Utilizing maternal healthcare services: are female-headed households faring poorly?

BACKGROUND: Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021). METHODS: The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. RESULTS: 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. CONCLUSION: The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. TRIAL REGISTRATION: Not Applicable. JEL CLASSIFICATION: D10, I12, J16.

Atenção hospitalar ao recém-nascido saudável no Brasil: estamos avançando na garantia das boas práticas? / Care for healthy newborns in Brazil: are we making progress in achieving best practices?

Resumo O artigo tem como objetivo comparar práticas do cuidado ao recém-nascido saudável no momento do nascimento em hospitais públicos e mistos conveniados ao SUS, segundo o tipo de parto, verificadas na pesquisa "Nascer no Brasil/2011" (NB) e no último ciclo avaliativo da RC, aqui denominada "Avaliação da Rede Cegonha/2017" (ARC). O NB incluiu uma amostra com representatividade nacional de 266 hospitais e a ARC foi conduzida em 606 maternidades inseridas na estratégia Rede Cegonha, totalizando 15.994 e 8.047 pares de puérperas e recém-nascidos saudáveis, respectivamente. Entre os dois estudos, NB-2011 e ARC-2017, embora a proporção de cesariana tenha se mantido em torno de 44%, a prevalência do contato pele a pele com o RN, da amamentação na sala de parto e nas primeiras 24h de vida aumentaram, 140%, 82% e 6%, respectivamente. Já a proporção de aspiração de vias aéreas superiores do RN, caiu 65%. Os resultados indicam que o uso de diretrizes baseadas em evidências para o cuidado de recém-nascidos saudáveis aumentou na prática clínica, considerando o período de seis anos entre os estudos comparados. Apesar desse progresso, permanecem importantes desafios para garantir as melhores práticas para a totalidade de mulheres e recém-nascidos, principalmente em relação aos partos cesáreos.

Abstract This paper aims to compare best practices for healthy newborns in public and mixed hospitals affiliated with SUS, according to type of birth, between "Nascer no Brasil/2011" (NB - Birth in Brazil) and in the last assessment cycle of Rede Cegonha, here called "Avaliação da Rede Cegonha/2017" (ARC - Stork Network Assessment). NB included a sample with national representativeness of 266 hospitals, and ARC was conducted in 606 maternity hospitals included in the Rede Cegonha strategy, totaling 15,994 and 8,047 pairs of healthy mothers and newborns, respectively.Between the two studies, NB-2011 and ARC-2017, although the proportion of cesarean sections remained around 44%, the prevalence of skin-to-skin contact with newborns, breastfeeding in the delivery room and breastfeeding in the first 24h of life increased by 140%, 82% and 6%, respectively. The proportion of upper airway aspiration of newborns dropped 65%. The results indicate that the use of evidence-based guidelines for the care of healthy newborns has increased in clinical practice, considering the six-year period between the compared studies. Despite the progress, important challenges remain to ensure best practices for all women and newborns, especially in relation to cesarean births.

The perinatal bereavement project: development and evaluation of supportive guidelines for families experiencing stillbirth and neonatal death in Southeast Brazil-a quasi-experimental before-and-after study.

BACKGROUND: For most parents, getting pregnant means having a child. Generally, the couple outlines plans and has expectations regarding the baby. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. Validating the grief of these losses has been a challenge to Brazilian society, which is evident considering the childbirth care offered to bereaved families in maternity wards. Positively assessed care that brings physical and emotional memories about the baby has a positive impact on the bereavement process that family undergoes. Therefore, this study aims to assess the effects supportive guidelines have on mental health. They were designed to assist grieving parents and their families while undergoing perinatal loss in public maternities in Ribeirão Preto, São Paulo state, Brazil. METHOD: A mixed-methods (qualitative/quantitative), quasi-experimental (before/after) study. The intervention is the implementation of bereavement supportive guidelines for women who experienced a stillbirth or a neonatal death. A total of forty women will be included. Twenty participants will be assessed before and twenty will be assessed after the implementation of the guidelines. A semi-structured questionnaire and three scales will be used to assess the effects of the guidelines. Health care professionals and managers of all childbirth facilities will be invited to participate in focus group. Data will be analyzed using statistical tests, as well as thematic analysis approach. DISCUSSION: The Perinatal Bereavement guidelines are a local adaptation of the Canadian and British corresponding guidelines. These guidelines have been developed based on the families' needs of baby memories during the bereavement process and include the following aspects: (1) Organization of care into periods, considering their respective needs along the process; (2) Creation of the Bereavement Professional figure in maternity wards; (3) Adequacy of the institutional environment; (4) Communication of the guidance; (5) Creation of baby memories. We expect that the current project generates additional evidence for improving the mental health of women and families that experience a perinatal loss. Trial registration RBR-3cpthr For many couples, getting pregnant does not only mean carrying a baby, but also having a child. Most of the time, the couple has already made many plans and has expectations towards the child. When these plans are interrupted because of a perinatal loss, it turns out to be a traumatic experience for the family. In Brazilian culture, validating this traumatic grief is very difficult, especially when it happens too soon. The barriers can be noticed not only by the way society deals with the parents' grief, but also when we see the care the grieving families receive from the health care establishment. Creating physical and emotional memories might bring the parents satisfaction regarding the care they receive when a baby dies. These memories can be built when there is good communication throughout the care received; shared decisions; the chance to see and hold the baby, as well as collect memories; privacy and continuous care during the whole process, including when there is a new pregnancy, childbirth and postnatal period. With this in mind, among the most important factors are the training of health staff and other professionals, the preparation of the maternity ward to support bereaved families and the continuous support to the professionals involved in the bereavement. This article proposes guidelines to support the families who are experiencing stillbirth and neonatal death. It may be followed by childbirth professionals (nurses, midwives, obstetricians and employees of a maternity ward), managers, researchers, policymakers or those interested in developing specific protocols for their maternity wards.

