Horizontal inequity in the utilisation of Continuum of Maternal Health care Services (CMHS) in India: an investigation of ten years of National Rural Health Mission (NRHM)

Background Continuum of Maternal Health Care Services (CMHS) has garnered attention in recent times and reducing socio-economic disparity and geographical variations in its utilisation becomes crucial from an egalitarian perspective. In this study, we estimate inequity in the utilisation of CMHS in India between 2005 and 06 and 2015-16. Methods We used two rounds of National Family Health Survey (NFHS) - 2005-06 and 2015-16 encompassing a sample size of 34,560 and 178,857 pregnant women respectively. The magnitude of horizontal inequities (HI) in the utilisation of CMHS was captured by adopting the Erreygers Corrected Concentration indices method. Need-based standardisation was conducted to disentangle the variations in the utilisation of CMHS across different wealth quintiles and state groups. Further, a decomposition analysis was undertaken to enumerate the contribution of legitimate and illegitimate factors towards health inequity. Results The study indicates that the pro-rich inequity in the utilisation of CMHS has increased by around 2 percentage points since the implementation of National Rural Health Mission (NRHM), where illegitimate factors are dominant. Decomposition analysis reveals that the contribution of access related barriers plummeted in the considered period of time. The results also indicate that mother’s education and access to media continue to remain major contributors of pro-rich inequity in India. Considering, regional variations, it is found that the percentage of pro-rich inequity in high focus group states increased by around 3% between 2005 and 06 and 2015-16. The performance of southern states of India is commendable. Conclusions Our study concludes that there exists a pro-rich inequity in the utilisation of CMHS with marked variations across state boundaries. The pro-rich inequity in India has increased between 2005 and 06 and high focus group states suffered predominantly. Decentralisation of healthcare policies and granting greater power to the states might lead to equitable distribution of CMHS.

Effectiveness of Respectful Maternity Care Interventions for Women Using Maternal Health Care: A Systematic Review Protocol

Background: Studies have indicated the mistreatment of women during maternal health care provision as being a driving factor for women eschewing professional care. The mistreatment of women is not only a violation of human rights, but also a significant contributor to poor-quality maternal care. Various strategies aimed at preventing the mistreatment of women and enhancing respectful maternity have been proposed, however, the positive effects and outcomes of these interventions necessitate further clarity. This systematic review will examine the effectiveness of respectful maternity care intervention programs in preventing the mistreatment of women whilst enhancing respectful maternity care in health facilities.Methods: A systematic review will be undertaken according to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA)2020. Both published and unpublished randomised, non-randomised controlled and observational studies obtained from PubMed, CINHAL, EMBASE, AJOL, and other databases and grey literature sources will be assessed against an inclusion and exclusion criteria to include in the review. Two independent reviewers will assess the papers selected for retrieval to ensure methodological validity. Standardised critical appraisal instruments from the Critical Appraisal Skills Program (CASP) and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) will be used. The data will be extracted from papers included in the review using two independent reviewers' standardised data extraction tool. Evidence synthesis and, wherever possible, meta-analysis will be performed. Certainty of the evidence will be assessed by using GRADE criteria. Systematic review protocol registration: Submitted to PROSPERO on 9th of November 2021 (ID. 287049).

Women Empowerment and Utilization of Maternal Health Care in Pakistan

The impact of women's empowerment is examined on the utilization of maternal health care services in Pakistan. The empirical analysis based on logistic regression shows that women's education is the most important factor to improve maternal health among women. Other predisposing factors like parity and health belief are also contributing factors. Household wealth status turned out to be the most significant factor among other enabling factors like ease of access and source of information. Death of the child in previous pregnancies is the only need factor and we have found it statistically significant in the case of postnatal care.

Association between health insurance enrolment and maternal health care service utilization among women in Ethiopia

Background Health insurance was considered as the third global health transition which can increase access to health care services by eliminating monetary obstacles to maternal health care use, particularly in emerging nations. Hence, this study aimed to assess the association between health insurance enrolment and maternal health care service utilization among women in Ethiopia. Methods A cross-sectional study was conducted using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set. About 4278 mothers who had delivered at least one child in the last five years of the survey were selected in the study. Multivariate logistic regression analysis was performed to measure the relationship between health insurance enrolment and maternal health care service utilization by controlling confounders An adjusted odds ratio with a 95% confidence interval and p-values < 0.05 were well-thought-out to state the imperative association. Results The overall health insurance coverage among the women was 4.7%. About, 18.1% of women from households in the poorest wealth quantile had no health insurance coverage for maternal health care services. Moreover, 84% of women lived in a rural area did not enclose by health insurance. According to multivariate logistic regression, the likelihoods of ANC utilization were 1.54 times (AOR: 1.54; 95% CI: 1.06–2.25) higher among mothers who were enrolled in health insurance compared to their counterparts. In the same vein, the likelihoods of been attended by a skilled birth attendant were 1.84 times (AOR: 1.84; 95% CI: 1.1–3.08) higher among mothers who were enrolled in health insurance. Conclusions This study has shown that women enrolled in health insurance were associated with skilled delivery and recommended ANC utilization than women who did not enroll in health insurance. Health insurance enrolment enterprises must be available to all pregnant women, particularly those of poorer socioeconomic rank.

