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PubMed2002

Maternal health in sudden intrauterine unexplained death: do urinary tract infections protect the fetus?

OBJECTIVE: To study the impact of maternal health and obstetric complications on the risk for sudden intrauterine unexplained death. METHODS: All 76 cases of sudden intrauterine unexplained death and 165 explained stillbirths among singletons in Oslo, Norway (1986-1995) were compared with 582 controls. Information on maternal health was registered from antenatal health cards and the Medical Birth Registry of Norway. The effect of pregnancy duration was studied before logistic regression analysis corrected for pregnancy duration was performed. RESULTS: Urinary tract colonization or infection in pregnancy was associated with a reduced risk for subsequent sudden intrauterine unexplained death (odds ratio [OR] 0.29 [0.12-0.74]), whereas insufficient physiologic hemodilution during pregnancy (lowest hemoglobin greater than 13 g/mL) increased the risk for sudden intrauterine unexplained death (OR 9.50 [1.30-69.3]). However, the risk for sudden intrauterine unexplained death remained unaffected by the total number of indicators of impaired maternal health during pregnancy, in contrast to significant impact on other stillbirths. CONCLUSION: Urinary tract colonization or infection may offer protection against sudden intrauterine unexplained death. We hypothesize that the subsequent maternal immune response offers transplacental protection against lethal fetal infections by common pathogens of urinary tract infections. Other health indicators have little impact on sudden intrauterine unexplained death.

Female↗
PubMed2000

The socio-economic determinants of maternal health care utilization in Turkey.

The purpose of this study is to investigate the individual-, household- and community-level factors that affect women's use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.

Adolescent↗
PubMed2006

[Study on maternal health care status to agricultural and nomadic counties in Tibet Autonomous Region of China].

OBJECTIVE: To understand the current situation of maternal health care and the association between maternal health care and relevant factors. METHODS: According to a cross sectional study design, 1512 mothers having children under 3 years old were drawn under stratified random sampling method and interviewed at their households in 15 counties, Tibet Autonomous Region of China. RESULTS: 77.6% of the pregnant women received at least one antenatal checkup with an average of 3.89 times while the rate of antenatal checkup over 5 times was 26.3%. The hospital delivery rate was 40.4% in this area. 83.9% of the women received education under the health care program during pregnancy and 66.2% of them were visited by health workers after delivery. Major factors of the antenatal checkups would include the resource of income, living in nomadic area, personal sanitation, antenatal health care education, mobilization of delivery at hospital, knowledge of antenatal health care etc. CONCLUSIONS: There had been great improvement in women's health care in this area as compared with the status in 1999, but the frequency of receiving antenatal checkup was still not enough and the rate of hospital delivery was also low as compared with 46 counties in western areas of China. Poor knowledge of health care during pregnancy seemed to be the major factor that limited the utilization of antenatal health care. Knowledge on health and common sense of health care should be disseminated to improve the antenatal care and to enhance the hospital delivery rate.

Agriculture↗
PubMedDate not supplied

Costs of maternal health care services in three anglophone African countries.

This paper is a synthesis of a case study of provider and consumer costs, along with selected quality indicators, for six maternal health services provided at one public hospital, one mission hospital, one public health centre and one mission centre, in Uganda, Malawi and Ghana. The study examines the costs of providing the services in a selected number of facilities in order to examine the reasons behind cost differences, assess the efficiency of service delivery, and determine whether management improvements might achieve cost savings without hurting quality. This assessment is important to African countries with ambitious goals for improving maternal health but scarce public health resources and limited government budgets. The study also evaluates the costs that consumers pay to use the maternal health services, along with the contribution that revenues from fees for services make to recovering health facility costs. The authors find that costs differ between hospitals and health centres as well as among mission and public facilities in the study sample. The variation is explained by differences in the role of the facility, use and availability of materials and equipment, number and level of personnel delivering services, and utilization levels of services. The report concludes with several policy implications for improvements in efficiency, financing options and consumer costs.

Efficiency, Organizational↗
PubMed2001

Maternal health, antenatal and at 8 weeks after delivery, in home versus in-hospital fetal monitoring in high-risk pregnancies.

