Maternal Health Research Papers - Academia.edu (original) (raw)

Objectives: To examine the prevalence of domestic violence (DV) and its associations with obstetric complications and psychological health in women on antenatal and postnatal wards. Study design: A cross-sectional survey conducted in an inner-London teaching hospital. Two hundred English-speaking women aged 16 and over, were interviewed between July 2001 and April 2002. The Abuse Assessment Screen was used to assess for experiences of DV. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The analysis of predictors of obstetric complications grouped together those known to be associated with DV. Results: 23.5% of women had lifetime experience of DV, 3% during the current pregnancy. Women with a history of DV were significantly more likely to be single, separated or in non-cohabiting relationship and to have smoked in the year prior to and/or during pregnancy. Higher EPDS scores were significantly associated with DV, single, separated or non-cohabiting status, and obstetric complications. Both a history of DV and increased EPDS scores were significantly associated with obstetric complications after controlling for other known risk factors. Conclusions: Domestic violence is regarded as an important risk marker for the development of obstetric complications and depressive symptomatology. This finding of itself justifies training and education of maternity health professionals to raise awareness. #

- by Susan Bewley
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- Domestic Violence, Adolescent, Maternal Health, London

Background: A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. Methods: An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre-(2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. Results: The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. Conclusions: MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.

- by Onno Van Schayck
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- Program Evaluation, Child health, Qualitative Research, Urban Health

Introduction The maternal mortality rate in Indonesia is still quite high. It requires good knowledge for early prevention. The study aimed to analyze the determinants of knowledge of the pregnancy danger signs in Indonesia. Methods The samples used were 85,832 women of childbearing age (15-49 years old). The variables included understanding of danger signs of pregnancy, types of residence, age, education, employment, marital status, wealth, parity, the autonomy of health, current pregnancy status, and media exposure. The determinant was pointed out by using binary logistic regression. Results Urban women were 1.124 times more likely to understand the pregnancy danger signs of than rural women. Older women could identify pregnancy danger signs better than those aged 15-19 years. The more educated a woman is, the higher knowledge of the pregnancy danger signs she has. Married women or those who live with their partner were at 1.914 times likely to identify the pregnancy danger signs than unmarried ones or those who have never been in a relationship. If the wealth status gets higher, knowledge of the pregnancy danger signs will be better too. Grande multiparous women were at 0.815 times more likely to understand the pregnancy danger signs than primiparous. Women with the autonomy of health had 1.053 times chances to identify the pregnancy danger signs than those without autonomy. Women who were currently pregnant had 1.229 times better understanding of the pregnancy danger signs than women who were not currently pregnant. Media exposure had a good effect on women's understanding of the pregnancy danger signs.

We conducted this retrospective case-control study to identify possible risk factors of delivery through caesarean section in the Far North Region of Cameroon. Data was collected retrospectively from delivery room registers at the Provincial Hospital, Maroua, Cameroon from 01/01/2003 to 31/12/2004. The overall 125 eligible caesarean deliveries were compared with 244 women who delivered vaginally during the study period. The odds ratio as well as the 95% confidence interval was used to measure the relationship between maternal characteristic and risk of delivery by caesarean section. We found that the marital status is similar in the two study populations. Risk factors associated with cesarean section were: maternal age less than 17 years (OR 3.55, 95%CI: 1.46–8.64), maternal age over 39 years (OR 3.55, 95% CI: 1.17–10.75), nulliparity (OR 2.72, 95% CI: 1.59–4.66), grand multiparty (OR 3.43, 95% CI: 1.79–6.57), and macrosomia (OR 4.82, 95% CI: 1.49–16.44). There was a weak association with absent or poor. Caesarean delivery is associated with extreme ages of reproductive life, macrosomia, nulliparous and grand multiparous status. We strongly recommend that these factors be taken into consideration to strengthen the mother and child health programs in Cameroon and countries with similar socioeconomic profiles.

