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Background Postpartum depression is associated with low socioeconomic status, adverse birthing processes, and life stress. Increasing evidence of mistreatment during childbirth, negative birth experiences, and poor quality of maternal care is of global concern. Objective To assess the risk of experiencing depressive symptoms among postpartum women exposed to mistreatment during institutional birthing in Nepal. Method We conducted a prospective cohort study from 29 March to 19 August 2022. Of 1629 women who gave birth in a hospital in Nepal, 1222 were assessed for mistreatment during childbirth and depressive symptoms using the Edinburgh Postnatal Depression Scale. We used binomial generalized linear mixed model to examine the risk ratio of postpartum depressive symptoms in women exposed to mistreatment during childbirth. Results The prevalence of postpartum depressive symptoms was 4.4%. Women exposed to mistreatment during childbirth were almost fifty percent more likely to have postpartum depressive symptoms (cRR 1.47; 95% CI 1.14, 1.89; p = 0.003) compared with the unexposed group. Furthermore, adolescent mothers exposed to mistreatment during childbirth had a seventy percent increased risk of depressive symptoms (aRR 1.72; 95% CI 1.23, 2.41; p = 0.002). Similarly, women who gave birth to female infants were thirty percent more likely to experience postpartum depressive symptoms (aRR 1.32; 95% CI 1.01–1.74; p = 0.039). Conclusion We observed an association between postpartum depressive symptoms and mistreatment during institutional births in Nepal. The implementation of appropriate respectful maternity care during childbirth and also routine screening for depressive symptoms is critical to improving perinatal mental health and well-being.

Abstract Background Ensuring the data quality of Individual Medical Records becomes a crucial strategy in mitigating maternal and newborn morbidity and mortality during and around childbirth. However, previous research in Ethiopia primarily focused on studying data quality of institutional birth at the facility level, overlooking the data quality within Individual Medical Records. This study examined the data completeness and consistency within Individual Medical Records of the institutional birth service and associated factors. Methods An institution-based retrospective cross-sectional study was conducted in two districts of Northwest Ethiopia. Data were obtained by reviewing three sets of Individual Medical Records of 651 women: the delivery register, Integrated Individual Folder, and integrated card. The proportions of completeness and consistency were computed. A multilevel binary logistic regression was used to identify factors of completeness and consistency. An odds ratio with a 95% confidence interval was used to assess the level of significance. Results Overall, 74.0% of women’s Individual Medical Records demonstrated good data completeness ( > = 70%), 95%CI (70.5, 77.3), while 26% exhibited good consistency, 95%CI (22.9, 29.7). The presence of trained providers in data quality (AOR = 2.9, 95%CI: (1.5, 5.7)) and supportive supervision (AOR = 11.5, 95%CI: (4.8, 27.2)) were found to be associated with completeness. Health facilities’ practice of root cause analysis on data quality gaps (AOR = 8.7, 9%CI: (1.5, 50.9)) was statistically significantly associated with the consistency. Conclusions Most medical records were found to have good completeness, but nearly only a quarter of them found to contain consistent data. Completeness and consistency varied on the type of medical record. Health facility’s root cause analysis of data quality gaps, the presence of trained providers in data quality, and supportive supervision from higher officials were identified as factors affecting data quality in institutional birth service. These results emphasize the importance of focused efforts to enhance data completeness and consistency within Individual Medical Records, particularly through consideration of Individual Medical Records in future provider training, supervision, and the implementation of root cause analysis practices.

