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Background: Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. Data and Methods: The study uses data from the fifth round of the National Family Health Survey conducted in 2019–2021 and analyzed 26,552 (15–49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Results: Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. Conclusion: There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality. Significance: What is already known about this subject? Existing literature in India mostly highlights a clear connection between women's autonomy and maternal healthcare services utilization. Women with higher autonomy, decision-making power, and mobility are more likely to use these services. However, in exploring the link between women's empowerment and maternal healthcare, some studies focus on education, employment, and media access among Indian mothers, sidelining broader empowerment dimensions. What this study adds? This study is likely the first to investigate the relationship between women's empowerment and the level of maternal healthcare service utilization in India. It covers key dimensions of women's empowerment, including Attitude to Violence, Social Independence, and Decision-making Power. Moreover, it is possibly the first Indian research paper to employ a survey-based women's empowerment index in this context. Notably, the assessment highlights Social Independence as a significant dimension. [ABSTRACT FROM AUTHOR]

Background: Utilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services.Methods: We used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015-16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care.Results: Only17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother's education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play.Conclusion: The study suggests that the major determinants of utilisation of CMHS are access to media, mother's education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour. [ABSTRACT FROM AUTHOR]

This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy. [ABSTRACT FROM AUTHOR]

Introduction: Catastrophic health expenditure is defined as payments for health services exceeding 40% of household disposable income after subsistence needs are met. Utilization of maternal health care services has been recognized as a significant factor in influencing maternal and child mortality. India continues to account for a quarter of all maternal and child deaths at the world level. The cost of health care is comparatively higher in private sector than the public health facilities. Households using private inpatient services are more likely to face catastrophic expenditure. Materials and Method: This paper has utilized the data collected by the National Sample Survey Organization (NSSO) during January-June, 2014. It is a cross sectional dataset available in public domain. The dataset provides information on Social Consumption and Health scenario of the population. To carry out the research, descriptive statistics, bivariate and logistic regression analysis has been used. FINDINGS The study shows that urban sector, primary educated and women belonging to poorest wealth quintile bear high catastrophic health expenditure than their other counterparts. Western and Southern region have low percentage of women going for catastrophic expenditure on maternal health care. The likelihood of catastrophic health expenditure on maternal health care decreases with the increase in wealth quintile from poorest to richest. Conclusion: Place of residence, educational status and wealth index plays an important role in determining the catastrophic health expenditure on maternal health care. Further research needs to be done in exploring the factors that leads to inequity of the expenditure used in the utilization of maternal health care. [ABSTRACT FROM AUTHOR]

India is committed to Millennium Development Goals regarding prenatal health but still the utilization of quality source of prenatal-care is lacking. In this paper an attempt has been made to examine the socioeconomic determinants of utilization of quality source of prenatal-care by the women in the age group of 15-49 years. Micro data having 25,896 observations from Indian Demographic Health Survey 2006 has been used. Binary logistic regression analysis is utilized to determine the association between the utilization of quality source of prenatal-care and explanatory variables categorized into demographic, socioeconomic, health and regional characteristics. Quality source of prenatal-care is defined as the prenatal-care taken from medical expert. The results have shown that age of woman at first marriage, husband's age, woman's education, husband's education, final say on woman's health-care by woman and husband collectively and husband alone, wealth index, female head of household, ever terminated pregnancy, household covered by insurance and husband's presence during prenatal visits increase the probability of utilization of quality source of prenatal-care. However, the combined family structure, birth-order of the child and living of the household in the town as compared the capital and large city decrease the probability of utilization of quality source of prenatal-care by Indian women. The implementation of law of minimum age for marriage, expansion in maternal health insurance, participation of husband in prenatal-care are proposed for enhancing the utilization of quality source of prenatal-care. [ABSTRACT FROM AUTHOR]