- by Eugene Kongnyuy
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- Sexual and Reproductive Health, Maternal Health, Maternal Mortality
- by Lars Plantin
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- Nursing, Child health, Focus Groups, Content Analysis
- by Tracie Collins
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- Adolescent, Maternal Health, Pregnancy, Young Adult

The lack of human resources is one of the main bottlenecks to achieving the Millennium Development Goals on maternal and child health. A coherent national policy, recognized across government, needs to be in place to overcome this especially in countries severely affected by HIV/AIDS. Such a policy should cover selection of pre-service students, the qualifications of trainers and training sites, supportive supervision, career path development, a package of carefully thoughtout incentives for the retention of staff, strategies for interaction with communities, and an agreed-upon health staff HIV/AIDS policy. Without such coherent human resource planning, a large number of countries will fail to reduce maternal and newborn mortality.

- by Jerker Liljestrand
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- Health Care, Midwifery, Human Resource, Maternal Health

Maternal deaths in the Philippines remain high. These deaths are mostly due to the large proportion of home births, complications of pregnancy and delivery, and lack of access to facilities and competently trained staff. Utilizing a descriptive, one-shot survey design, the study aimed to determine the reasons why women in a municipality in Iloilo prefer home birth. The respondents were interviewed using a validated questionnaire. Descriptive statistics were used to analyze and interpret the findings. The study revealed that the proportion of home births progressively declined from 2012 to 2014. Birth being imminent or inevitable is the number one reason that supports home birth. Autonomy, safety, affordability, readily available birthing equipment and supplies, accessibility of birth attendant, remote access by going to the birthing center, lack of transportation, and bad weather conditions also led women to give birth at home. Women from the rural areas of the municipality utilized available resources in the community which prompted the predominance of home deliveries assisted by traditional birth attendants (TBAs) and even midwives, who were readily available nearby. This study recommends continuous improvement in existing maternal health interventions and strategies through engagement of women in policy planning, improvement of health service delivery, infrastructural enhancement, better care practices and continuous health education.

- by Research and Statistics Center
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- Maternal Health

Pregnancy and childbirth are traditionally recognised as life events that are to be cherished and celebrated. However, recent media coverage and official reports of deaths by suicide, including the last report of the Confidential Enquiry on Maternal and Child Health (CEMACH) (2004) have raised public and health professionals’ awareness of the potential dangers of mental health problems to mothers during pregnancy and in the first year after giving birth. Suicidality has been reported as a common symptom in postpartum psychosis (PPP) (Burt and Stein, 2002). While PPP is a rare event following birth, other more common mental health issues associated with childbirth are correlated positively with suicide. This has led to the US Congress introducing a ‘House Resolution’ (H.Res 51) encouraging the US National Institutes of Health to investigate the mental health issues associated with postpartum mental health problems (Lindahl et al, 2005). Surprisingly, there is a paucity of literature investigating the prevalence of suicide during pregnancy and the year after giving birth. Lindahl et al (2005), in a systematic review of prevalence studies of maternal suicide, identified only nine studies globally that have attempted to identify the scope of the problem of maternal suicide.

- by Iain McGowan
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- Traumatic Stress, Suicide, Suicidology, Maternal Health

Objective: to describe how women's maternal health, particularly at a psychosocial level, is assessed and promoted during the postnatal hospital stay. Design: postal survey of public hospitals providing postnatal care and interviews with care providers. Setting: all publicly funded maternity units and selected health professionals in Victoria, Australia. Participants: hospital postal survey: sixty six hospital respondents; interviews: 38 maternity unit managers, clinical midwives and medical practitioners. Findings: there was little consistency across the State in relation to routine observations of the mother. Physical checks were much more common than enquiring about how women felt physically. Practice in psychosocial assessment was also diverse, with care plans/maps (clinical pathways) being the main tool to guide assessment. Most participants reported that psychosocial assessment was undertaken during pregnancy. Follow-up after birth also varied. Hospital respondents reported that emotional well-being is assessed postnatally by observation and conversation with women. Participants who were interviewed reported that midwives had mixed skills in assessing and dealing with complex psychosocial issues. Three hospitals administer the Edinburgh Postnatal Depression Scale to women in the days after birth, and three hospitals provide routine sessions of structured debriefing. Survey participants reported that the busy and, at times, chaotic nature of postnatal wards affected the provision of care and the level of psychosocial support offered to women. Key conclusions: although one of the stated aims of early postnatal care is the promotion of maternal well-being, the diversity of practices and the routine nature of many of these practices suggest that care is often not individualised or woman-centred. The reliance of detecting and managing women with particular psychosocial issues during pregnancy results in this aspect of care being given less priority postnatally than may be ideal. Implications for practice: strategies are required to provide health professionals with guidelines and skills to enhance the detection of women who have, or have the potential to develop, health problems after birth. This requires a reorganisation of the way early postnatal care is provided in relation to the use of routine practices; the ability of