Background: Postpartum depression is associated with low socioeconomic status, adverse birthing processes, and life stress. Increasing evidence of mistreatment during childbirth, negative birth experiences, and poor quality of maternal care is of global concern. Objective: To assess the risk of experiencing depressive symptoms among postpartum women exposed to mistreatment during institutional birthing in Nepal. Method: We conducted a prospective cohort study from 29 March to 19 August 2022. Of 1629 women who gave birth in a hospital in Nepal, 1222 were assessed for mistreatment during childbirth and depressive symptoms using the Edinburgh Postnatal Depression Scale. We used binomial generalized linear mixed model to examine the risk ratio of postpartum depressive symptoms in women exposed to mistreatment during childbirth. Results: The prevalence of postpartum depressive symptoms was 4.4%. Women exposed to mistreatment during childbirth were almost fifty percent more likely to have postpartum depressive symptoms (cRR 1.47; 95% CI 1.14, 1.89; p = 0.003) compared with the unexposed group. Furthermore, adolescent mothers exposed to mistreatment during childbirth had a seventy percent increased risk of depressive symptoms (aRR 1.72; 95% CI 1.23, 2.41; p = 0.002). Similarly, women who gave birth to female infants were thirty percent more likely to experience postpartum depressive symptoms (aRR 1.32; 95% CI 1.01–1.74; p = 0.039). Conclusion: We observed an association between postpartum depressive symptoms and mistreatment during institutional births in Nepal. The implementation of appropriate respectful maternity care during childbirth and also routine screening for depressive symptoms is critical to improving perinatal mental health and well-being. PAPER CONTEXT: Main findings: Despite widespread reports of mistreatment during childbirth in health facilities, little is known about possible association with poor perinatal mental health outcomes. Added knowledge: This prospective cohort study in Nepal found an association between postpartum depressive symptoms and mistreatment during institutional childbirth. Global health impact for policy and action: Postpartum depression is a global health issue, and there is an urgent need for interventions to promote respectful maternity care. [ABSTRACT FROM AUTHOR]

Background: Ensuring the data quality of Individual Medical Records becomes a crucial strategy in mitigating maternal and newborn morbidity and mortality during and around childbirth. However, previous research in Ethiopia primarily focused on studying data quality of institutional birth at the facility level, overlooking the data quality within Individual Medical Records. This study examined the data completeness and consistency within Individual Medical Records of the institutional birth service and associated factors. Methods: An institution-based retrospective cross-sectional study was conducted in two districts of Northwest Ethiopia. Data were obtained by reviewing three sets of Individual Medical Records of 651 women: the delivery register, Integrated Individual Folder, and integrated card. The proportions of completeness and consistency were computed. A multilevel binary logistic regression was used to identify factors of completeness and consistency. An odds ratio with a 95% confidence interval was used to assess the level of significance. Results: Overall, 74.0% of women’s Individual Medical Records demonstrated good data completeness (> = 70%), 95%CI (70.5, 77.3), while 26% exhibited good consistency, 95%CI (22.9, 29.7). The presence of trained providers in data quality (AOR = 2.9, 95%CI: (1.5, 5.7)) and supportive supervision (AOR = 11.5, 95%CI: (4.8, 27.2)) were found to be associated with completeness. Health facilities’ practice of root cause analysis on data quality gaps (AOR = 8.7, 9%CI: (1.5, 50.9)) was statistically significantly associated with the consistency. Conclusions: Most medical records were found to have good completeness, but nearly only a quarter of them found to contain consistent data. Completeness and consistency varied on the type of medical record. Health facility’s root cause analysis of data quality gaps, the presence of trained providers in data quality, and supportive supervision from higher officials were identified as factors affecting data quality in institutional birth service. These results emphasize the importance of focused efforts to enhance data completeness and consistency within Individual Medical Records, particularly through consideration of Individual Medical Records in future provider training, supervision, and the implementation of root cause analysis practices. [ABSTRACT FROM AUTHOR]

