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PubMed2026

Leading with Innovation: Maternal Health Transformation in New York City Health + Hospitals.

New York City's (NYC) maternal health crisis drew close attention in the late 2010s, driven by alarming data: Approximately 30 women died annually during childbirth in NYC, Black non-Hispanic women were 12 times more likely to die than white women, and more than 3,000 women experienced life-threatening birth complications each year. In response, NYC committed $12.8 million in July 2018 to reduce maternal mortality and eliminate racial disparities.NYC Health + Hospitals (H+H)-the nation's largest public health system, serving 1.1 million patients annually with roughly 15,000 births per year-became the primary vehicle for this initiative. With 80 percent of the system's deliveries covered by Medicaid and a patient population that is 51.2 percent Hispanic and 27.1 percent Black, H+H is uniquely positioned to lead the fight against maternal health inequity.Three flagship programs anchor H+H's response to the city's maternal mortality rate. The OB Simulation Program, launched in 2012 and expanded in 2018, was the first in the nation to use mannequins of color to train thousands of providers in obstetric emergencies. The Maternal Home Program, piloted at H+H's Kings County Hospital in 2019 and scaled system-wide by 2021, has served more than 10,341 patients, generating more than 33,000 referrals for social, behavioral health, and community resources. The Cardio-Obstetrics Program located at Kings County Hospital targets cardiovascular disease-the leading cause of maternal death among Black women-through screening, education, and community outreach. These programs are a health equity imperative, made more urgent by impending federal Medicaid cuts resulting from the H.R.1 One Big Beautiful Bill Act (passed on July 4, 2025).

Humans↗
PubMed1992

Evaluation of maternal health programs: approaches, methods and indicators.

Evaluation of maternal health services is an essential function of any health system. Single or multiple aspects of a program can be evaluated but they must be clearly defined. To assess success of a program the dimensions of coverage, equity, quality, women's satisfaction, efficiency and cost-effectiveness must be considered. These can be measured according to some standard criteria, and various methods are described, including randomized clinical trials, randomized community trials, before and after studies, and observational studies, including the case-control approach and confidential inquiries into maternal deaths. Indicators to assess effectiveness of a maternal health program may relate to structure, i.e., available resources or organizational arrangement; process, including changes in quantity of services provided; or outcome indicators that measure maternal mortality or morbidity.

Female↗
PubMed1992

Promoting maternal health in developing countries.

Most maternal deaths are preventable, yet more than 500,000 women die annually worldwide. However, the risk of maternal mortality is unevenly distributed; 99 percent of all maternal deaths occur in developing countries. This article examines the causes of this disparity and suggests several recommendations for social workers to promote maternal health in developing countries.

Developing Countries↗
PubMed2005

Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal.

Couple-friendly reproductive health services and male partner involvement in women's reproductive health have recently garnered considerable attention. Given the sensitive nature of gender roles and relations in many cultures, understanding the context of a particular setting, potential barriers, and attitudes towards a new intervention are necessary first steps in designing services that include men. In preparation for a male involvement in antenatal care intervention, this qualitative study specifically aims to: (a) understand the barriers to male involvement in maternal health and (b) explore men's, women's, and providers' attitudes towards the promotion of male involvement in antenatal care and maternal health. In-depth interviews were conducted with fourteen couples and eight maternal health care providers at a public maternity hospital in Katmandu, Nepal. Additionally, seventeen couples participated in focus group discussions. The most prominent barriers to male involvement in maternal health included low levels of knowledge, social stigma, shyness/embarrassment and job responsibilities. Though providers also foresaw some obstacles, primarily in the forms of hospital policy, manpower and space problems, providers unanimously felt the option of couples-friendly maternal health services would enhance the quality of care and understanding of health information given to pregnant women, echoing attitudes expressed by most pregnant women and their husbands. Accordingly, a major shift in hospital policy was seen as an important first step in introducing couple-friendly antenatal or delivery services. The predominantly favorable attitudes of pregnant women, husbands, and providers towards encouraging greater male involvement in maternal health in this study imply that the introduction of an option for such services would be both feasible and well accepted.

Adult↗
PubMed1989

Maternal health care and outcome of pregnancies in Kainji Lake Area of Nigeria.