- by Jo Rayner
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- Nursing, Health Promotion, Midwifery, Maternal Health
- by Nikaelly Lopes
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- Women's Rights, Gender and Sexuality, Maternal Health, Maternity

Background Community Based Health Insurance (CBHI) Schemes are promising alternatives for a cost sharing health care system which hopefully leads to better utilization of health care services, reduce illness related income shocks and eventually lead to a sustainable and fully functioning universal health coverage. Objective This study focused on factors influencing the people's enrolment and hindrances for enrollment of CBHI program. Method Altogether 316 households were taken according to population proportionate sampling method.Community based cross-sectional analytical study was carried out with preformed questionnaire among members and non- member in four villages. Sample unit for enrollee were selected by using population proportionate systematic random sampling method using enrolled register and for non-enroll systematic random sampling technique was used using household list from VDC. Result For non- members 28.3% small benefit package was main reason for non membership. ...

- by Laxmi Subedi
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- Public Health, Maternal Health

The Preventing Maternal And Neonatal Deaths (PREMAND) project works to understand the social and cultural factors that may contribute to the deaths and near-misses (people who almost die but end up surviving) of mothers and babies in four districts in Northern Ghana. Examples of these factors include such thing as treating a sick baby at home with traditional medicine instead of going to a hospital or health center, or pregnant women needing permission from several people before they can go to a hospital to deliver. These social and cultural factors will be placed on a map to understand where patterns and clusters of deaths and near-misses are present in these four communities. The final phase of the project will include support and small grants for community members and local leaders to use these maps and this information to create their own solutions that address the specific needs of each community. Background While Ghana is a leader in some health indicators among West African n...

- by Peter Hockey
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- International Development, Global Health, United Nations, Quality Improvement

Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. The World Health Organization has developed a toolkit that contains adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocket Book of Hospital Care for Children, teaching material, assessment, and mortality audit tools. These tools have been field-tested by doctors, nurs...

- by Giorgio Tamburlini
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- Child health, Global Health, Child Welfare, Health Planning

Objectives-Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well-Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. Methods-Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale up of the interventions, are employed in a pre/post study design, using longitudinal multivariate logistic and linear regression models. Results-After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. Conclusions-These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.

- by Madeleine Valera
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- Philippines, Developing Countries, Population Dynamics, Midwifery

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of "maternal separation". Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.

- by Inge Van Nistelrooij
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- Midwifery, Care Ethics, Maternal Health, Birth

This chapter is about the construction of birth in rural Bangladesh. In Bangladesh, maternal deaths are very prevalent, 320 per 100,000 live births annually, and the construct of birth that is produced in everyday life results in many... more

- by sabina rashid
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- Maternal Health, Everyday Life, Case Study, Health System

We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status. STUDY DESIGN: Eighty sedentary women were assigned randomly to either an exercise group (n ϭ 40) or a control group (n ϭ 40). Maternal perception of health status and several pregnancy outcomes were recorded.

- by Mireia Pelaez
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- Obstetrics, Perception, Randomization, Public Health

This study examined the factors that influence the use of maternal healthcare services in Ethiopia and particularly assessed the use of antenatal and delivery-care services. Data for the study were drawn from the 2000 Ethiopia Demographic and Health Survey. Multivariate logistic regression analysis was employed to explore the relative importance of a number of demographic and sociocultural variables in the likelihood of using these services. Results of the study showed that the coverage of maternity-care services was very low in Ethiopia, i.e. about 27% and 6% of women, respectively, received professionally-assisted antenatal and delivery-care services in the five years preceding the survey. The study also revealed that demographic and sociocultural factors were the most important aspects that influenced the use of maternal healthcare services in Ethiopia. The independent factors influencing the use of maternal healthcare services included education of mothers, marital status, place...

