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Ghosh A, Mistri B. Socio-demographic and infrastructural variables influencing maternal risk concentration among ever-married women of reproductive age in rural West Bengal, India. Int J Health Plann Manage 2024. [PMID: 38803039 DOI: 10.1002/hpm.3805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world. OBJECTIVES The present study aims to determine prevalence of maternal risk and the influencing variables among ever-married women belonging to the reproductive age group (15-49) of Birbhum district, West Bengal. METHODS A cohort-based retrospective cross-sectional study was carried out among the sample of 229 respondents through a purposive stratified random sampling method and a pre-designed semi-structured questionnaire. The ordinal logistic regression (OLR) model was taken as a tool of assessment. Before developing the proportional OLR model, we have checked the multicollinearity effect among the predictors and the first-order effect modifier was evaluated as well. We performed data analysis using SPSS version 26. RESULTS The result shows that illiterate women (Odds ratios [OR] = 2.81, 95% CI, 0.277-1.791), from lower standard of living (OR = 1.14, 95% CI, -0.845-1.116), married before the age of 15 years (OR = 21.96, 95% CI, -0.55-6.73) and between the age of 15-18 years (OR = 24.51. 95% CI, -0.45-6.85) are more likely to be affected by the higher concentration of maternal risk. Other important predictor is the time of pregnancy registration. Considering the transport and related en-route causalities, the result portraying a clear picture where the distance and travel time becoming significant factors in determining the concentration of maternal risk. CONCLUSION Incidences of child marriages should be restricted. Eradicating factors influencing an individual's decision to seek care would be an essential contribution in excluding the dominant maternal risk factors.
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Affiliation(s)
- Alokananda Ghosh
- Department of Geography, Tehatta Sadananda Mahavidyalaya, Purba Bardhaman, West Bengal, India
| | - Biswaranjan Mistri
- Department of Geography, The University of Burdwan, Burdwan, West Bengal, India
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Reisz T, Murray K, Gage AJ. Associations between child marriage and reproductive and maternal health outcomes among young married women in Liberia and Sierra Leone: A cross-sectional study. PLoS One 2024; 19:e0300982. [PMID: 38768254 PMCID: PMC11104668 DOI: 10.1371/journal.pone.0300982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Child marriage has been associated with a range of negative maternal and reproductive health outcomes. This study explored these associations in Liberia and Sierra Leone and examined how child marriage intersected with other measures of social disadvantage. METHODS Data were derived from 631 and 1,325 married or cohabitating women aged 20-24 interviewed in the 2019-2020 Liberia and 2019 Sierra Leone Demographic and Health Surveys, respectively. Analyses were stratified by country. Regression models examined associations between age at first marriage (<15, 15-17, and 18+ years) and reproductive and maternal health outcomes, as well as interactions between child marriage and measures of social disadvantage. Multivariable regression results were presented as adjusted odds ratios and 95% confidence intervals. RESULTS Over half of currently married/cohabitating women aged 20-24 in Liberia (52%) and Sierra Leone (54%) married before age 18, and over one in 10 married before age 15. In both countries, after adjusting for other factors, being married before the age of 18 was significantly associated with early fertility, high fertility, and low fertility control. Associations were particularly strong among women who first married before age 15. In Liberia, women who married at age 15-17 had significantly lower odds of skilled attendance at delivery and institutional delivery if they lived in the North Central region. Sierra Leonean women who married before age 15 had lower odds of institutional delivery and lower odds of four or more ANC visits if they lived in the North Western region. CONCLUSION This study found clear associations between child marriage and negative reproductive health outcomes in Liberia and Sierra Leone, with stronger associations among women married in early adolescence. Child marriage and region of residence intersected to shape young women's access to skilled attendance at birth and institutional delivery. These findings call for further investigation and targeted intervention.