A study of maternal health care and outcome of pregnancies in a rural area of Nigeria is presented. Over 80% of women sought maternal health care from the traditional midwives. The chance of survival of the child born was found to decrease with parity. In 95% of families child spacing was between 1-3 years. The peak incidence of multiple pregnancy occurred earlier and the rate was found lower than has been reported elsewhere. The health institutions in the urban area were found to differ in the quality of maternal services provided. The best service was not accessible to a larger population. The relevance of training the traditional midwives to the improvement of maternal health care was stressed, and the provision of referral centres to support them was recommended.

Adolescent↗
PubMed2002

WHO indicators for evaluation of maternal health care services, applicability in least developed countries: a case study from Eritrea.

The World Health Organization has recommended a number of process indicators to monitor the effect of health care programmes on maternal mortality. This study was therefore conducted to know if the recommended process indicators are useful also in the least developed countries. In 1994, all 17 health facilities offering maternal health care in a rural province in Eritrea were visited. An assessment was made of the obstetric services provided, obstetric complications, and accessibility of health facilities. The study revealed that necessary data were available for most indicators. The indicators were helpful to follow the coverage of obstetric care and to identify problems within the health care system. However, in countries where the coverage of assisted deliveries is low with few obstetric complications seen within the health care system, the indicators cannot be used as a tool to monitor the effect of maternal health care programmes on maternal mortality.

Developing Countries↗
PubMed2006

Women's groups' perceptions of maternal health issues in rural Malawi.

BACKGROUND: Improvements in preventive and care-seeking behaviours to reduce maternal mortality in rural Africa depend on the knowledge and attitudes of women and communities. Surveys have indicated a poor awareness of maternal health problems by individual women. We report the perceptions of women's groups to such issues in the rural Mchinji district of Malawi. METHODS: Participatory women's groups in the Mchinji district identified maternal health problems (172 groups, 3171 women) and prioritised problems they considered most important (171 groups, 2833 women). In-depth qualitative data was obtained through six focus-group discussions with the women's groups, three with women's group facilitators, and four interviews with facilitator supervisors. FINDINGS: The maternal health problems most commonly identified by more than half the groups were anaemia (87%), malaria (80%), retained placenta (77%), obstructed labour (76%), malpresentation (71%), antepartum and postpartum haemorrhage (70% each), and pre-eclampsia (56%). The five problems prioritised as most important were anaemia (sum of rank score 304), malpresentation (295), retained placenta (277), obstructed labour (276). and postpartum haemorrhage (275). HIV/AIDS and sepsis were identified or prioritised much less because complexity and contextual factors hindered their consideration. INTERPRETATION: Rural Malawian women meeting in participatory groups showed a developed awareness of maternal health problems and the concern and motivation to address them. Community mobilisation strategies, such as women's groups, might be effective at reducing maternal mortality because they can draw on the collective capacity in communities to solve problems and make women's voices heard by decision-makers.

Adolescent↗
PubMedDate not supplied

Associations between measures of socioeconomic status and maternal health behavior.

Lower socioeconomic status (SES) is consistently associated with adverse pregnancy outcomes. One mechanism that may account for this association is that maternal health behaviors vary with SES. To examine this possibility, we addressed how women may be differently categorized by diverse measures of SES and the effect that choice of measure has on the relationship between SES and maternal health behaviors. We used population-based data for Caucasian women (n = 10,055) from Alaska, Maine, Oklahoma, and West Virginia who delivered a live infant in 1990-1991 and participated in the Pregnancy Risk Assessment Monitoring System. Five SES measures were evaluated: education; poverty status; Medicaid payment for delivery; Women, Infants, and Children (WIC) enrollment during pregnancy; and residential crowding. Three maternal health behaviors (smoking, delayed/no prenatal care, unintended pregnancy) were examined to assess the variation among the associations between SES measures and behaviors. Item response rates were high for all SES measures (range: 88.9%-100.0%), and there was low correlation between measures. Most of the SES measures were related to maternal health behaviors. However, the strength of association varied between each measure and behavior and was weaker for women who were younger than 20 years old or not married. In view of the multifaceted nature of SES, several measures may be needed to appropriately assess the relationship between SES and maternal health behaviors.

Female↗
PubMed1996

Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.

Data Collection↗
PubMedDate not supplied

Rediscovering the "M" in "MCH": maternal health promotion after childbirth.