- by Yared Mekonnen
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- Demography, Nutrition and Dietetics, Ethiopia, Adolescent
- by Vincent De Brouwere
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- Health Behavior, Developing Countries, Health, Kenya

Objective To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.Design Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.Participants All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.Results The response rate was 62.5% (n= 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (435%), sexual problems (26.%), haemorrhoids (24.%) and perineal pain (21%); 16.% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.9 [95% CI 3.–6.]), sexual problems (OR 2.6 [95% CI 1.–3.]), and urinary incontinence (OR 1.81 [95% CI 1.–2.1). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.Conclusion Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.

- by Stephanie Brown
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- Maternal Health, Pregnancy, Self Disclosure, Victoria

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.

- by A Rahman
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- Social Policy, Mental Health, Politics, Gender Equality

A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.

- by Susan Murray
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- Anthropology, Developing Countries, Health, Maternal Health

Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted.

- by Celso Pagatpatan, Jr. and +1
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- Disaster Studies, Focus Groups, Access to health services, Maternal Health

Background: Forty years of safe motherhood programming has demonstrated that isolated interventions will not reduce maternal mortality sufficiently to achieve MDG 5. Although skilled birth attendants (SBAs) can intervene to save lives, traditional birth attendants (TBAs) are often preferred by communities. Considering the value of both TBAs and SBAs, it is important to review strategies for maximizing their respective strengths. Objectives: To describe mechanisms to integrate TBAs with the health system to increase skilled birth attendance and examine the components of successful integration. Method: A systematic review of interventions linking TBAs and formal health workers, measuring outcomes of skilled birth attendance, referrals, and facility deliveries. Results: Thirty-three articles met the selection criteria. Mechanisms used for integration included training and supervision of TBAs, collaboration skills for health workers, inclusion of TBAs at health facilities, communication systems, and clear definition of roles. Impact on skilled birth attendance depended on selection of TBAs, community participation, and addressing barriers to access. Successful approaches were contextspecific. Conclusions: The integration of TBAs with formal health systems increases skilled birth attendance. The greatest impact is seen when TBA integration is combined with complementary actions to overcome context-specific barriers to contact among SBAs, TBAs, and women.

- by Alison Morgan
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- Global Health, Midwifery, Health, Maternal Health
- by Lisa Elumalai (née Davidson)
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- Economic Growth, Global Health, Population Health, Maternal Health

This paper highlights some of the challenges facing maternal health in Nepal and to suggest possible solutions for improvements. Key literature from across the globe is reviewed and discussed in a Nepalese context. Maternal mortality remains one of the biggest public health problems in Nepal. Lack of access to basic maternal healthcare, difficult geographical terrain, poorly developed transportation and communication systems, poverty, illiteracy, women's low status in the society, political conflict, shortage of health care professional and under utilization of currently available services are major challenges to improving maternal health in Nepal. In order to effect real improvements in maternal health, attention needs to be focused both on biomedical and social interventions. Improving health facilities, mother's nutrition, women's position in the society such as freedom of movement, providing education to female children, integrating Traditional Birth Attendants into local health services can play a vital role in the improvement of mothers' health.

- by Bibha Simkhada and +1
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- Poverty, Health Care, Midwifery, Public Health
- by Anna Madill
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- Psychology, Clinical Psychology, Social Psychology, Developmental Psychology

Objective: To estimate the associations between biomedical, social and health care factors and the occurrence of severe pre-eclampsia, eclampsia or HELLP syndrome. Study design: A case-control study conducted in 14 of the 15 maternity hospitals of Brussels. Cases were all 99 women who delivered in these hospitals in 1996 and who had severe pre-eclampsia, eclampsia or HELLP syndrome. Controls were 200 women without these severe maternal conditions, randomly selected among women who delivered in the same hospitals during the same period. Crude odds ratios were computed and adjusted odds ratios were derived from logistic regression. Results: Indicators of social deprivation such as low educational level, poverty and illegal residence or asylum request, were strongly associated with the outcome in univariate analysis. So were African or Turkish ethnicity, obesity, chronic hypertension and primiparity. Logisitic regression showed that no access to national health insurance and history of residence in another country were strongly and independently associated with the outcome (adjusted odds ratio ¼ 4.0 (95% confidence interval 1.1, 14.0) and 3.7 (95% confidence interval 1.9, 7.3), respectively). Conclusions: The burden of pre-eclampsia is concentrated in socially disadvantaged women. Health services should be more responsive to the specific needs of these women. Low access to health care may contribute to the occurrence of severe pre-eclampsia in our setting. #