Reduction in maternal mortality is one of UNDP's important Sustainable Development Goals. India alone has a share of almost one-fifth of the world's maternal deaths. Within India, Uttar Pradesh continues to be highest in maternal deaths. Despite unavailability of data on maternal deaths in India, it is evident from proxy indicators on mother's wellbeing that women belonging to lower caste are more vulnerable to maternal deaths than are women of higher caste. Several studies are available on the causes of poor accessibility to maternal health services, but there is a paucity of studies focusing on caste (social identity) as a hindrance to access to maternal health services. Keeping in view the backdrop, the present paper attempts to study the accessibility of maternal health services by different social groups controlling their education and wealth position. The study uses data from the National Family Health Survey-3. The unit of analysis is the women who had home-based child delivery. The dependent variable is the visits made by any health personnel to women who had home-based child delivery. Binary Logistic Regression analysis revealed that after controlling wealth and education, women from scheduled caste category were more than two times less likely to be visited by health workers compared to that for higher caste women. Similarly, educated women of scheduled caste had lower accessibility to health services than did the educated women of the higher caste. Findings suggest that the social identity of a woman is playing a crucial role in or rising over economic and education variables as determinants in accessing maternal health services. This may have a serious implication on the implementation of several maternal health policies in India. [ABSTRACT FROM AUTHOR]

Context: Empathy and self-esteem are essential in delivering quality health care, particularly for women in labor and giving birth. Aims: The aim of this study was to determine the empathy quotient and self-esteem of the second-year and final-year medical and nursing students and labor room staff. Settings and Design: This cross-sectional study was conducted at a teaching hospital in southern India between September and December 2021. Materials and Methods: The inclusion criteria for the study were (i) nursing or medical students currently in their second or final year and (ii) obstetrician or nursing officer or intern currently posted in the labor room. Empathy quotient and self-esteem were measured using the Cambridge Behavioral Scale and Rosenberg's Self-Esteem Scale, respectively. Statistical Analysis Used: The scale scores were summarized as mean (standard deviation), percentages, and 95% confidence intervals. The association between empathy quotient, self-esteem, age, gender, designation, and experience duration was analyzed. We performed multivariable analysis using binary logistic regression. P <0.05 was considered statistically significant. Results: Of the 400 participants included in the study, 36.8% (42.7% - medical, 26.2% - nursing personnel) had lower than average empathy quotient scores, and 13.3% (18.4% - medical, 4.1% - nursing personnel) had low self-esteem. Self-esteem had a statistically significant, independent effect on empathy quotient, as noted in the multivariable analysis among medical and nursing personnel. There was a significant difference between empathy quotient and self-esteem scores in medical and nursing personnel across various designations (P < 0.05). Conclusion: A third of the participants had empathy quotient ratings that were below average, and one-eighth of participants had low self-esteem. Self-esteem and empathy quotient are interdependent; hence has to addressed together. The empathy quotient and self-esteem vary across different designations emphasising the need to take measures to nurture it. [ABSTRACT FROM AUTHOR]

Background: Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period.Methods: Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE.Results: The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE.Conclusions: Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened. [ABSTRACT FROM AUTHOR]

Despite the implementation of several national-level interventions, institutional delivery coverage remains unsatisfactory in India's low performing states (LPS), leading to a high burden of maternal mortality. This study investigates the levels, differentials, and determinants of institutional deliveries in LPS of India. The study also delineates a holistic understanding of barriers to delivery at health facilities and the utilization of the Janani Suraksha Yojana (JSY) specifically designed to improve maternal and child health of disadvantaged communities. A cross-sectional study was conducted using data from the National Family Health Survey (NFHS)-4, 2015–16. The study was carried out over India's nine LPS utilizing 112,518 women who had a living child in the past five years preceding the survey. Bivariate and multivariate regression analysis techniques were used to yield findings. Of the study sample, nearly three-quarters (74%) of women delivered in a health institution in the study area, with the majority delivered in public health facilities. The multivariate analysis indicates that women who lived in rural areas, belonged to disadvantaged social groups (e.g. Scheduled caste/tribes and Muslims), and those who married early (before 18 years) were less likely to utilize institutional delivery services. On the other hand, women's education, household wealth, and exposure to mass media were found to be strong facilitators of delivering in a health facility. Meeting with a community health worker (CHW) during pregnancy emerged as an important predictor of institutional delivery in our study. Further, interaction analysis shows that women who reported the distance was a 'big problem' in accessing medical care had significantly lower odds of delivering at a health facility. The study suggests emphasizing the quality of in-facility maternal care and awareness about the importance of reproductive health. Furthermore, strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage. [ABSTRACT FROM AUTHOR]