OBJECTIVE: To assess maternal health outcome, comparing high-risk pregnant women to either domiciliary monitoring or in-hospital monitoring, and a low risk pregnant group. DESIGN: Paper and pencil questionnaire, distributed antenatal and 8 weeks after the delivery. SETTING: A university hospital. SUBJECTS: Three groups: 130 high-risk pregnant women, who entered a randomized clinical trial and were allocated to either home (n=69) or in-hospital monitoring (n=61), and a reference cohort of low risk pregnant women (n=55). MAIN OUTCOME MEASURES: Antenatal physical and mental health (RAND36) and social experiences; mode of delivery; complications postpartum; physical health, mental health, and social experiences at 8 weeks postpartum. RESULTS: In all groups, antenatal physical health was considerably lower compared to the physical health of US women aged 18--44 years. Antenatal mental health was lower in high-risk women than in low-risk women (P<0.05). Antenatal maternal health, the mode of delivery, and maternal complications postpartum did not differ significantly between in-hospital and domiciliary monitored women. Eight weeks after delivery, physical health improved considerably in all groups; mental health was significantly lower in high-risks as compared to low-risk women (P<0.01). The allocated monitoring strategy showed a significant effect on mental health at 8 weeks after delivery; the mental health score being lower in the domiciliary monitored group (P<0.05). CONCLUSIONS: At 8 weeks after the delivery, physical health improves substantially in all groups. Mental health is higher in low-risks than in high-risks. Within the high-risk group domiciliary and in-hospital monitored women have the same physical maternal outcome at 8 weeks after delivery. However, mental maternal health in in-hospital monitored women at 8 weeks was probably biased by a medicalization effect.

Adolescent↗
PubMed1994

Reliability and validity of an instrument to measure maternal health beliefs.

Noncompliance with recommended preventive pediatric care continues to be a major problem, especially in inner-city pediatric clinics. There has been little evaluation of the maternal beliefs that are associated with such noncompliance, perhaps because there are no instruments which have been assessed for reliability and validity. To evaluate the internal consistency and construct validity of a maternal health belief instrument, we interviewed 500 mothers of healthy full-term newborns postpartum. Forty-eight items measured the maternal health beliefs, according to Health Belief Model constructs (perceived susceptibility, perceived severity, perceived benefits of medical care, perceived barriers, and health motivation). Construct validity was assessed by principal components factor analysis. Eight internally consistent indices emerged, including illnesses having high and low perceived susceptibility, and low and moderate perceived benefit. Logistical access barriers and economic access barriers were also distinct. Perceived severity and health motivation formed single indices. This maternal health belief instrument was internally consistent in the study sample and showed evidence of construct validity. These indices may make important independent contributions to understanding variation in preventive well-child care utilization.

Adult↗
PubMed2003

Did mothers begin with an advantage? A study of childbirth and maternal health in England and Wales, 1778-1929.

This paper contributes to two ongoing debates among demographers. One deals with the immediate and deferred health effects of childbearing in the past, and the other with competing explanations--the frailty and insult accumulation hypotheses--for differences in individual health later in life. The study population consists of working women who lived at four locales in England and Wales in parts of the period 1778-1929 and who were under observation for incapacitating sickness during and after their childbearing years. Mothers within the study population are contrasted with a comparison group made up principally of non-mothers. The mothers began their reproductive careers with an advantage in health that was especially evident in the duration of sickness episodes. Even though individual births were less hazardous than individual sicknesses at the same ages, the cumulative effect of childbearing appears to have eroded the mothers' advantage. By ages 50-74 the mothers resembled the comparison group in health.

Adult↗
PubMedDate not supplied

Utilization of maternal health services in Ejisu District, Ghana.

A study on the utilization of maternal health services in Ejisu district of Ghana was carried out in January and February 1990. 1200 women aged between 15 and 49 were interviewed in 80 communities. The findings of the study indicated that over 50% of respondents married under 20 years, 70% of them attended antenatal clinic at least 4 times in their last pregnancy, over 80% had their last delivery in a health facility and over 80% knew about at least one modern method of family planning. Only 5.5% were currently using a modern family planning method. 90% of them were willing to stay in a maternity waiting home if advised to do so. Most would be prepared to stay for a month or 2. 20% of the respondents knew about local herbal preparations used for first aid in bleeding in pregnancy, although they would seek definitive treatment at a health facility. From the study, some women were not using the services. These would have to be reached through improving the quality of care in health facilities and increasing community awareness on maternal health in order to improve accessibility and utilization further.