- by Rikke Qvist and +1
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- Obesity, Health Care, Africa, Turkey

Introduction: It is challenging to predict fetal macrosomia before delivery. This study aimed at assessing predictors of fetal macrosomia at Iringa Regional Referral Hospital in Tanzania from June to December 2020. Method: An unmatched case-control study with 216 participants of whom 72 were cases-women who delivered babies weighing ≥ 4000g-and 144 were controls-women who delivered babies weighing 2500g to 3499g. The purposive sampling technique described below was employed to recruit both controls and cases. SPSS version 25 software program was used for data entry and analysis. Results: Of the 216 participants, 116 (53.7%) were aged between 25-34 years (standard deviation 6.0). The majority of 132 (61.1%) delivered at a gestational age of 37-39 weeks + 6 days of whom 17 (23.6%) were cases and 115 (79.86%) were controls. The predictors of fetal macrosomia were advanced gestation age (AOR=8.10, 95% CI 3.66-17.91, p=<0.0001) and diabetes mellitus during pregnancy (AOR =14.94, 95% CI 1.60-39.91, p= 0.0178). Conclusion: Women with higher gestational age and gestational diabetes mellitus are at an increased risk of delivering a baby with macrosomia at Iringa Regional Referral Hospital. An early plan for the mode of delivery, such as labour induction, will aid the prevention of advanced gestational age. Ensuring a healthy diet and physical exercises in our communities will help to reduce diabetes mellitus and hence fetal macrosomia.

- by Dr. Ngadaya
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- Maternal Health, Maternal child health, Obsterics and Gynecology

Background: Antenatal care (ANC) is important for both maternal and fetal health. Pregnant women with late initiation of ANC are more likely to attain poor outcomes of pregnancy. Little is known about the magnitude of receiving late ANC among pregnant women in Myanmar. Therefore, the present study was conducted to determine the prevalence of late initiation of ANC and its determinants among pregnant women attending antenatal clinic at Pyin-Oo-Lwin General Hospital, Mandalay region during 2014.
Methods: A hospital-based cross-sectional study was conducted. Altogether 333 pregnant women were included in the study. Data were collected through face-to-face interview after getting informed consent from the respondents.
Results: The prevalence of late initiation of ANC was 56.2% (95% CI: 50.6%, 61.6%). Univariate analysis revealed that residence; education and occupation of pregnant woman, husband’s occupation, gravidity, parity and being planned pregnancy were significantly related to late initiation of ANC. Based on the results of multivariate logistic regression analysis, residence, education of pregnant woman, occupation of husband, parity and being planned pregnancy were identified as significant determinants of receiving late ANC.
Conclusions: Late ANC attendance is high in the study area. Hence, it is important to provide health education on the timing of ANC among women with reproductive age. Community’s awareness on importance of receiving early ANC also needs to be promoted. Family planning program (i.e., birth-spacing in Myanmar) should be enhanced to prevent unplanned pregnancies.
Key words: Antenatal care, Late antenatal care, Late initiation, Mandalay, Myanmar

- by win-myint oo
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- Maternal Health, Maternal and Child Health, Antenatal Care

- by Martin Prince
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- Social Policy, Mental Health, Politics, Gender Equality

Unsafe induced abortion in Myanmar is a hidden public health problem accounted for 10
per cent of total maternal deaths each year. The legal restrictions and the unavailability of the
contraceptive methods are the main barrier and the main reason for the women to access the safe
abortion services. The prevention of unwanted pregnancies by various family planning methods will
be the most feasible action legally and culturally. Moreover, the expansion of the legal limit to
certain conditions and accessible PAC services will save the women lives and improve the
wellbeing.

