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The value information leads to effective utilisation of services. The study identifies the gap in information about maternal health services and their utilisation. The information which has led to utilisation of services can be assiduously labelled as value information or value awareness. The relationship has been explored between awareness about maternal health services and service utilisation among Janani Suraksha Yojana (JSY) beneficiaries in Punjab, a high-performing state in India as per NRHM. Further, an assessment of impact of demographics on beneficiaries with information and those who utilised the services has been explored. Information received and utilisation of ante-natal checkups (ANC), delivery care and post-natal checkups (PNC) services have been studied for two districts in the state of Punjab, India. Chi-square test has been applied to know the association between the maternal health services and the select districts with respect to information and services utilised. Impact of demographic variables such as age, education, income and caste have been evaluated for information and utilisation of maternal health services. The dispersed information that has not triggered in utilisation of services by JSY beneficiaries have been used as an ingredient to explore and understand the deterring factors in non-utilisation of maternal care services in the rural areas of developing country like India. Results highlight that a significant association exists between the utilisation of maternal health services among the select districts in the state of Punjab (χ 2 = 8.73, p -value = 0.0127); however, there is no association between the informed beneficiaries and the districts for the maternal health services. No impact of demographic variables has been found on the beneficiaries with information about maternal health services and those who utilised the services. The gap in awareness and utilisation of services throws light on the lurking concerns of unrecognised benefits, uncaring attitude towards health, prejudices about institutional delivery and PNC being considered an unimportant service among the beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Utilization of maternal health services is the most significant component of safe motherhood, with severe effects on mother and child health. Though early and timely utilization of maternal health care services is recommended, many women do not access them. This study is aimed at examining the spatial clustering of maternal health services utilization and its associated socio-economic factors in Tanzania. Methods: The secondary data analysis was conducted using Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-16. Spatial clusters of high and low use of maternal health care were detected using the Bernoulli model implemented in SaTScan™ software. The multiple logistic regression model was used to identify the predictors of maternal health services utilization in Tanzania. Results: The Spatial analysis revealed that antenatal care and delivery care are heterogeneous across regions. High utilization was detected in Eastern and East-central regions, while low utilization was detected in northern and northwest regions. Moreover, mother's age, education level, wealth status, and several children were identified as predictors of the use of antenatal care and delivery care. Conclusion: Results suggest spatial variation across the regions, though the data are insufficient to identify factors associated with a specific cluster. More data and analysis are needed to establish factors associated with high and low utilization of maternal health care services. [ABSTRACT FROM AUTHOR]

Background: Present study aims to examine the socioeconomic and demographic factors that affect health care utilization, health care expenditure and financing strategies for delivery care in India. Methods: The study uses data from National Family Health Survey (NFHS-4), 2015-2016. Descriptive, bivariate and multivariate regression analysis were carried out to examine health care utilization, out of pocket expenditure and financing strategies for delivery care in India. We used hardship financing as when people resort to borrowings, or sale of property/jewelry to pay for healthcare expenditure Results: Overall, Janani Suraksha Yojana (JSY) could cover less than 40% of the delivery care expenditure across all states. One-third of the households borrowed money or sold property/jewelry for delivery care expenditure. Highest exposure to hardship financing was observed in utilisation of private healthcare facilities for delivery. Women from the higher income quintiles are less likely to experience hardship financing as compared to women from the poorest wealth quintile. Conclusions: The study results will be useful for government to ensure that financing policies for delivery such as JSY are effective to provide availability and affordability of delivery healthcare in India. [ABSTRACT FROM AUTHOR]

This article compares the findings of "Avaliação da Rede Cegonha" (ARC - Stork Network Assessment), an evaluative study on the Rede Cegonha (RC - Stork Network) program, with Nascer no Brasil (NB - Born in Brazil), a national survey on labor and birth, conducted in 2011-12, before the start implementation of RC. ARC was conducted in 2017, in 606 maternity hospitals involved in RC and NB included a sample with national representation of 266 hospitals. In the current analysis, we included the 136 SUS hospitals that participated in both studies, totaling 3,790 and 12,227 puerperal women. We perform comparisons of best practices and interventions in the management of labor and delivery using Pearson's chi-square test for independent samples. The prevalence of best practices was, on average, 150% higher in ARC than in NB, with a greater relative increase in less developed regions, for older, brown and black women and less educated. Regarding interventions, there was an average reduction of 30% between NB and ARC, with a greater relative reduction in less developed regions and less educated women. There was a significant improvement in the scenario of care for labor and childbirth, with a reduction in regional, educational and racial inequalities in access to appropriate technologies, suggesting that the RC intervention was effective. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In an effort to improve utilization of maternal health care services, age at marriage of girls has gain very little attention by the policy maker and programmer. Studies have indicated that child marriage has serious negative consequences on maternal health. Moreover, there is a paucity of research on explaining the links between child marriage and maternal health care utilization. In this study, we aimed to examine the association between child marriage and utilization of maternal health care services using nationally representative sample survey of India. Cross-sectional observational study. India. A total number of 190,898 ever-married women who had at least one live birth during the last five years preceding the survey from the 2015 to 2016 National Family Health Survey (NFHS) were utilized. Outcome measures: At least four antenatal visits (ANC), ANC visit within first trimester, institutional delivery, delivery by skilled health personnel, and postnatal care (PNC) within 42 days of delivery. Predictor variable: Child marriage. Control variables: Socio-economic and demographic characteristics of women. Bivariate and multivariate analyses were performed for the analyses of the study data. The results of our study revealed that women who married at <18 years were significantly less likely to use maternal health care services than those married at ≥18 years even after accounting for socio-economic and demographic characteristics of women. Furthermore, nuanced analysis revealed that the odds of maternity care services is much lower for those women who married at ≤14 years compared with later married groups. The findings of our study suggest that efforts should be made to increase age at marriage of girls which could have positive impact on utilization of maternal health care services. Moreover, targeted intervention is needed to improve the utilization of maternity care especially among socio-economically vulnerable women. [ABSTRACT FROM AUTHOR]