Adolescent↗
PubMedDate not supplied

Maternal health care utilization in Jordan: a study of patterns and determinants.

This article analyzes the patterns and determinants of maternal health care utilization in Jordan, using data from the Jordan Fertility and Family Health Survey of 1983. The study focuses on the 2,949 women who had a child in the five years preceding the survey. Through multivariate analyses of differentials in the utilization of prenatal care and health care at delivery, the study assesses the effect of sociodemographic factors, including residence, education, parity, and standard of living. The coverage of maternal health care in Jordan is discussed in relation to the overall organization of health services, the various providers of care, and the role of cultural factors.

Adolescent↗
PubMed2002

Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania.

Following the difficult economic situation various countries introduced health sector reforms, including user charges to finance the system. The assessment of user costs for maternity services in Tanzania was part of a larger study, which covered inputs, outputs and efficiency of services. The study was carried out from October 1997 to January 1998 in Mtwara urban and rural district in South Tanzania. One hundred and seven women attending a quarter of government health facilities were randomly selected and interviewed. Twenty one key informants were also interviewed and service procedures observed. Users of maternity services pay mainly for admission, drugs, other supplies and travel costs. Travel costs represent about half of these financial costs. The average total costs vary between US$11.60 for antenatal consultation and US$135.40 for caesarean section at the hospital. Unofficial payments are not included in the calculation. The amounts vary and payment is irregular. We therefore conclude that time costs are constantly higher than financial costs. High direct payments and the fear of unofficial costs are acute barriers to the use of maternity services. User costs can substantially be reduced by the re-organisation of service delivery especially at antenatal consultation.

Cost-Benefit Analysis↗
PubMedDate not supplied

Maternal health services--the developing world.

Women in developing nations run 100 to 200 times the risk of dying in pregnancy and childbirth compared to women in affluent countries. The vast majority of these deaths are preventable. We examine 3 models of health development for their potential impact on maternal mortality. Although universal primary maternal health care would be ideal, resource limitations render its implementation impractical in many regions. The nonavailability of transport and referral services limits the impact of community-based programs. Selective primary health interventions have some role, but more costly and complex services are required to deal with hemorrhage, the complications of illegal abortion and to provide operative deliveries. Public health workers should focus on intersectoral programs at the community level which mobilize women around health issues. Sustainable development has the greatest potential to produce lasting changes in the risks of childbearing.

Developing Countries↗
PubMed2006

Women's position within the household as a determinant of maternal health care use in Nepal.

CONTEXT: Although gender inequality is often cited as a barrier to improving maternal health in Nepal, little attention has been directed at understanding how sociocultural factors may influence the use of health care. In particular, how a woman's position within her household may affect the receipt of health care deserves further investigation. METHODS: Data on ever-married women aged 15-49 from the 2001 Nepal Demographic and Health Survey were analyzed to explore three dimensions of women's position within their household-decision making, employment and influence over earnings, and spousal discussion of family planning. Logistic regression models assessed the relationship of these variables to receipt of skilled antenatal and delivery care. RESULTS: Few women reported participation in household decision making, and even fewer had any control over their own earnings. However, more than half reported discussing family planning with their husbands, and there were significant differences among subgroups in these indicators of women's position. Though associations were not consistent across all indicators, spousal discussion of family planning was linked to an increased likelihood of receiving skilled antenatal and delivery care (odds ratios, 1.4 and 1.3, respectively). Women's secondary education was also strongly associated with the greater use of health care (5.1-5.6). CONCLUSIONS: Gender inequality constrains women's access to skilled health care in Nepal. Interventions to improve communication and strengthen women's influence deserve continued support. The strong association of women's education with health care use highlights the need for efforts to increase girls' schooling and alter perceptions of the value of skilled maternal health care.

Adolescent↗
PubMed2001

Opportunities to improve maternal health literacy through antenatal education: an exploratory study.

