scholarly journals Changes in Inequality in Utilization of Maternal Health Care: Evidence from Skilled Birth Attendance in Mauritania for the Period 2007-2015

2021 ◽  
Author(s):  
Mohamed Vadel Taleb El Hassen ◽  
Juan M. Cabasés ◽  
Moulay Driss Zine Eddine El Idrissi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Prenatal Care ◽  
Concentration Index ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Services Utilization ◽  
Birth Attendance ◽  
Urban Rural ◽  
Type Decomposition

Background: The presence of a skilled health professional at delivery is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled births attendance services in Mauritania. The study identifies the inequality determinants and to explore its changes over the period 2007–2015. Methods: The concentration curve, concentration index, decomposition of the concentration index and Oaxaca-type decomposition technique were performed to measure socio-economics related inequalities in skilled birth attendance services utilization and identify contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007, 2011 and 2015. Results: The concentration index for skilled birth attendance services utilization dropped from 0.6324 [P < 0.001] in 2007 to 0.5852 [P < 0.001] in 2015. Prenatal care, household wealth Status and urban-rural location made the biggest contributions to socio-economic related inequalities. Decomposition of the concentration index and Oaxaca-type decomposition revealed changes prenatal care, rural-urban location made positive contributions to decline in inequality. However, alternation in household wealth score, woman’s age, her education level and the number of living children pushed the equality toward deterioration. Conclusion: Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania despite a slight decrease during the study period. Policy actions on eliminating urban-rural and wealth index disparity should target increase access to skilled birth attendance. Multisectoral Policy actions is needed to improve social determinants of health and to remove health system bottlenecks including socio-economic empowerment of women and girls, enhancing availability and affordability of Reproductive and Maternal Health commodities, improving availability of obstetrical providers in rural area, promoting a better distribution and quality of health infrastructure particularly health posts and health centers, and replacing user fees by an equitable, efficient and sustainable financing scheme under an universal health coverage vision.

scholarly journals Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Alem Desta Wuneh ◽  
Araya Abrha Medhanyie ◽  
Afework Mulugeta Bezabih ◽  
Lars Åke Persson ◽  
Joanna Schellenberg ◽  
...  
Keyword(s):  
Maternal Health ◽  
Child Health ◽  
Health Services ◽  
Wealth Index ◽  
Skilled Birth Attendance ◽  
Maternal Health Services ◽  
Child Health Services ◽  
Services Utilization ◽  
Birth Attendance ◽  
And Child Health

Abstract Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

UTILIZATION OF SKILLED BIRTH ATTENDANTS IN PUBLIC AND PRIVATE SECTORS IN VIETNAM

2009 ◽  
Vol 41 (3) ◽  
pp. 289-308 ◽  
Author(s):  
MAI DO
Keyword(s):  
Health Care ◽  
Private Sector ◽  
Health Care Services ◽  
Skilled Birth Attendant ◽  
Skilled Birth Attendance ◽  
Household Wealth ◽  
Public And Private ◽  
Birth Attendance ◽  
Delivery Services ◽  
The Government

SummaryThe private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women’s decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women’s household wealth, education, antenatal care and community’s wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

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 Maternal Health-Care in India: The Case of Tetanus Toxoid Vaccination

2013 ◽  
Vol 1 (1) ◽  
pp. 1-14
Author(s):  
Rana Ejaz Ali Khan ◽  
Muhammad Ali Raza
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Prenatal Care ◽  
Tetanus Toxoid ◽  
Binary Logistic Regression ◽  
Household Wealth ◽  
Maternal Health Care ◽  
Cash Transfer ◽  
Explanatory Variables ◽  
Health Related

Prenatal-care is one of the important elements of maternal health-care. In this paper an attempt has been made to examine the socioeconomic determinants of Tetanus Toxoid (TT) vaccination as a component of prenatal-care by the women in the age group of 15-49 years. Micro-data having 25847 observations from Indian Demographic and Health Survey (IDHS) has been used. To estimate the probability of TT vaccination binary logistic regression has been utilized. The explanatory variables categorized into socio-demographic characteristics of the woman, household characteristics, health-related characteristics, community characteristics and regional characteristics have been included in the analysis. The results explained that probability to have TT vaccination increases by woman’ education, woman’ age at marriage, husband’s age, husband’s education, husband’s living within household, husband’s presence at prenatal visit and household wealth. The woman’s living in small city, town and country side as well as final say on woman’s health-care by woman and husband collectively, and husband alone decrease the probability of TT vaccination. The study proposed targeted approach to enhance the TT vaccination in Indian women. The marginalized households should be targeted through cash transfer programs. Furthermore, the small cities and country sides should also be focused. The awareness and education of woman along with husband’s participation in maternal health-care cannot be ignored in policy making.

scholarly journals Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Petula Fernandes ◽  
Emmanuel Kolawole Odusina ◽  
Bright Opoku Ahinkorah ◽  
Komlan Kota ◽  
Sanni Yaya
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Reproductive Age ◽  
Maternal Healthcare ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan. Methods This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression. Results Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001). Conclusions Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

scholarly journals The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania.