- by Aung Pone Myint
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- Public Health, Maternal Health, Abortion, Myanmar

This study explored the quality of obstetric care in public-sector facilities and the constraints to programming comprehensive essential obstetric care (EOC) services in rural areas of Khulna and Sylhet divisions, relatively high-and low-performing areas of Bangladesh respectively. Quality was explored by physically inspecting all public-sector EOC facilities and the constraints through in-depth interviews with public-sector programme managers and service providers. Distribution of the functional EOC facilities satisfied the United Nation's minimum criteria of at least one comprehensive EOC and four basic EOC facilities for every 500,000 people in Khulna but not in Sylhet region. Human-resource constraints were the major barrier for maternal health. Sanctioned posts for nurses were inadequate in rural areas of both the divisions; however, deployment and retention of trained human resources were more problematic in rural areas of Sylhet. Other problems also plagued care, including unavailability of blood in rural settings and lack of use of evidence-based techniques. The overall quality of care was better in the EOC facilities of Khulna division than in Sylhet. 'Context' of care was also different in these two areas: the population in Sylhet is less literate, more conservative, and faces more geographical and sociocultural barriers in accessing services. As a consequence of both care delivered and the context, more normal vaginal and caesarian-section deliveries were carried out in the public-sector EOC facilities in the Khulna region, with the exception of the medical college hospitals. To improve maternal healthcare, there is a need for a human-resource plan that increases the number of posts in rural areas and ensures availability. All categories of maternal healthcare providers also need training on evidence-based techniques. While the centralized push system of management has its strengths, special strategies for improving the response in the low-performing areas is urgently warranted.

- by Nahid Kalim
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- Demography, Nutrition and Dietetics, Obstetrics, Quality of Mental Health Care

This study examines the association of leave duration with depressive symptoms, mental health, physical health, and maternal symptoms in the first postpartum year, using a prospective cohort design. Eligible employed women, eighteen years or older, were interviewed in person at three Minnesota hospitals while hospitalized for childbirth in 2001. Telephone interviews were conducted at six weeks (N=716), twelve weeks (N=661), six months (N=625), and twelve months (N=575) after delivery. Depressive symptoms (Edinburgh Postnatal Depression Scale), mental and physical health (SF-12 Health Survey), and maternal childbirth-related symptoms were measured at each time period. Two-stage least squares analysis showed that the relationship between leave duration and postpartum depressive symptoms is U-shaped, with a minimum at six months. In the first postpartum year, an increase in leave duration is associated with a decrease in depressive symptoms until six months postpartum. Moreover, ordinary least squares analysis showed a marginally significant linear positive association between leave duration and physical health. Taking leave from work provides time for mothers to rest and recover from pregnancy and childbirth. Findings indicate that the current leave duration provided by the Family and Medical Leave Act, twelve weeks, may not be sufficient for mothers at risk for or experiencing postpartum depression.

- by Rada K Dagher
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- Maternal Health, Postpartum Depression, Parental Leave, Employment Policy

This paper focuses on the relevance of applying an intersectionality framework for maternal health interventions in India, using the case of Janani Suraksha Yojana (JSY). JSY is a central government scheme which aims to reduce maternal deaths by financially incentivizing women to deliver in hospitals. The scheme has failed to reach the poorest women from marginalized communities and had limited impact in tackling maternal mortality. Drawing upon existing evidence, I will examine if JSY can be better served by an intersectionality framework to reduce maternal deaths which are disproportionately spread among women belonging to marginalized groups and communities.

Maternal health outcomes, just like other health indicators are influenced by sociocultural factors prevailing in the context where the population of interest exists. Human beings interact with their environment, both physical and sociocultural and these interactions influence their physical and mental wellbeing. Maternal mortality and morbidity is a marker of the status of health of the population. This review informed by recent development in maternal and newborn health was conducted to determine how the sociocultural factors have contributed to maternal health outcomes in Nigeria. It involved search of current and recent literature and identified twenty two (22) articles, the contents read and organized into themes-Gender and maternal health, sociocultural determinants and maternal health outcomes. The papers seek to provide answers on how factors within the physical and social environment have contributed to maternal health outcomes. Findings from the review revealed that social and cultural factors for example age, religion, traditional belief system, education, marital status, socioeconomic status and societal construction of gender are major determinants of maternal health outcomes in Nigeria. It recommended that for there to be any meaningful improvement on maternal health outcomes, it is incumbent that these factors are investigated further especially to the different context in which proposed interventions are to be implemented. It cautioned that it is important to consider the context as what might be a major determinant in some regions may actually not be seen as a serious factor in other parts of Nigeria.