Background The World Health Organization (WHO) recommends four antenatal care (ANC) visits, delivery in a health facility and three postnatal care (PNC) visits for women to optimize the maternal health outcomes. Objectives To examine the level and determinants of maternal health care seeking behaviour during pregnancy, delivery and the postnatal period, and assess the compliance with the WHO recommended levels of care in Bangladesh. Design/setting The study is based on secondary analysis of the data obtained from the 2014 Bangladesh Demographic and Health Survey (BDHS). The 2014 BDHS was a cross-sectional survey of a nationally representative sample of 17,863 ever-married women aged 15–49 years. The sample was selected following a two-stage stratified cluster sampling design. Participants The dataset from a subsample of 4.627 ever-married women who had delivered their last birth within three years before the survey were included in the analysis to meet the objectives of the study. Analysis Descriptive statistics and multinomial logistic regression model were used for data analysis. Findings It has been observed that only 31% mothers had recommended four or more ANC visits, 37% births were delivered at health facilities, and 65% mothers received at least one PNC visit. Only 18.0% mothers received the WHO recommended optimal level of four or more ANC visits, births in a health facility and at least one PNC visit. Mothers aged less than 20 years, living in rural area, having no education and media exposure, multiparous, poor wealth status, husband with no education and husband's employment status appeared as significant predictors of optimal level maternal health care after adjusting for other factors. Mothers living in Sylhet, Chittagong and Barisal regions were less likely to receive the optimum level health care. Key conclusion Utilization of maternal health care during pregnancy, delivery and the postnatal period among Bangladeshi women does not reflect the complete compliance with the WHO recommendations. Further studies are needed to identify the reasons for underutilization of optimum level maternal care practice in Bangladesh. Implication for practice The findings underscore the need for targeted intervention for those groups of mothers who were identified as having lowest level of maternal care across the continuum of care. [ABSTRACT FROM AUTHOR]

In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users’ perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy. [ABSTRACT FROM AUTHOR]

To test a statistically significant change in delivery by medically trained providers following introduction of a demand-side financing voucher, a population-based quasi-experimental study was undertaken, with 3,300 mothers in 2010 and 3,334 mothers at follow-up in 2012 in government-implemented voucher program and control areas. Results found that voucher program was significantly associated with increased public health facility use (difference-in-differences (DID) 13.9) and significantly increased delivery complication management care (DID 13.2) at facility although a null effect was found in facility-based delivery increase. A subset analysis of the five well-functioning facilities showed that facility deliveries increased DID 5.3 percentage points. Quintile-based analysis of all facilities showed that facility delivery increased more than threefold in lower quintile households comparing to twofold in control sites. The program needs better targeting to the beneficiaries, ensuring available gynecologist–anesthetist pair and midwives, effective monitoring, and timely fund reimbursements to facilities. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista CONAMED is the property of Comision Nacional de Arbitraje Medico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Objective: the percentage of births attended by health professionals is widely used to measure skilled attendance. This indicator is based on women''s reports of their birth attendant. This study explores how women identify health professionals attending their births. Design: exit interviews, focus groups, in-depth interviews and a community survey. Qualitative data were analysed by topic. Frequency of women''s responses on how they identify the birth attendant and other characteristics of birth care were generated through the community survey. Setting and participants: women in Ghana who had birthed with a health professional in the last 5 years. Measurements and findings: role, prior knowledge and uniform are the most common means by which women identify their attendant. These means of identification do not distinguish accurately between different types of health professional. Delivery events are more complex than is suggested through use of the indicator ‘percentage of deliveries with health professionals’. Fifty-five per cent of births were attended by more than one person. In 11.6% of births, women were attended only after the partial birth of their baby. Key conclusions and implications for practice: there is potential for incorrect identification of birth attendant by the use of women''s reports. None of the methods used could verify women''s reporting. Methodological developments in this area are necessary along with improved recording systems. Opportunities for women to identify health professionals should be enhanced. [Copyright &y& Elsevier]