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Affiliation(s)
- Taylor Reisz
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Kelly Murray
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Anastasia J. Gage
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Paul P, Closson K, Raj A. Is parental engagement associated with subsequent delayed marriage and marital choices of adolescent girls? Evidence from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey in Uttar Pradesh and Bihar, India. SSM Popul Health 2023; 24:101523. [PMID: 37860704 PMCID: PMC10583165 DOI: 10.1016/j.ssmph.2023.101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/25/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023] Open
Abstract
Objective This study examines the association between parental engagement and subsequent delayed marriage of adolescent girls and, secondarily, to assess whether parental engagement is positively associated with girls' involvement in marital decision-making regarding husband selection. Methods The study used longitudinal survey data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) in Uttar Pradesh and Bihar, India. We analysed 6168 unmarried adolescent girls aged 15-19 years at wave 1 (2015-16) who were interviewed in wave 2 (2018-19). Our outcomes were delayed marriage of girls (unmarried vs. married at 20-22 vs. married at 18-19 vs. married at <18) and, among those married at <18 years, girls' involvement in husband selection (alone vs. with parents vs. not involved). Parental discussion around school performance, friendships, menstruation, pregnancy, free time, and personal issues were the exposure variables. We applied unadjusted and adjusted multinomial regression models to assess associations between our exposure variables and each outcome variable. Results From wave 1 to wave 2, 1551 girls (31.2%) married; 567 girls (12.5%) married as minors (<18 years). We found that parental discussion around school performance (relative risk ratio [RRR]: 1.33), friendship (RRR: 1.37) and personal matters (RRR: 1.29) were positively associated with remaining unmarried relative to early marriage of girls. However, discussion with parents about menstruation was negatively associated with marriage at 20-22 (RRR: 0.67) and remaining unmarried (RRR: 0.80), compared to early marriage. Discussing school performance was negatively associated with marriage at 18-19 (RRR: 0.62) and at 20-22 (RRR: 0.50), relative to early marriage. Discussing personal issues with parents was positively associated with joint parent-girl decision-making regarding husband selection, relative to parents alone selecting the husband (RRR: 1.43). Conclusions Parental engagement on school performance, friendship, and personal issues in early adolescence may help delay marriage and support marital choice for girls in India.
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Affiliation(s)
- Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
- ASPIRE - A Society for Promotion of Inclusive and Relevant Education, Sarvodaya Enclave, New Delhi, India
| | - Kalysha Closson
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, CA, USA
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anita Raj
- Newcomb Institute, Tulane University, New Orleans, LA, USA
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Shanto HH, Al-Zubayer MA, Ahammed B, Sarder MA, Keramat SA, Hashmi R, Haque R, Alam K. Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries. Int J Public Health 2023; 68:1606288. [PMID: 37936874 PMCID: PMC10625904 DOI: 10.3389/ijph.2023.1606288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.
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Affiliation(s)
- Hasibul Hasan Shanto
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Md. Akib Al-Zubayer
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Benojir Ahammed
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Md. Alamgir Sarder
- Statistics Discipline, Science, Engineering and Technology (SET) School, Khulna University, Khulna, Bangladesh
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rubayyat Hashmi
- Centre for Housing Research, The University of Adelaide, Adelaide, SA, Australia
| | - Rezwanul Haque
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
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Singh M, Shekhar C, Shri N. Patterns in age at first marriage and its determinants in India: A historical perspective of last 30 years (1992-2021). SSM Popul Health 2023; 22:101363. [PMID: 36852378 PMCID: PMC9958403 DOI: 10.1016/j.ssmph.2023.101363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Reproductive health and well-being of a woman are associated with factors such as menarche, first marriage, first sex, first birth, and menopause. The beginning of these events also brings about significant changes in women's lives. Despite marrying early being acknowledged as a detrimental and discriminatory socio-cultural global practice, a huge proportion of girls are being married at an early age, often detrimental to maternal and child health. Adding to the current national debate for the revision of the minimum age at marriage for girls from 18 to 21 years it becomes important to understand the past scenario and current situation of age at marriage in India. In this study, first five rounds of the National Family Health Survey (NFHS) have been used as a data source. Cox Proportional Hazard Model, Multiple Classification Analysis (MCA), Kaplan Meier Curve, Life table survival analysis, hierarchical clustered heat map, Multivariate Decomposition Analysis (MDA), and geospatial mapping were used to fulfill the objective of the study. The results showed that almost 65.9% of women got married before reaching the age of 18 years in the year 1992-93 which reduced to 23.2% among women aged 20-24 years in 2019-21. Region, respondent's level of education, caste, religion, wealth, and mass media exposure were significantly associated with the age at first marriage. The hazard of age at marriage declined significantly with higher educational attainment [higher education- AHR:0.37; CI:0.36 to 0.37], improving household wealth [richest wealth- AHR:0.91; CI:0.90 to 0.91], and mass media exposure [AHR:0.96; CI:0.95 to 0.96]. Since, the age at marriage has a substantial impact on fertility pattern and has a strong association with maternal & child health, policies regarding improving the age at marriage and better enforcement of the concerned laws are required to meet the SDG targets.
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Affiliation(s)
- Mayank Singh
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Chander Shekhar
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Neha Shri
- Department of Survey research and Data analytics, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
- Corresponding author.
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Exploration of spatial clustering in maternal health continuum of care across districts of India: A geospatial analysis of demographic and health survey data. PLoS One 2022; 17:e0279117. [PMID: 36520872 PMCID: PMC9754170 DOI: 10.1371/journal.pone.0279117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India. DATA AND METHODS The study is based on the fourth round of National Family Health Survey data conducted in 2015-16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC. FINDINGS Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran's I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC. CONCLUSION The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.