RESUMO: CONTEXTO: Uma assistência avaliada positivamente por mães e pais que passaram pela perda perinatal permite a criação de memórias físicas e afetivas do bebê e possuem efeitos positivos no processo de luto da família. Este estudo avaliará os efeitos de uma diretriz de acolhimento na saúde mental de mulheres em processo de luto perinatal e neonatal em maternidades públicas do município de Ribeirão Preto (SP, Brasil). MéTODO: Estudo de métodos mistos (quantitativo e qualitativo), quase-experimental (antes e depois). A intervenção é a implementação de diretrizes de acolhimento ao luto de mulheres que tiveram um natimorto ou óbito neonatal. Um total de quarenta mulheres serão incluídas. Vinte participantes serão avaliadas antes, e vinte após a implementação da diretriz de acolhimento nas instituições. Serão aplicadas três escalas e uma entrevista semiestruturada para avaliar os efeitos da diretriz. Profissionais da saúde e gestores serão convidados a participar de grupos focais. Os dados serão analisados por meio de testes estatísticos, e sob a metodologia de análise temática. A diretriz de acolhimento contará com material baseado em diretrizes canadense e britânica. DISCUSSãO: As diretrizes brasileiras de luto perinatal propostas são uma adaptação local das diretrizes canadense e britânica. Baseamo-nos na necessidade da família por memórias físicas e afetivas da criança morta para facilitar a vivência do processo do luto. Elas incluem os seguintes aspectos: (1) organização dos períodos da assistência a partir de suas respectivas necessidades, (2) criação do papel do Profissional do Luto, (3) ambientação das instituições, (4) disseminação das diretrizes e (5) criação de memórias do bebê. Espera-se que o projeto gere evidências adicionais para melhorar a saúde mental de mulheres e famílias que vivenciam uma perda perinatal. Registro do estudo: RBR-3cpthr.

Male and female birth attendance and assistance in a species of non-human primate (Rhinopithecus bieti).

Birth attendance, or midwifery service, is an important characteristic in human evolution, and has been argued to separate our lineage from other taxa in the animal kingdom. Recent studies, however, indicate that similar or analogous behaviors also may occur in a small number of nonhuman primate species. Here, we report the first case of both male and female attendance and female birth assistance in a wild species of nonhuman primate, the black-and-white snub-nosed monkey (Rhinopithecus bieti). At our field site in Yunnan, China we observed a diurnal birth event in which the leader male of a one-male unit (OMU) remained in close- proximity (0-2 m) to the parturient, groomed her, and remained vigilant over a five hour pre- and postpartum period. In addition, a multiparous female member of the OMU also remained in close proximity to the soon-to-be mother, helped to pull the neonate from the birth canal, took the neonate from the new mother within 15 s of the birth, held the infant for 20 min, and then severed the umbilical cord. For the next several days the leader male traveled in close-proximity to the new mother and four days after the birth event, we observed him to share food with her. Given that diurnal births are extremely rare in this primate species; it remains unclear the degree to which the events we observed commonly occur during nighttime births. We argue that adult male and female black-and-white snub-nosed monkeys are highly attracted to young infants, and birth attendance and birth assistance in this, and certain other primate species, may play a critical role in maternal and infant survivorship.

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals.