Background and Aims: Although global birth outcomes have improved considerably in the last 40 years, there are disparities in underdeveloped countries, particularly Ethiopia, remain significant. However, there was inadequate data about the adverse outcome in the study area. This study aimed to assess the proportion and associated factors of adverse birth outcomes among women who gave birth at South Gondar Health Institutions in 2021. Methods: The multistage sampling technique was used to select 928 participants from December 15, 2020, to February 2, 2021. Face‐to‐face interviewer‐administered questionnaires and card reviews were used. The data were entered into Epi‐Data 4.2 and analyzed by SPSS version 23. The statistical association was determined using the odds ratio, 95% confidence interval (CI), and a p‐value of less than 0.05. Results: The proportion of fetal and maternal adverse birth outcomes were 26.7%, and 12.3%, respectively. Previous history of abortion (adjusted odds ratio [AOR] = 2.10, 95% CI = 1.31, 3.66), antenatal care (ANC) follow up (AOR = 3.30, 95% CI = 1.67, 6.58), premature rupture of membrane and hyperemesis (AOR = 3.27, 95% CI = 1.55, 5.89), obstructed labor and meconium‐stained amniotic fluid (AOR = 2.31, 95% CI = 1.21, 4.39), and cesarean birth (AOR = 0.50, 95% CI = 0.28, 0.88) were significantly associated fetal adverse birth outcome. Antepartum hemorrhage during the latest pregnancy was associated with maternal adverse birth outcomes (AOR = 1.87, 95% CI = 1.03, 3.38). Conclusion: The proportion of adverse birth outcomes in this study was high. Provide community‐based health information about ANC follow‐up, and community mobilization to reduce abortion. Appropriately manage premature rapture of the membrane after hospital admission. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Although global birth outcomes have improved considerably in the last 40 years, there are disparities in underdeveloped countries, particularly Ethiopia, remain significant. However, there was inadequate data about the adverse outcome in the study area. This study aimed to assess the proportion and associated factors of adverse birth outcomes among women who gave birth at South Gondar Health Institutions in 2021. Methods The multistage sampling technique was used to select 928 participants from December 15, 2020, to February 2, 2021. Face‐to‐face interviewer‐administered questionnaires and card reviews were used. The data were entered into Epi‐Data 4.2 and analyzed by SPSS version 23. The statistical association was determined using the odds ratio, 95% confidence interval (CI), and a p‐value of less than 0.05. Results The proportion of fetal and maternal adverse birth outcomes were 26.7%, and 12.3%, respectively. Previous history of abortion (adjusted odds ratio [AOR] = 2.10, 95% CI = 1.31, 3.66), antenatal care (ANC) follow up (AOR = 3.30, 95% CI = 1.67, 6.58), premature rupture of membrane and hyperemesis (AOR = 3.27, 95% CI = 1.55, 5.89), obstructed labor and meconium‐stained amniotic fluid (AOR = 2.31, 95% CI = 1.21, 4.39), and cesarean birth (AOR = 0.50, 95% CI = 0.28, 0.88) were significantly associated fetal adverse birth outcome. Antepartum hemorrhage during the latest pregnancy was associated with maternal adverse birth outcomes (AOR = 1.87, 95% CI = 1.03, 3.38). Conclusion The proportion of adverse birth outcomes in this study was high. Provide community‐based health information about ANC follow‐up, and community mobilization to reduce abortion. Appropriately manage premature rapture of the membrane after hospital admission.

Abstract Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website ( https://clinicaltrials.gov ) on 3rd October 2017. The trial identifier is NCT03299491 .

Abstract Background Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Conclusion Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. Trial registration ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

Abstract Background Ethiopia is one of the ten countries in the world that together account for almost 60% of all maternal deaths. Recent reductions in maternal mortality have been seen, yet just 26% of women who gave birth in Ethiopia in 2016 reported doing so at a health facility. Maternity waiting homes (MWHs) have been introduced to overcome geographical and financial barriers to institutional births but there is no conclusive evidence as to their effectiveness. We aim to evaluate the effects of upgraded MWHs and local leader training in increasing institutional births in the Jimma zone of Ethiopia. Methods A parallel, three-arm, stratified, cluster-randomized controlled trial design is being employed to evaluate intervention effects on institutional births, which is the primary outcome. Trial arms are: (1) upgraded MWH + religious/community leader training; (2) leader training alone; and (3) standard care. Twenty-four primary health care unit catchment areas (clusters) have been randomized and 3840 women of reproductive age who had a pregnancy outcome (livebirth, stillbirth or abortion) are being randomly recruited for each survey round. Outcome assessments will be made using repeat cross-sectional surveys at baseline and 24 months postintervention. An intention to treat approach will be used and the primary outcome analysed using generalized linear mixed models with a random effect for cluster and time. A cost-effectiveness analysis will also be conducted from a societal perspective. Discussion This is one of the first trials to evaluate the effectiveness of upgraded MWHs and will provide much needed evidence to policy makers about aspects of functionality and the community engagement required as they scale-up this programme in Ethiopia. Trial registration ClinicalTrial.gov, NCT03299491. Retrospectively registered on 3 October 2017.