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Subramanee SD, Agho K, Lakshmi J, Huda MN, Joshi R, Akombi-Inyang B. Child Marriage in South Asia: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15138. [PMID: 36429857 PMCID: PMC9691026 DOI: 10.3390/ijerph192215138] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Background: Child marriage is a serious public health issue with dire implications at the individual and societal level. Almost half of all child marriages globally originate from South Asia. The aim of this study is to identify consistent factors associated with and resulting from child marriage in South Asia through a review of available evidence. Methods: This systematic review adhered to the 2015 Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, namely PsycINFO, CINAHL, EMBASE, Ovid Medline, PUBMED, and Scopus were searched. Retrieved studies were exported to EndNote and screened for eligibility using pre-determined criteria. The quality of the included studies was rated using 14 quality appraisal criteria derived from the National Institutes of Health (NIH) Tool. Results: A total of 520 articles were retrieved from six databases. Of these, 13 articles met the eligibility criteria and were included in this study. Factors consistently associated with child marriage in South Asia were rural residence, low level of education, poor economic background, low exposure to mass media and religion (Hindu and Muslim in particular countries). Maternal health care factors resulting from child marriage included: low utilization of antenatal care services, low institutional delivery, and low delivery assistance by a skilled birth attendant. Conclusions: Child marriage results from an interplay of economic and social forces. Therefore, to address the complex nature of child marriage, efforts targeting improvement in education, employment, exposure to health information via mass media, and gender egalitarianism are required. This systematic review was registered with PROSPERO [CRD42020190410].
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Affiliation(s)
- S Daarwin Subramanee
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Kingsley Agho
- School of Health Science, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Josyula Lakshmi
- The George Institute for Global Health, Hyderabad 500 082, India
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, India
| | - Md. Nazmul Huda
- ARCED Foundation, Dhaka 1216, Bangladesh
- Translational Health Research Institute, Western Sydney University, Campbeltown, NSW 2560, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Hyderabad 500 082, India
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
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Datta B, Pandey A, Tiwari A. Child Marriage and Problems Accessing Healthcare in Adulthood: Evidence from India. Healthcare (Basel) 2022; 10:healthcare10101994. [PMID: 36292439 PMCID: PMC9601764 DOI: 10.3390/healthcare10101994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022] Open
Abstract
The association between child marriage and the access to or utilization of maternal and antenatal healthcare has been widely studied. However, little is known about child brides' access to healthcare for illnesses later in life. Using data on 496,283 married women aged 18 to 49 years from the India National Family and Health Survey 2015-2016, we developed an 11-point composite score (ranging from 0 to 10) outlining the extent of problems accessing healthcare, as follows: (i) no/little problem (score 0 to 2), (ii) some problems (score 3 to 6), and (iii) big problems (score 7 to 10). The differences between child brides and their peers married as adults were assessed by the relative risk ratios obtained from multinomial logistic regressions. The adjusted risk of having "some problems" and "big problems" accessing healthcare relative to "no/little problem" for child brides was found to be 1.22 (95% CI: 1.20-1.25) and 1.26 (95% CI: 1.22-1.29) times that of those married as adults, respectively. These findings highlight the disproportionate barriers to healthcare access faced by women married as children compared to women married as adults and the need for further research to inform policies regarding effective public health interventions to improve healthcare access.
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Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA 30912, USA
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
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Factors Affecting Nonadherence to WHO’s Recommended Antenatal Care Visits among Women in Pastoral Community, Northeastern Ethiopia: A Community-Based Cross-Sectional Study. Nurs Res Pract 2022; 2022:6120107. [PMID: 36051824 PMCID: PMC9427308 DOI: 10.1155/2022/6120107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. More than half of the pregnant women in Ethiopia do not receive the recommended number of antenatal care visits. In the Afar region, where women have limited access to healthcare services due to pastoral livelihood, evidence on noncompliance to the adequate number of antenatal care visits is scarce. Therefore, this study was intended to examine the level of nonadherence to the recommended antenatal care visits and its associated factors in the pastoral community of Northeast Ethiopia. Methods. A community-based cross-sectional study was conducted from 04 February to 22 March 2020 among randomly selected 703 women who gave birth within 24 months preceding the survey in the Transform HDR districts of the Afar region. Data were collected using a pretested structured interviewer-administered questionnaire. Data were entered into Epi-data version 4.2 and finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the nonadherence to the recommended antenatal care visits. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at a
-value <0.05. Results. Nonadherence to the recommended antenatal care visits was 57.0% (95% CI: 53.3%–60.7%). Attending primary (AOR (95% CI): 0.39 (0.22–0.72)) and secondary education and above (AOR (95% CI): 0.25 (0.08–0.77)), being married at the age of 18 years or older (AOR (95% CI): 0.48 (0.36–0.71)), and attending antenatal care at a health center (AOR (95% CI): 0.46 (0.26–0.81)) were associated decreased odds of nonadherence to the recommend visits. Moreover, a higher likelihood of nonadherence was found among women from households not possessing communication media (AOR (95% CI): 1.85 (1.18–2.88)) and those who initiated antenatal care attendance during the second (AOR (95% CI): 5.23 (3.54–7.72)) and third trimesters (AOR (95% CI): 8.81 (1.88–41.20)). Conclusions. Nearly six in ten women do not receive the recommended antenatal care visits, consistent with the national prevalence. Women’s education, age at marriage, type of health facility, possession of mass media, and timing of antenatal care attendance were associated with nonadherence to the recommended antenatal care visits. Thus, improving women’s literacy, dissemination of information regarding antenatal care through mass media, and strengthening interventions targeted to end child marriage are important in scaling up the level of adherence. Moreover, supporting community-based health education through health extension programs is crucial in reaching women with limited access to mass media.
