Home births: A growing phenomenon with potential risks

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990-2017

BACKGROUND

The United Nations (UN) Sustainable Development Goal - 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990-2017.

METHODS

We obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR.

RESULTS

First, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was - 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR.

CONCLUSION

The decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.

Comparison of Frequency of Home Births in the Member States of the EU Between 2015 and 2019

Introduction. The disagreement of the general public’s views on home births is practically identical for the professional public and specialists also. The core of the problem lies in the disunity between individual countries of the European Union—complete prohibition under the risk of committing a crime on one side and standard procedure perceived as something completely common on the other side. Methods. The authors focused on the prevalence of home births in individual EU countries, together with the proportion of neonatological mortality compared to the number of live births, which are data that, unlike home births, are mandatory in each EU Member State. Data on home births were obtained from available official and verified sources such as the Ministry of Health, reviews published by the WHO, or published peer-reviewed scientific and professional works. Secondary data were procured via Web of Science, Scopus, or PubMed. Results. The aim of the study was to trace the documented numbers of home births in the individual states of the European Union in the years 2015 to 2019, to analyze them with data on live births together and with data on infant mortality. A comparative analysis of the compiled data can be used to conclude which countries have the highest domestic birth rates and how the birth rate is manifested in these countries. Based on the analysis of available data, it can be determined that the Netherlands, Denmark, and Germany have the highest share of domestic births. The link between home births and increased neonatal mortality has not been established. Eastern Europe countries have the highest neonatal mortality, namely Romania (1.19%) and Malta (0.63%). Conclusion. The Netherlands has the highest domestic birth rate per 100 000 inhabitants with a 5-year average of 161 922 (overall average of all live births 993.40), but is also in 11th place in neonatal mortality, together with Denmark and Belgium, which have 0.35% neonatal neonatal mortality. The country with the lowest neonatal mortality of 0.19% is Slovenia. The total average of all children born in 5 years (915 live births) is 1.422. When monitoring the number of domestic births in other countries in the years 2015 to 2019, an increasing tendency of this trend is observed.