Background: Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia.Methods: A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions.Results: Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22).Conclusions: Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women's use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated.Trial Registration: The trial was retrospectively registered on the Clinical Trials website ( https://clinicaltrials.gov ) on 3rd October 2017. The trial identifier is NCT03299491 . [ABSTRACT FROM AUTHOR]

Background: Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia., Objective: This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia., Methods: We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the "Wegera" and "Tach-armacheho" districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95% CIs, was computed using a difference-in-differences model., Results: In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95% CI 4.18-19; P=.03) than in the comparator district., Conclusions: This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up., (©Biniam Kefiyalew Taye, Lemma Derseh Gezie, Asmamaw Atnafu, Shegaw Anagaw Mengiste, Jens Kaasbøll, Monika Knudsen Gullslett, Binyam Tilahun. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 05.04.2024.)

Background: Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women's groups suggests that group care models may both improve access to care and the quality of care delivered through women's empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. Methods: The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. Results: A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Conclusion: Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. Trial registration: ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered. [ABSTRACT FROM AUTHOR]

Objectives This study examines the influence of women's birth practices on their daughters' location of childbirth in Ethiopia, investigating the importance of intergenerational patterns of care on contemporary birth practices. Methods A qualitative survey of women aged 60 and over in three cities in Ethiopia. Results Nearly all first generation women gave birth at home, but the majority of their daughters give birth in facilities. Perceptions of childbirth practices among both women and their daughters have shifted towards facility births, despite the prevalence of home birth in the previous generation. Conclusions Birth culture has experienced a profound shift in Ethiopia within one generation, especially in urban areas, where health facilities are more easily accessible. Older generations of women have positive attitudes towards facility birth, and can help influence their daughters to give birth with medical assistance. This aligns with both national and global maternal health policies which promote safe motherhood through facility birth. [ABSTRACT FROM AUTHOR]

Introduction: Institutional births are advocated as a key strategy to reduce maternal mortality This study is aimed to identify whether the practice of place of birth is changing over time and to explore the factors contributing to women's decision for choice of place of birth. Methods: A community based cross-sectional study was carried out in an urban resettlement colony of Delhi. A semi-structured questionnaire was used to interview the mothers with children less than or equal to 3 years of age. The place of birth was assessed in relation to socio-demographic and obstetric characteristics of the study participants. Reasons for preferring home birth were also analyzed. Results: A total of 1293 mothers were included in the study. Of these majority 1068 (82.6%) had institutional births while 225 (17.4%) were home births. A skilled birth attendant was present in only 39 (17.3%) of home births while 17 (7.5%) mothers gave birth with the help of relatives. Higher socio-economic status and higher income of the family; higher educational status of mother and head of the family was associated with institutional birth and the difference was statistically significant. Main reasons cited for preferring home birth were tradition (29.2%), financial constraints (7.3%), no one to look after (16.3%), pressure from family despite of awareness 6.3%, and other reasons. Conclusions: Institutional births have shown an increasing trend in India, however a significant proportion of women still prefer home as place of birth. Socio-cultural factors and financial constraints have an important role in MCH service utilization and need to be addressed. [ABSTRACT FROM AUTHOR]