Purpose: Globally, low-middle-income countries continue to account for almost all of the pregnancy-related mortalities that are largely preventable through adequate utilization of essential maternal health care services such as antenatal care (ANC) and skilled birth assistance (SBA). Promoting the use of ANC and SBA services are hindered by numerous policy- and capacity-related barriers along with widespread inequality in utilization of the existing services that further exacerbates the scenario. In an attempt to better understand the geography of inequality in service utilization, we conducted this brief descriptive study by using World Health Organization (WHO) data on ANC and SBA utilization among the member states. Methods: This was a descriptive study based on open access data on ANC and SBA use between 2012 and 2015 available through the Global Health Observatory of WHO. Country-level data were collected for Asia (41 countries), Africa (35 countries), Europe (35 countries), North America (10 countries), Latin America and the Caribbean (25 countries), and Oceania (16 countries). Cross-country and continent comparisons were made using dot and bar charts. Results: The overall prevalence of ANC and SBA use were, respectively, 78.17% and 88.33%. Considerable disparities were found in terms of ANC and SBA use across the continents, especially in Asia and Africa. Globally, the poorest performing countries included Afghanistan, Somalia, and South Sudan where more than three-quarters of the women remain deprived of ANC and SBA services during the period of 2012 and 2015. The greatest inequality in ANC use was observed in Africa (9.4% in Somalia and 99.9% in Libya), whereas that of SBA use was observed in Asia (17.8% in Afghanistan vs. 100% in Bahrain). Europe was the most equal of all regions in terms of both ANC (66.8% in Albania vs. 99.7% in Belarus) and SBA (94.4% in Denmark vs. 100% in Lithuania) use. Conclusion: Although in the majority of countries more than three-quarters of the women receive ANC and SBA services, the extent of intraregional inequality remains overwhelming especially for Asia and Africa. Progress toward maternal health-related targets should be interpreted in terms of the disparities to ensure a more even and sustainable outcome at both national and global level.

Percepção das gestantes sobre o pré-natal em um centro de atendimento do interior do sul do Brasil / Pregnant women perceptions about prenatal care in a health care center in the interior of the south of Brazil

O objetivo deste estudo descritivo e qualitativo foi conhecer a percepção das gestantes sobre a importância do pré-natal e sobre o papel da equipe de saúde durante o pré-natal e sua relação com a gestante. Para tanto, realizou-se entrevista com 14 gestantes com idade entre 18 e 38 anos, em Unidade de Referência à Saúde da Mulher, em município do interior do estado do Rio Grande do Sul. Os dados foram analisados a partir da técnica de análise numa perspectiva dialética, sendo analisadas as relações contidas nos discursos, tanto da perspectiva individual quanto coletiva. Para elas, o pré-natal é um momento importante para se conhecer como está a saúde do bebê e a sua. Neste sentido, o papel da equipe de saúde é fundamental. No entanto, relataram dificuldades quanto à oportunidade de conversarem com os médicos sobre isso, pois eles têm pouco tempo e disponibilidade para orientações. Salientaram que enfermeiras e nutricionistas são mais acessíveis e oferecem informações importantes sobre este momento. Os resultados deste estudo mostram a necessidade de mais espaços de escuta das gestantes, de suas necessidades e inseguranças, pois isto poderá impactar positivamente na saúde da gestante e do recém-nascido.(AU)

The aim of this descriptive and qualitative research was to know pregnant women´s perceptions about the importance of prenatal care and about their relation with the health care team. The survey´s profile is qualitative and it researched a group of 14 pregnant women with ages between 18 and 38, in the Woman´s Health Reference Unit of Cruz Alta, RS. Data were collected through individual interviews with open questions and dealt with by a dialectical content analysis method. The relations found in discourse were analyzed both individually and collectively. Women said that prenatal care is important for them to know about theirs and the baby´s health conditions. They also argued that the health team may facilitate or make it difficult for them to get the necessary information. Lack of opportunity to talk to doctors about fears and anxieties about pregnancy and especially about delivery is something that makes the communication difficult. On the other hand, the team composed by nurses and nutritionists is usually very attentive and the orientations they give are highly important for pregnancy and childbirth.(AU)

Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012-13.

The aim of this study was to determine the association between maternal utilisation of health-care services and socio-demographic factors among reproductive-age women in Pakistan. We used the sample of ever-married reproductive-age women (n = 7446) from the Pakistan Demographic and Health Survey (PDHS), 2012-13. We measured maternal utilisation of health-care services by using three dependent variables: number of antenatal care (ANC) visits, delivery assistance by a skilled health provider, and delivery in a health-care facility. Around 36.6% of women had made four or more ANC visits, 59% had received assistance from skilled health providers during delivery, and 55.3% had given birth in a health-care facility. On multivariable logistic regression, all three variables were positively associated with education and wealth, and negatively associated with birth order and women's autonomy. Policymakers and health planners may use our findings to develop efficient strategies, particularly for uneducated women and those with poor economic status, to improve the utilisation of maternal health-care services in Pakistan.

Daytime birth and postbirth behavior of wild Rhinopithecus roxellana in the Qinling Mountains of China.

Reports and quantitative descriptions of wild primate births are rare due to the frequent occurrence of nighttime parturitions. The aim of this study was to describe in detail one daytime birth event in a free-ranging band of Sichuan snub-nosed monkeys (Rhinopithecus roxellana), a highly endangered colobine species endemic to China. Using focal-animal sampling, we recorded both the birth event and behavior of the mother and other group members. The partum stage lasted 4 min 10 s. Immediately after parturition, the mother severed the umbilical cord, ingested the placenta, and cleaned the newborn. During the birthing process, the mother received what may possibly be described as birth assistance from one multiparous female within the same one-male unit. Although "aunting" or infant caregiving behavior has previously been reported in coloblines, this is the first putative case of birth assistance in a nonhuman primate.