This paper examines the concept of maternal health literacy, defined as the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children. Specifically, it investigates the feasibility of using the concept of health literacy to guide the content and process of antenatal classes. The paper reports on the results of focus groups and interviews conducted with a range of health care providers, pregnant women and new mothers to obtain different perspectives on the issues surrounding antenatal education and parenting. The results give us a realistic look at what women are learning from existing antenatal education and how it can be improved. Comparing the results from the educators and the women, the same basic issues surface. Both recognize that there are serious time limitations in antenatal classes. These limitations, combined with natural anxiety and curiosity about childbirth, generally ensure that the content of classes is confined to pregnancy and childbirth. The limitations of time are also cited as a reason for the teaching methods being heavily weighted towards the transfer of factual information, as distinct from the development of decision-making skills, and practical skills for childbirth and parenting The results indicate clearly that antenatal classes cannot possibly cover all there is to know about pregnancy, childbirth and parenting. If the purpose of antenatal classes is to improve maternal health literacy, then women need to leave a class with the skills and confidence to take a range of actions that contribute to a successful pregnancy, childbirth and early parenting. This includes knowing where to go for further information, and the ability to analyse information critically. The authors conclude that this would represent a very challenging change in orientation for both the educators and pregnant women included in this study. Work continues on the development of the tools that will be needed to support this change.

Australia↗
PubMed2006

Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy.

BACKGROUND: In the first year after childbirth, 94% of women experience one or more major health problems (urinary incontinence, faecal incontinence, perineal pain, back pain). Difficulties in intimate partner relationships and changes affecting sexual health are also common. The aim of this study is to investigate changes in women's health from early pregnancy until four years after the birth of a first child. METHODS/DESIGN: The Maternal Health Study is a longitudinal study designed to fill in some of the gaps in current research evidence regarding women's physical and psychological health and recovery after childbirth. A prospective pregnancy cohort of >1500 nulliparous women has been recruited in early pregnancy at six metropolitan public hospitals in Melbourne, Australia between April 2003 and December 2005. In the first phase of the study participants are being followed up at 30-32 weeks gestation in pregnancy, and at three, six, nine, 12 and 18 months postpartum using a combination of self-administered questionnaires and telephone interviews. Women consenting to extended follow-up (phase 2) will be followed up six and 12 months after any subsequent births and when their first child is four years old. Study instruments incorporate assessment of the frequency and severity of urinary and bowel symptoms, sexual health issues, perineal and abdominal pain, depression and intimate partner violence. Pregnancy and birth outcome data will be obtained by review of hospital case notes. DISCUSSION: Features of the study which distinguish it from prior research include: the capacity to identify incident cases of morbidity and clustering of health problems; a large enough sample to detect clinically important differences in maternal health outcomes associated with the method of birth; careful exposure measurement involving manual abstraction of data from medical records in order to explore mediating factors and possible causal pathways; and use of a variety of strategies to improve ascertainment of health outcomes.

Journal Article↗
PubMed2005

Perinatal stroke in baby, prothrombotic gene in mom: does this affect maternal health insurance?

BACKGROUND: Maternal prothrombotic disorders may contribute to stroke in the fetus before and during birth. Many of the mothers of children with perinatal stroke have no previous history of pathologic thrombosis. OBJECTIVE: To determine if finding the Factor V Leiden mutation, prothrombin 20210 G-A gene defect, or methylene tetrahydrofolate reductase C677T mutation in an asymptomatic mother of a child with perinatal stroke would affect that mother's ability to obtain health insurance. METHODS: 1) The authors reviewed the literature on genetic prothrombotic risk factors and health insurance. 2) The authors surveyed the 17 largest insurance carriers in Indiana to find if diagnosing genetic prothrombotic risk factors in asymptomatic mothers of children with perinatal stroke would affect the mothers' health insurance status. RESULTS: Three articles on genetic prothrombotic risk factors and insurance were identified. Twelve of 17 insurance companies responded to our survey; three had policies on genetic testing. Most companies refused to provide clear, useful information on their policies regarding these risk factors. CONCLUSIONS: The authors are currently unable to counsel their patients' families on the long-term insurance implications of screening for genetic prothrombotic risk factors. The insurance implications of diagnosing healthy women with genetic prothrombotic risk factors need further study.

Blood Coagulation Disorders↗
PubMed2003

Determinants of the use of maternal health services in rural Bangladesh.

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.

Adolescent↗