Although maternal mortality is not a major health concern in the United States, evidence is accruing that after 6 weeks postpartum mothers continue to face mental and physical health, lifestyle, and parenting concerns. Exemplar areas for enhanced maternal health promotion after childbirth include (a) lifestyle changes in exercise, nutrition, and smoking, and (b) psychosocial well-being, particularly mood and body image. Research on health of women after childbirth supports rethinking the scope and duration of maternal health promotion.

Adaptation, Psychological↗
PubMed1999

The scope of unmet maternal health needs in pediatric settings.

OBJECTIVE: Previous work has focused attention on the prevalence of specific maternal health problems known to affect children, such as smoking or depression. However, the cumulative health burden experienced by mothers and the potential for a practical pediatric health services response have not been examined. The aims of this study were to characterize: 1) the prevalence and cumulative burden of maternal health behaviors and conditions, 2) maternal access to a source of comprehensive adult primary care, and 3) maternal perceptions of a pediatric role in screening and referral. METHODS: We surveyed 559 consecutive women bringing a child 18 months of age or less to one of four pediatric primary care sites between July 1996 and May 1997. The pediatric sites included one outpatient program in an academic hospital, one in a community health center, and two in-staff model practices of a managed care organization (these last two were combined for analysis). The self-administered questionnaire contained previously validated questions to assess health behaviors and conditions (smoking, alcohol abuse, depression, violence, risk for unintended pregnancy, serious illness, self-reported health) and access to care (regular source, regular provider, health insurance, care delayed or not received). Maternal attitudes toward a pediatric role in screening and referral were also elicited. RESULTS: In the three settings, response rates ranged from 75% to 84%. The average age of the women ranged from 25.1 to 32. 1 years and the average age of the children ranged from 6.5 to 8.0 months. Across the settings, the percentage of women reporting at least one health condition (66%-74%) was similarly high, despite significant demographic differences among sites. Many women reported more than one condition (31%-37%); among all women who smoked, 33% also screened positive for alcohol abuse, 31% for emotional or physical abuse, and 48% for depression. Access to comprehensive adult primary care was variable with 23% to 58% of women reporting one or more barriers depending on the site. Across all sites, >85% of mothers reported they would "not mind" or "would welcome" a pediatric role in screening and referral. CONCLUSIONS: Two-thirds of women bringing their children for pediatric care had health problems regardless of the site of care. Many women also reported substantial barriers to comprehensive health care. Most women reported acceptance of a pediatric role in screening and referral. Given the range and depth of maternal health needs, strategies to connect or reconnect mothers to comprehensive adult primary care from a variety of pediatric settings should be explored.

Adult↗
PubMed2002

Welfare to work? Impact of maternal health on employment.

OBJECTIVES: This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment. METHODS: Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex. RESULTS: There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems. CONCLUSIONS: Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

Adult↗
PubMed1997

Utilization of maternal health services offered by the Health Insurance Organization in Alexandria.

This study examines the extent of utilization of maternal health services (MHS) currently offered by Health Insurance Organization (HIO) in Alexandria. A total of 1040 insured married females working in primary, preparatory and secondary schools in three educational regions in Alexandria were interviewed. Data was collected about socio-economic status of females, their knowledge about MHS offered by HIO, as well as sources of receiving MHS other than HIO. Barriers preventing utilization of such services and recommendations for improvement were explored from beneficiaries. The results revealed that for the last pregnancy, about half the sample utilized antenatal services and about one fourth utilized natal services, while a very small percentage (8%) utilized family planning services. The private sector was the main source for receiving MHS for non-utilizer. Lack of confidence and low quality of services were the main barriers preventing utilization. Complete physical examination, examination of fetal heart sound and improvement of physical environment of obstetrics and gynecology department were the main recommendations for improvement of MHS offered by HIO.

Adolescent↗
PubMed2003

The inequality of maternal health care in urban sub-Saharan Africa in the 1990s.

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa. The dis-advantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care.

Africa South of the Sahara↗
PubMed2005

Effective financing of maternal health services: a review of the literature.