- by ANTOR O NDEP and +3
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- Maternal Health

The intent of this study is to explore why and in what ways rural, poor women in Bangladesh adhere to indigenous birth practices and resist cosmopolitan obstetric care. To understand the complexities of childbirth, a multidimensional framework encompassing culture, gender, socio-economic, political economy and historical perspectives is used. I used ethnographic methods to have deeper understanding of childbirth practices predominantly

- by Kaosar Afsana
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- Political Economy, Maternal Health, Health Science, Participant Observation

The fetal phase of life has long been recognized as a sensitive period of development. Here we posit that pregnancy represents a simultaneous sensitive period for the adult female with broad and persisting consequences for her health and development, including risk for psychopathology. In this review, we examine the transition to motherhood through the lens of developmental psychopathology. Specifically, we summarize the typical and atypical changes in brain and behavior that characterize the perinatal period. We highlight how the exceptional neuroplasticity exhibited by women during this life phase may account for increased vulnerability for psychopathology. Further, we discuss several modes of signaling that are available to the fetus to affect maternal phenotypes (hormones, motor activity, and gene transfer) and also illustrate how evolutionary perspectives can help explain how and why fetal functions may contribute to maternal psychopathology. The developmental psychopathology perspective has spurred advances in understanding risk and resilience for mental health in many domains. As such, it is surprising that this major epoch in the female life span has yet to benefit fully from similar applications.

- by Molly Fox
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- Psychopathology, Maternal Health, Brain Plasticity
- by Raj Kumar Subedi
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- Maternal Health, Maternal and Child Health

In response to the direct and indirect consequences of removing birthing practices from communities, Canada is exploring new initiatives to return childbirth to Aboriginal communities. Lessons learned and insights into this major problem can be used internationally to plan efforts to reduce maternal mortality in low-resource countries around the world.

- by Christine Butt and +1
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- Midwifery, Health Policy, Community Participation, Maternal Health

The purpose of this paper was to define mobile health (mHealth) for maternal healthcare in the context of developing countries. This paper also aimed to identify and classify different mHealth apps and services used for maternal healthcare in developing countries by means of a Literature Survey. This paper is part of a larger study which aims to develop guidelines and strategies for implementing mHealth apps and services to support maternal healthcare in public hospitals in Namibia. Studies have revealed that mHealth apps and services have been useful tools in facilitating patient engagement in the healthcare process. This paper contributes to the understanding of existing apps and services which have been adopted for maternal healthcare in developing countries and provides useful insights on the research gaps to support the development of guidelines and strategies for implementing mHealth apps and services for maternal healthcare in public hospitals in Namibia. Twenty papers on mHealth apps and services met the inclusion and exclusion criteria. The findings suggest that short message service and mobile apps have been popular for supporting pregnant and postpartum women in developing countries. Research gaps were identified and recommendations were provided for the Namibian public health sector. The findings of this paper could inform researchers as well as health policymakers within the Namibian public health sector on services which could improve maternal healthcare services in Namibia.

- by Gloria Iyawa
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- Developing Countries, Maternal Health, Mobile Health, Mhealth

This descriptive correlational study was conducted to determine the maternal profile, awareness and utilization of Basic Emergency Obstetrics and Newborn Care (BEmONC) among women of reproductive age (WRA) in a rural municipality in Iloilo. The 346 respondents were selected using stratified random sampling technique. Data were gathered using a structured interview schedule prepared and validated prior to the actual data collection. For univariate, frequency, percentage, and mean were utilized to describe the data while Chi-square, Gamma, and Cramer’s V were used to analyze and determine relationships between variables. The results revealed that most of the respondents were highly aware of the Rural Health Unit (RHU) as a BEmONC facility and its services. However, most of them have utilized only the prenatal package but not the childbirth and postnatal services. Hypothesis testing found a significant relationship between utilization of BEmONC services and employment status, income level, educational status, OB score, pregnancy status and awareness of BEmONC services. Increasing awareness about maternal and child health care and facility-based services and educating women planning for safe childbirth to deliver in a BEmONC facility that is attended by a skilled medical health professional are essential for the survival of the mother and the newborn.