Background: The influence of health workers on uptake of maternal healthcare services is well documented; however, their outreach for family planning (FP) services and influence on the intention to use contraceptives is less explored in the Indian context. This study examined the extent of health worker outreach for FP service and its effects on intention to use contraceptives among currently married women aged 15-49 years.Methods: This study used data from two rounds of the National Family Health Survey (NFHS) of India, conducted during 2005-06 and 2015-16 respectively. Bivariate analysis and multivariate logistic regression were used to understand the level of and change in health worker outreach for FP services over time, and its association with intention to use contraceptives among currently married women.Results: In the past 10 years, health workers' outreach for FP service has significantly increased by about 10 percentage points, although the level is not optimal and only 28% of non-users were reached by health workers in 2015-16. Increase in the outreach to younger and low parity women was higher than their respective counterparts. Intention to use contraceptive among women who were not using any method was 41% when health workers contacted and discussed FP, compared to only 20% when there was no such contact with health workers. Multivariable analysis suggests that contact with health workers has significant positive effects on intention to use contraceptive (AOR = 3.05; p < 0.001; 95% CI 2.85-3.27).Conclusion: Increased scope of outreach of frontline health workers to provide FP communication and services will not only help in building knowledge of contraceptive methods but will also increase women's intention to use a method. For India, this may be the most promising way to achieve the Sustainable Development Goals 3.7, which calls for universal access to reproductive health services. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality and morbidity continues to remain high in India, despite the existence of successive national programs for improving maternal and child health since the 1980s. In 2005, the Government of India launched the National Rural Health Mission to provide accessible, affordable and quality health care to the rural population, especially the vulnerable populations. Reduction in MMR to 100/100,000 is one of its goals and the Janani Suraksha Yojana is the key strategy to achieve this reduction. But the awareness of scheme is low in women from rural areas and urban slums, especially in low performing states. Aims: To study the comparative awareness of JSY and the socio-demographic factors influencing it, among the recently delivered women (RDWs). Methodology: A community based cross-sectional study was carried out in the ten rural areas and urban slums coming under the practice areas of JNMC, AMU, Aligarh for a period of one year. The prevalence of institutional delivery in Uttar Pradesh as found in a study by UNFPA 2008 (50.2%) was used for calculation of sample size. The yielded sample size 300 was selected proportionately from these areas. The study subjects were interviewed by a pre-designed and pre-tested questionnaire. Statistical analysis used: MS excel, chi square and logistic regression. Results: Awareness regarding the existence of a monetary scheme related to institutional delivery was more in rural areas i.e 75%. Regarding components of JSY maximum people (78%) were aware about the cash component. Religion, caste, parity, socio-economic status and place of residence showed a significant statistical association with the level of awareness of JSY. Conclusions: There is an urgent need to strengthen IEC campaigns and monitoring strategies for JSY as well as regularize the monetary flow for the health workers [ABSTRACT FROM AUTHOR]

We measured levels of women's health knowledge and their association with the reporting of maternal health complications and related health care use. We found that women with higher levels of health knowledge reported more pregnancy and postnatal complications, and used more maternal health care services. Education has a positive impact on health, but education alone is not enough to ensure recognizing and reporting of health complications and increasing the demand for maternal health care services. We conclude that the provision of health education for women will help them to identify maternal health complications and improve their reporting and related health care use. [ABSTRACT FROM AUTHOR]