Mistreatment during institutional childbirth is multifactorial and can have a detrimental effect on women’s health and future care-seeking behaviour. Understanding its determinants is essential for improving respectful maternity care. This study aimed to explore women’s experiences of mistreatment during childbirth in Nepal. Sixteen in-depth interviews were conducted with women who had recently given birth in a tertiary health facility (between 5 and 16 weeks postpartum). Participants were selected using purposive sampling to ensure a heterogenous sample. Data were analysed using Nvivo12, following Braun and Clarke’s thematic analysis approach. Four themes were identified: (1) mistreatment and undignified care, (2) health system constraints, (3) adverse hospital culture, (4) power and territorial display. Mistreatment and undignified care included abuse, threats, neglect, inadequate communication, painful medical procedures and lack of autonomy. Health system constraints included inadequate resources and overcrowding. Adverse hospital culture was characterised by work stress among health professionals, a rigid hierarchical structure and the normalisation of mistreatment practices. Power and territoriality were evident in an atmosphere of fear for women with restricted companionship during birth. Favorable institutional strategies and tailored interventions are needed to eliminate solitary births and to provide women-centered respectful care by motivated and competent health professionals.

Background: India accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India. Methods: Between January 2009 and 2011,1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth. Findings: The median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR] = 7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p< 0.001) and private institutions (AOR=3.00, p < 0.001). Conclusions and implications: As a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status. [ABSTRACT FROM AUTHOR]

The decades-long global efforts to reduce maternal morbidity and mortality have shown overall progress, but most developing countries are still lagging significantly. This study aimed to assess the prevalence of non-institutional childbirths in the Gambella State and to identify socio-demographic factors responsible for non-institutional utilization of available birth services by reproductive-aged mothers. A community-based cross-sectional study design was adopted using a multi-stage random sampling technique. Binary logistic regression was used to identify factors associated with the selected place of birth. EpiData version 3.1 and SPSS version 13.0 were applied for data entry and analyses. All the 657 eligible mothers recruited for this study responded to the interview. 71% of the total respondents had non-institutional childbirths (NICB), and the rest had their most recent childbirth in an institution with skilled healthcare providers' assistance. Socio-demographic factors were significantly associated with NICB. Nuer (AOR = 2.12, 95% CI: 1.23-3.63) and Majang ethnic (AOR = 1.98, 95% CI: 1.02-3.83) groups had higher rates of NICB than the rest of the study population. The prevalence of non-institutional childbirths in Gambella remained two times higher than the institutional childbirths.

Background: Ethiopia is one of the ten countries in the world that together account for almost 60% of all maternal deaths. Recent reductions in maternal mortality have been seen, yet just 26% of women who gave birth in Ethiopia in 2016 reported doing so at a health facility. Maternity waiting homes (MWHs) have been introduced to overcome geographical and financial barriers to institutional births but there is no conclusive evidence as to their effectiveness. We aim to evaluate the effects of upgraded MWHs and local leader training in increasing institutional births in the Jimma zone of Ethiopia.Methods: A parallel, three-arm, stratified, cluster-randomized controlled trial design is being employed to evaluate intervention effects on institutional births, which is the primary outcome. Trial arms are: (1) upgraded MWH + religious/community leader training; (2) leader training alone; and (3) standard care. Twenty-four primary health care unit catchment areas (clusters) have been randomized and 3840 women of reproductive age who had a pregnancy outcome (livebirth, stillbirth or abortion) are being randomly recruited for each survey round. Outcome assessments will be made using repeat cross-sectional surveys at baseline and 24 months postintervention. An intention to treat approach will be used and the primary outcome analysed using generalized linear mixed models with a random effect for cluster and time. A cost-effectiveness analysis will also be conducted from a societal perspective.Discussion: This is one of the first trials to evaluate the effectiveness of upgraded MWHs and will provide much needed evidence to policy makers about aspects of functionality and the community engagement required as they scale-up this programme in Ethiopia.Trial Registration: ClinicalTrial.gov, NCT03299491. Retrospectively registered on 3 October 2017. [ABSTRACT FROM AUTHOR]