2020 ◽  
Author(s):  
Corinna Vossius ◽  
Estomih Md ◽  
Robert Moshiro ◽  
Paschal M ◽  
Jan Terje Kvaløy ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Low Birthweight ◽  
Care Facility ◽  
Health Care Facility ◽  
Skilled Birth Attendance ◽  
Health Care Facilities ◽  
Birth Attendance ◽  
Vaginal Deliveries ◽  
The Impact

Abstract Background: Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees . Methods: Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes. Results: A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently, while labour complication and caesarean sections were more frequent. There was a reduction of newborns with birth weight less than 2500 grams. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks. Conclusion: After the introduction of ambulance and delivery fees an increase in labour complications and caesarean sections of about 80 per 1000 births and a decrease in non-cephalic presentations and newborns with low birthweight of about 17 per 1000 births each was observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.

scholarly journals Wealth Status, Health Insurance, and Maternal Health Care Utilization in Africa: Evidence from Gabon

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
N’doh Ashken Sanogo ◽  
Sanni Yaya
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Maternal Health ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Services Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services

Background. To achieve the universal health coverage among other Sustainable Development Goals, African countries have shown the commitment by implementing strategies to improve access and coverage of health care services whose access is still very low. The achievement of universal health care requires the provision and availability of an adequate financing system. This study explored the wealth-related association of compulsory health insurance on maternal health care utilization in Gabon. Methods. The study used the 6th round of Gabon Demographic and Health Surveys (GDHSs)—2012 data to explore three outcome measures of maternal health care utilization extracted on number of antenatal care (ANC) visits during pregnancy, place of birth delivery, and postnatal health care. The dependent variable was women with health insurance coverage against those without. Logistic regression and propensity scoring matching analysed associations of health insurance coverage on women’s utilization of health care. Results. Mean (+/− SD) age of women respondents of reproductive age was 29 years (9.9). The proportion of at least 4 antenatal care visits was 69.2%, facility-based delivery was 84.7%, and postnatal care utilization was 67.9%. The analysis of data showed disparities in maternal health care services utilization. The GDHS showed maternal age, and geographical region was significantly associated with maternal health care service utilization. A high proportion of urban dwellers and Christian women used maternal health care services. According to the wealth index, maternal health services utilization was higher in women from wealthy households compared to lower households wealth index (ANC (Conc. Index = 0.117; p≤0.001), facility-based delivery (Conc. Index = 0.069; p≤0.001), and postnatal care (Conc. Index = 0.075; p≤0.001), respectively). With regard to health care insurance coverage, women with health insurance were more likely to use ANC and facility-based delivery services than those without (concentration indices for ANC and facility-based delivery were statistically significant; ANC: z-stat = 2.69; p=0.007; Conc. Index: 0.125 vs. 0.096 and facility-based delivery: z-stat = 3.38; p=0.001; Conc. Index: 0.076 vs. 0.053, respectively). Conclusion. Women enrollment in health insurance and improved household’s financial status can improve key maternal health services utilization.

scholarly journals Effect of power outages on the use of maternal health services: evidence from Maharashtra, India

2019 ◽  
Vol 4 (3) ◽  
pp. e001372 ◽  
Author(s):  
Mustafa Koroglu ◽  
Bridget R Irwin ◽  
Karen A Grépin
Keyword(s):  
Maternal Health ◽  
Caesarean Section ◽  
Health Services ◽  
Skilled Birth Attendance ◽  
Maternal Health Service ◽  
Power Outage ◽  
Lower Odds ◽  
Birth Attendance ◽  
Low Middle Income Countries ◽  
Caesarean Section Delivery

IntroductionElectricity outages are common in low/middle-income countries and have been shown to adversely affect the operation of health facilities; however, little is known about the effect of outages on the utilisation of health services.MethodsUsing data from the 2015–2016 India Demographic Health Survey, combined with information on electricity outages as reported by the state electricity provider, we explore the associations between outage duration and frequency and delivery in an institution, skilled birth attendance, and caesarean section delivery in Maharashtra State, India. We employ multivariable logistic regression, adjusting for individual and household-level covariates as well as month and district-level fixed effects.ResultsPower outage frequency was associated with a significantly lower odds of delivering in an institution (OR 0.98; 95% CI 0.96 to 0.99), and the average number of 8.5 electricity interruptions per month was found to yield a 2.08% lower likelihood of delivering in a facility, which translates to an almost 18% increase in home births. Both power outage frequency and duration were associated with a significantly lower odds of skilled birth attendance (OR 0.97; 95% CI 0.95 to 0.99, and OR 0.99; 95% CI 0.992 to 0.999, respectively), while neither power outage frequency nor duration was a significant predictor of caesarean section delivery.ConclusionPower outage frequency and duration are important determinants of maternal health service usage in Maharashtra State, India. Improving electricity services may lead to improved maternal and newborn health outcomes.

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.

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