Background: Maternal health (MH) services provide an invaluable opportunity to inform and educate women about family planning (FP). It is expected that this would enable women to choose an appropriate method and initiate contraception early in the postpartum period. In this study we examined interactions with health providers for MH services, and the effect of FP information provision during these interactions on the postpartum use of modern contraceptive methods.Methods: This study used midline data collected from 990 women who had delivered a live birth between January 2010 and the date of the midline survey in 2012. These women were asked a series of questions about their last delivery, including interactions with health providers during pregnancy, delivery and the postpartum period, if they received FP information during these interactions, and their contraceptive use during the postpartum period.Results: The study found that FP information provision as part of antenatal care in the third trimester, delivery and the postpartum period have a positive association with postpartum modern contraceptive use in urban Uttar Pradesh. However, health providers often miss these opportunities. Despite a high proportion of women coming into contact with health providers when utilising MH services, only a small proportion received FP information during these interactions.Conclusions: Integration of FP with MH services can increase postpartum modern contraceptive use. With the launch of the National Urban Health Mission, there now exists appropriate policy and programmatic environments for integration of FP and MH services in urban settings in India. However, this will require a concentrated effort both to enhance the capacity of health providers and encourage supportive supervision. [ABSTRACT FROM AUTHOR]

Objective: This study examines the determinants of utilisation of skilled birth attendants (SBAs) amongst 2886 rural women in the state of West Bengal, India, using data from a survey of 2012-2013 conducted by the Birbhum Health and Demographic Surveillance System. Method: Multilevel logit regression models were estimated and qualitative investigations conducted to understand the determinants of utilisation of SBAs in rural West Bengal. Results: Among women who delivered their last child during the 3 years preceding the survey, 69.1 % of deliveries were assisted by SBAs, while 30.9 % were home deliveries without any SBA assistance. Multivariate analysis revealed that apart from socio-demographic and economic factors (such as household affluence, women's education, birth order, uptake of comprehensive ANC check-ups, advice regarding danger signs of pregnancy and household's socio-religious affiliation), supply side factors, such as availability of skilled birth attendants in the village and all-weather roads, have significant effect on seeking skilled assistance. Our findings also show that unobserved factors at village level independently influence uptake of SBA-assisted delivery. Conclusions for Practice: The present findings emphasise that both demand and supply side intervention strategies are essential prerequisites to enhance skilled birth attendance. Ample communication is observed at the individual level, but improving community level outreach and advocacy activities could generate further demand. SBAs can be better integrated by accommodating the socio-religious needs of local communities, such as providing female doctors and doctors with similar socio-religious backgrounds. [ABSTRACT FROM AUTHOR]

Aim: Maternal health services potentially play a significant role in improving reproductive health. Access to skilled assistance and well-equipped health institutions during delivery can reduce maternal mortality and morbidity and improve pregnancy outcomes. In this study, we examined the relationship between the use of maternal health care services and the frequency of reproductive health complications (during pregnancy, delivery and after delivery) in Assam. Subject and methods: We used data from the third round of the District Level Household and Facility Survey (DLHS, 2007-2008) which collects information about reproductive and child health services. Descriptive and multivariate analyses were used to understand the relationship between the use of health care services and the frequency of complications in pregnancy. Results: Findings show that more than half of women reported having any complication during pregnancy and delivery. Post delivery complications in Assam are reported less by women as compared to any pregnancy and delivery complications. It is also found statistically significant that women who received full antenatal care during pregnancy reported less complications during the delivery and post-partum period. We found a positive correlation in the study area between having any complication during pregnancy with higher reporting of any delivery and post-delivery complication. Conclusion: The study concludes that use of intensive health-care services reduces health complications. Therefore, it is necessary to improve community awareness on maternal health to motivate women to use more antenatal care services to reduce health complications during the reproductive time span. [ABSTRACT FROM AUTHOR]