The dropout rate and associated factors of the continuum of maternal health care services before and during Covid-19 Pandemic among women who gave birth in the last two years in Addis Ababa, Ethiopia, 2021. A comparative cross-sectional study design

Background A continuum of maternal health care is the continuity of care during pregnancy, delivery, and post-delivery period. However, the dropout rate of the continuum care and factors associated with it during the COVID-19 pandemic were not well documented in the study setting. Hence, this study was used to assess the dropout rate and associated factors of the continuum of care before and during the COVID-19 pandemic. Methods A community-based comparative cross-sectional study was conducted among 630 women who gave birth in the last two years in Addis Ababa. An interviewer-administered questionnaires were used to collect the data. The Epi data version 4.6 and STATA version 14 statistical Softwares were used for data entry and analysis, respectively. Binary logistic regression model was used to identify associated factors of the dropout rate of a continuum of care. Result The dropout rate of the continuum of maternal healthcare was 58.39% (95% CI: 52.56-64.00) and 73.24% (95% CI: 67.91-77.98) before and during the covid-19 pandemic respectively. Women who had no information about PNC (AOR =1.88, 95% CI: 1.01-3.50), not received appropriate care (AOR = 3.92, 95% CI: 1.84-8.37), no information about maternal health care (AOR=2.57, 95% CI: 1.28-5.16), birth preparedness and complication readiness (AOR=0.47, 95% CI: 0.26-0.86), and had history of pregnancy-related complications (AOR=2.07, 95% CI: 1.17-3.68), were dropped out from continuum of care during the covid-19 pandemic. whereas, unplanned pregnancy (AOR= 3.35, 95% CI: 1.60-7.04), not know postpartum danger signs (AOR=1.79,95% CI: 1.03-3.12), and no information about maternal health care (AOR= 1.85, 95% CI: 1.06-3.23) were dropped out from continuum of care before covid-19 pandemic. Conclusion This study underscores nearly three fourth and more than half of women during and before the covid-19 pandemic dropped out from the continuum of care, respectively. Information about maternal health care, birth preparedness and complication readiness, information about PNC, and knowing postpartum danger signs were significantly associated with the dropout rate of the continuum of care. Thus, adapting policy that supports service delivery modification during such pandemic, promoting birth preparedness and complication readiness is very crucial.

Two-fifths of women are not autonomous in maternal health service utilization: A community-based cross-sectional study

Background: Autonomy of women in health care decision-making is tremendously crucial for improved maternal health outcomes and women’s empowerment. Women with greater freedom of movement are more likely to receive maternal health services. However, little has been investigated about women’s autonomy in maternal health care decision-making and contributing factors in Ethiopia. The aim of this study was to assess decision-making autonomy on maternal health care services utilization and associated factors among women.Methods: A community-based cross-sectional study was conducted in Mettu rural Woreda, Ilu Aba Bor zone, southwest Ethiopia from June 19 to August 20, 2021. Data was collected using a pretested interviewer-administered questionnaire from 541 randomly selected women. The collected data was entered into Epi-Data version 3.1 and exported to SPSS version 22 for analysis. Bivariate and multivariate logistic regression was used to identify factors associated with women's decision-making autonomy on maternal health service utilization. The significance of association was declared by using the odds ratio with a 95% confidence interval and a p-value less than 0.05 in the multivariable model.Results: Out of 522 women included in the analysis, 322 (60.5%) (95% CI: 56.2%-64.7%) were found to be autonomous on maternal health service utilization. Age category from 30-39 years, AOR=4.27 (95%CI: 1.59-11.43), attending primary education and above, AOR=3.87 (95%CI: 2.15-6.99), greater than five family size, AOR=0.25 (95%CI: 0.15-0.41), and distance from the health facility, AOR=5.33 (95%CI: 2.50-11.33) were significantly associated with women's decision-making autonomy on maternal health care services utilization.Conclusion: Even though every woman has the right to participate in her own health care decision-making, around two fifths of them have no role in making health care decisions about their own health. Socio-demographic factors like age and education were found to influence women’s autonomy. Special attention has to be given to women living in rural areas in order to reduce their dependency through education.