Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

Background Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. Results Out of 7326 women, 6625 (90.4, 95% CI: 89.9–91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2–91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0–86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37–19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46–2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08–1.73), having tertiary education (aOR 2.71, 95% CI: 1.32–5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19–1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29–0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36–0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56–0.85) and being a working woman (aOR 0.66, 95% CI: 0.52–0.84) were associated with lower odds of utilizing PNC. Conclusion Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

Developing an Evaluation Model for Maternity Care: A Mixed-Method Study from Iran

Background: Maternity care is an integral part of primary health care (PHC) systems worldwide. This study aimed to develop a new model for evaluating the maternity health program (MHP) in Iran. Methods: In this mixed-methods study, first, the challenges of MHP were surveyed through systematic review and expert interviews. Next, to identify the existing shortcomings in MHP evaluation system, the SWOT technique, cross-sectional study and comparative analyses were used. Finally, the Delphi technique was used to reach consensus on developed evaluation standards. Results: The final developed evaluation model contains five dimensions including reproductive health/family planning, maternity health, health records, evaluation, and resources management. Overall, this model has 32 standards and 289 measures. The scores obtained for the sum of the measures in two importance and applicability criteria were 8.24 and 7.85, which these scores are estimated to be equal to 91.55 and 87.22 percent of the highest possible scores, respectively. Conclusion: Considering the comprehensiveness of the obtained model, it is hoped that it could lead to performance improvement of the PHC centers in the area of maternity health.

Assessment of Women’s Experience of Care during Childbirth for Quality Improvement at Level 5 Health Facilities in Bungoma County, Kenya

High maternal and newborn mortality is a pressing problem in developing countries. Poor treatment during childbirth contributes directly and indirectly to this problem. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya, 20% of women report having experienced some form of disrespect and abuse (D&A). Bungoma County is among the 15 counties with the worst maternal and newborn health statistics in Kenya. The maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births, while skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited formal research on respectful maternity care. The study aimed at assessing women’s experience of care during childbirth at Level 5 health facilities in Bungoma County. The specific objectives were to determine the women’s experiences of care during childbirth, to determine factors contributing to disrespect and abuse during childbirth and to identify strategies for addressing issues affecting respectful maternity care for promoting quality of maternal and newborn care. A cross-sectional descriptive study design was used. It involved 360 mothers. Analysis of quantitative data was done using SPSS. Descriptive statistics were presented in graphs, tables, frequencies and percentages. Qualitative data was analysed thematically. The prevalence of D&A was 42.2%, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, and absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationships were factors leading to D&A. It was concluded that there is a need for increased incorporation of Respectful Maternity Care (RMC) in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritising policy actions for improving the quality of maternal and newborn health outcomes and indicators.

Comparative assessment of mortality and lethality rates of newborns at the regional level

In order to assess the mortality and lethality rates of newborns in obstetric organizations of the North-Western Federal District in 2013–2019, a comparative analysis of official statistics data was carried out. It was found that in the North-Western Federal District in the period from 2013 to 2019, there was an almost annual decrease in newborn mortality rates. The overall decrease in mortality in maternity care organizations of the Federal District (from 2,5% to 1,9%) was mainly due to a decrease in mortality in obstetric hospitals of the first and second levels (respectively from 3,2% to 1,2% and from 1,7% to 0,7%), while most children died in perinatal centers, where the mortality rate has not changed in recent years (2013 – 4,1%; 2019 – 4,0%). The study showed a decrease in mortality rates in the subjects of the Russian Federation that are part of the federal district, except for the city of St. Petersburg. The average hospital lethality rate of newborns in maternity care organizations of the North-Western Federal District during 2013–2019 was in the range of 1,9%–2,0%, did not change significantly and corresponded to the national average. However, the level of hospital lethality significantly differed in individual subjects of the district – in more than half of them, the level of hospital lethality exceeded the average, while in others it was significantly lower. Thus, the decrease in the mortality and lethality rates of newborns in maternity care organizations indicates an increase in the quality of medical care for children in the North-Western Federal District. dicates an increase in the quality of medical care for children in the North-Western Federal District.

The International Childbirth Initiative: An Applied Anthropologist’s Account of Developing Global Guidelines

This chapter describes my personal experiences as an applied anthropologist serving as the lead editor in the development of a set of international guidelines focused on improving quality of maternity care: the International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care (2018). The ICI’s purpose is to encourage global awareness and local implementation of the MotherBaby-Family Model of Care. This is a model based on women’s rights and humane, respectful, family-centered care. The ICI’s creation story is continuous with global movements to improve the quality of maternity care and with a deep history of birth activism by practitioners, public health advocates, and social scientists aimed at decreasing unnecessary medical intervention in childbirth. This narrative is widely relevant for understanding how to develop and implement global guidelines that can flexibly adapt to local contexts. The ICI was developed by the merging of the 2015 FIGO Guidelines to Mother-Baby Friendly Birthing Facilities with the pre-existing International MotherBaby Childbirth Initiative (IMBCI) in an intense and rewarding group process. The chapter discusses factors that contributed to the successful development of clear global guidelines for high-quality maternity care. These include attention to process, alignment with key values of the women’s health and midwifery movements, multilevel collaboration and networking around a clear vision, garnering input from many people with diverse voices and perspectives, and patience with and commitment to the tasks at hand.

Applying Salutogenesis in Midwifery Practice

This chapter presents midwifery as unique amongst the healthcare professions because it mostly focuses on physiological processes and a period of transition in the life of a woman and her family. Thus, midwives work across a childbearing continuum and the health-ease dis-ease continuum. The “midwifery model of care” and its approach to childbearing focuses on wellness rather than illness and works closely with women to help them mobilize their own resources to move towards greater health. But the contrasting pathogenic approach to maternity care is still ubiquitous in contemporary healthcare provision with over-medicalization of childbirth and overuse of interventions, which can also cause more harm than good.While there is resonance between midwifery practice and salutogenesis, research examining the relationship is still in its infancy. Few researchers explicitly draw on salutogenic theory. Of these, few studies and scoping reviews are described in more detail. They suggest that there is an alignment between salutogenesis and midwifery practice.The chapter concludes by stressing that salutogenesis, with its focus on health rather than pathology, offers a promising way forward to underline that much of midwifery work is health promotion and must be operationalized accordingly in midwifery practice.

The Application of Salutogenesis in Birth, Neonatal, and Infant Care Settings

In this chapter, the relation of salutogenesis to maternity care is discussed by giving a critical overview of studies in perinatal care, primarily measuring and promoting parental sense of coherence (SOC) and well-being.An overview is given on salutogenic approaches to neonatal and infant service provision. Important aspects of and salutogenic interventions for parent–child attachment in the first year of a child’s life are examined. Parents’ and caregivers’ relationship with their infants and newborns plays a critical role in shaping the emotional, cognitive, and social development of their child. Different interventions of early support to optimize parenting capacity and their impact are also discussed.Although the chapter focuses only on examples of salutogenic approaches based on reasonable evidence, there is a growing awareness of the value of salutogenic approaches to the provision of maternity care, and to facilities and services to enhance parenting and well-being in infancy and early childhood. Research gaps are identified, and suggestions for the direction of future research are outlined.