Health care can be funded in a number of ways ranging from direct user charges (out of pocket) payments to indirect methods that pool across time (prepayment) and across different risk and wealth groups (insurance and general taxation). All these methods can be used to finance maternal health services. When assessing the impact of financing mechanisms it is important to be aware of the different ways they effect service delivery patterns and utilisation. Specifically most systems have both equity and efficiency aspects that combine to impact on health service utilisation and health status. In general indirect methods that help families to pool the costs of maternal health services are preferable to direct methods of payment. It is also clear, however, that user charges may sometimes help to mitigate deficiencies in systems of pooled funding. Available literature suggests that financing mechanisms for maternal health services could be improved by systems that increase transparency, help to mitigate demand-side costs of services and provide funding for that promote transparent charging for services. While the limited experience of demand-side mechanisms for improving access to maternal health services more evaluation is required.

Maternal Health Services↗
PubMed2006

Maternal health during pregnancy and perinatal mortality in Bangladesh: evidence from a large-scale community-based clinical trial.

Perinatal mortality is very high in Bangladesh. In this setting, few community-level studies have assessed the influence of underlying maternal health factors on perinatal outcomes. We used the data from a community-based clinical controlled trial conducted between 1994 and 1997 in the catchment areas of a large MCH/FP hospital located in Mirpur, a suburban area of Dhaka in Bangladesh, to investigate the levels of perinatal mortality and its associated maternal health factors during pregnancy. A total of 2007 women were followed after recruitment up to delivery, maternal death, or until they dropped out of the study. Of these, 1584 who gave birth formed our study subjects. The stillbirth rate was 39.1 per 1000 births [95% confidence interval (CI) 39.0, 39.3] and the perinatal mortality rate (up to 3 days) was 54.3 per 1000 births [95% CI 54.0, 54.6] among the study population. In the fully adjusted logistic regression model, the risk of perinatal mortality was as high as 2.7 times [95% CI 1.5, 4.9] more likely for women with hypertensive disorders, 5.0 times [95% CI 2.3, 10.8] as high for women who had antepartum haemorrhage and 2.6 times [95% CI 1.2, 5.8] as high for women who had higher haemoglobin levels in pregnancy when compared with their counterparts. The inclusion of potential confounding variables such as poor obstetric history, sociodemographic characteristics and preterm delivery influenced only marginally the net effect of important maternal health factors associated with perinatal mortality. Perinatal mortality in the study setting was significantly associated with poor maternal health conditions during pregnancy. The results of this study point towards the urgent need for monitoring complications in high-risk pregnancies, calling for the specific components of the safe motherhood programme interventions that are designed to manage these complications of pregnancy.

Adult↗
PubMed2006

[Poverty and sociocultural factors in the use of maternal health services in Ivory Coast].

BACKGROUND: Better health for populations is linked to the adequate access to health services. This is particularly important in developing countries, where a number of economic, social, and geographic barriers exist. Pregnant women are particularly at risk, as they have many health needs and problems. In addition, the use of maternal health services is particularly influenced by economic and socio-cultural factors. Therefore, we intended to appreciate the association between poverty, socio-cultural factors and use of maternal health services in Ivory Coast. METHODS: For this study, our data were from the demographic and health survey in Ivory Coast in 1998. We used the logistic regression models to analyze the relation between poverty, socio-cultural factors and use of services (antenatal care, type of delivery). RESULTS: 62.4% of women used antenatal care adequately and 48.9% delivered in good conditions. Poverty is strongly linked to the use of services whatever the socio-cultural and demographic aspects are, with the poor using less services than the richer. Concerning the impact of socio-cultural characteristics, women living alone or with one adult (OR=1.60; 95% IC=1.06-2.42), those who are Christian (OR=1.83; 95% IC=1.25-2.67) or Akan are more likely to have adequate antenatal care than women living with 5 adults or more, having traditional or no religion, and those who are Senoufo or non Ivorian. Besides, when the number of children increases, they are less likely to consult. Primiparous, Christians (OR=2.45; 95% IC=1.68-3.59) or Muslims (OR=1.73; 95% IC=1.10-2.72) are more likely to deliver in a health center with a qualified assistance. CONCLUSION: Poverty has a negative effect on the use of maternal services but one should also take into account certain socio-cultural characteristics, namely number of adults in the household, parity, ethnicity and religion. While reducing poverty, it appears important to involve family members and religious or ethnic leaders in order to improve this use.

Adolescent↗