Spatio-temporal disparities in maternal health service utilization in Rwanda: What next for SDGs?

The Sustainable Development Goals (SDGs) in part aim to further improve maternal health outcomes by reducing spatial disparities in utilization of critical services such as antenatal and assisted delivery, with emphasis on decentralization and integration of strategies. Yet, our understanding of within country spatial disparities in maternal health services (MHS) utilization over time has been scant. By fitting multiple regression models to a pooled dataset of the 2010/11 and 2014/15 Rwanda Demographic and Health Surveys (n = 12,273), and employing post-estimation margins analysis, we examined spatial differentiation of MHS trends prior to the SDGs in Rwanda. Our study found that women in 2014/15 were more likely to utilize antenatal services and assisted delivery (OR = 1.757, p ≤ 0.001) compared with 2010/11, but with nuanced spatial variations. Compared with Nyarugenge, women in nineteen out of the twenty-nine remaining districts were more likely to report utilization of antenatal services and skilled birth delivery, while the probability of accessing four or more antenatal services in seven districts declined between 2010/11 and 2014/15. Physical, financial and socio-cultural factors were associated with maternal health service utilization over the period. Based on our findings, we present policy suggestions for improving utilization of MHS in Rwanda and in similar contexts in the SDGs period.

Debated agronomy: public discourse and the future of biotechnology policy in Ghana.

This paper examines the highly contested and ongoing biotechnology (Bt) policy-making process in Ghana. We analyse media content on how Bt is viewed in the context of Ghana's parliamentary debate on the Plant Breeders Bill and within the broader public policy-making literature. This paper does not seek to take a position on Bt or the Bill, but to understand how policy actors influence the debate with political and scientific rhetoric in Ghana. The study reveals that in the midst of scientific uncertainties of Bt's potential for sustainable agriculture production and food security, policy decisions that encourage its future adoption are heavily influenced by health, scientific, economic, environmental and political factors dictated by different ideologies, values and norms. While locally pioneered plant breeding is visible and common in the Ghanaian food chain, plant breeding/GMOs/Bt from international corporations is strongly resisted by anti-GMO coalitions. Understanding the complex and messy nature of Bt policy-making is critical for future development of agricultural technology in Ghana and elsewhere.

Timing and utilisation of antenatal care service in Nigeria and Malawi.

As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log-log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.

Utilisation of skilled birth attendants over time in Nigeria and Malawi.

Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery - one of the indictors of MDG 5 - has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.