
Maternal Healthcare ◽  
Determinant Factors ◽  
Number Of Children ◽  
Mother’S Age

Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother’s age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husband’s occupational status, the number of children, and access to the healthcare facility. Next, factors that drive mothers’ delivery at the healthcare facility were the mother’s education level, husband’s educational level, and residential area. The use of postnatal care was determined by the mother’s occupational status, husband’s educational level, number of children, wealth index, access to the healthcare facility, and residential area. Conclusions: Although there were differences in the determinant factors of three key maternal healthcare services, the mother’s age and household wealth index were the typical determinants of all maternal healthcare services utilisation. Providing a tailored programme aligned with these determinant factors may ensure that mothers can access and adequately utilise maternal healthcare services.

Trends in the location of the HIV-positive population in Australia: Implications for access to healthcare services and delivery

Sexual Health ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. 154 ◽  
Author(s):  
Marina Carman ◽  
Jeffrey Grierson ◽  
Marian Pitts ◽  
Michael Hurley ◽  
Jennifer Power
Keyword(s):  
Healthcare Service ◽  
Service Use ◽  
Healthcare Services ◽  
Capital City ◽  
Service Development ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Service Access ◽  
Longitudinal Data Collection ◽  
Positive Population

Background: Examining existing and potential trends in the HIV-positive population in Australia is important for current and future healthcare service development and delivery. Methods: A new analysis of existing data on this population from the HIV Futures 5 survey was based on linking a geographic breakdown of respondents based on ‘area type’ – capital city or inner suburban, outer suburban, regional centre and rural – with patterns of healthcare service access. In addition, the distance between the postcode of the respondent’s residence and the postcode of the doctor seen for HIV-related treatment was calculated. An analysis of ‘area type’ by income and age was also conducted. Results: The ‘area type’ analysis showed important differences in patterns of access to antiretroviral prescriptions and choice of provider for HIV-related and general healthcare. The median distance travelled to see a doctor for HIV-related treatment was higher for those living in outer suburbs than those living in regional centres. Discussion: Differences in service use appear to be related to geographic accessibility of different service types. However, there may be other important social, economic and cultural factors involved. Ageing and socio-economic pressures may be influencing a move away from inner suburban areas where most HIV-specific care is located. This new analysis assists in finding the right balance between increasing the accessibility of HIV-specific services and ‘mainstreaming’. Longitudinal data collection would further assist in tracking trends in geographic location, and how often and at what intervals people living with HIV utilise healthcare services.

Abstract 3: Patient Satisfaction and Healthcare Service Utilization Following Premature Acute Coronary Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Marisa Okano ◽  
Roxanne Pelletier ◽  
Hassan Behlouli ◽  
Louise Pilote ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Service Utilization ◽  
Healthcare Service ◽  
Healthcare Services ◽  
Satisfaction Level ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Satisfaction With Healthcare Services

Objectives. Patient centered care is recognized as central to a high-quality healthcare system. Satisfaction with healthcare services may be differentially experienced among young adults suffering from heart disease. The current study examined the association between patient satisfaction with healthcare services, utilization, and clinical outcomes in patients with premature acute coronary syndrome (ACS). Methods and Results. We used data from 1033 patients (≤ 55 years) hospitalized for ACS and enrolled into the prospective cohort study, GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond PRemature Acute Coronary SYndrome). Participants were recruited between January 2009-April 2013, from 24 centers across Canada, 1 in the US, and 1 in Switzerland. Patient satisfaction with treatment and subsequent healthcare service utilization/clinical outcomes were assessed within 12 months post-index ACS through questionnaire and medical chart review. The median age of our cohort was 48 years and 30% were female. Ninety two percent of males and females reported high satisfaction with healthcare services; however, among patients with low satisfaction we observed lower social support (48% vs. 24%; p<.0001) and higher rates of depression (46% vs. 22%; p<.0001) at baseline. Multivariable Cox regressions adjusted for patient characteristics and clinical risk factors indicated lower risk of cardiac ER visits (HR=0.56; 95%CI, 0.34-0.93; P=0.01) and cardiac rehospitalization (HR=0.55; 95%CI, 0.28-1.07; P=0.08) among patients with higher satisfaction. There was no association between patient satisfaction level and risk of major adverse cardiac events (MACE) (HR=0.61; 95% CI, 0.32-1.19 P=0.15). Conclusions. Patients with lower satisfaction with healthcare services at index ACS were more likely to visit the ER and to be rehospitalized for cardiac reasons. Patient satisfaction level was not associated with risk of adverse clinical outcomes. Our results suggest that the younger ACS population may be a tangible target for reducing healthcare utilization through increased patient satisfaction.

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