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Dadras O, Khampaya T, Nakayama T. Child Marriage, Reproductive Outcomes, and Service Utilization among Young Afghan Women: Findings from a Nationally Representative Survey in Afghanistan. Stud Fam Plann 2022; 53:417-431. [PMID: 35736515 DOI: 10.1111/sifp.12207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study explored the prevalence of child marriage and its association with reproductive outcomes and service utilization among young women in Afghanistan. We conducted a secondary analysis of data from the 2015 Afghanistan Demographic and Health Survey (DHS), focusing on women aged 20-24 years old based on the United Nations' recommendation on child marriage study. Multivariate logistic models examined the association between child marriage, reproductive outcomes, and service utilization. An estimated 52% of the Afghan women aged 20-24 married at ages less than 18 years. Poverty and illiteracy were associated with the higher likelihood of early marriage. There was a significant negative relationship between child marriage and history of rapid repeat childbirth, delivery by skilled personnel, and institutional delivery. In both adjusted and unadjusted models, women married at age ≤14 were more likely to experience terminated or unintended pregnancy, inadequate ANC, unmet need for family planning, and fistula; while, for those married at age 15-17 years, only terminated or unintended pregnancy remained significant. Strict international law enforcement and advocacy are needed in the current situation of Afghanistan to increase young women's education, promote their civil rights, and improve their autonomy and role in decision-making concerning their fertility preferences and reproductive health.
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Affiliation(s)
- Omid Dadras
- Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Nakhon Si Thammarat, Thailand.,Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Iran
| | - Tanaporn Khampaya
- School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Japan
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Ahinkorah BO, Budu E, Seidu AA, Bolarinwa OA, Agbaglo E, Adu C, Arthur-Holmes F, Samad N, Yaya S. Girl child marriage and its association with maternal healthcare services utilization in sub-Saharan Africa. BMC Health Serv Res 2022; 22:777. [PMID: 35698223 PMCID: PMC9195447 DOI: 10.1186/s12913-022-08117-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa. METHODS We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval. RESULTS Young women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors. CONCLUSION Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Obasanjo Afolabi Bolarinwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Department of Health Promotion, Education and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Arthur-Holmes
- Department of Sociology and Social Policy, Lingnan University, 8 Castle Peak Road, Tuen Mun, Hong Kong
| | - Nandeeta Samad
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Urquia ML, Batista RF, Cunha Cardoso V, Grandi C, Fafard St Germain AA. The perinatal epidemiology of child and adolescent marriage in Brazil, 2011–2018. SSM Popul Health 2022; 18:101093. [PMID: 35464613 PMCID: PMC9018448 DOI: 10.1016/j.ssmph.2022.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 10/28/2022] Open
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Zaveri A, Paul P, Roy R, Chouhan P. Facilitators and Barriers to the Utilisation of Maternal Healthcare Services in Empowered Action Group States, India. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221088359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of adequate reproductive healthcare services is critical to mothers and newborn babies. This study aimed to examine the facilitators and barriers to maternal healthcare utilisation in the Empowered Action Group (EAG) states. Data were drawn from the fourth round of the National Family Health Survey, 2015–16 ( n = 103,984). In this study, full antenatal care (ANC), delivery assistance by the skilled birth attendant (SBA) and postnatal care (PNC) within 2 days of delivery were taken as indicators of maternity care. Overall, approximately 13% of women received full ANC, 69.4% were delivered by SBA and 57.7% had PNC within 2 days of delivery. The findings of this study reveal that urban residence, higher education, wealthier economic status, exposure to mass media and contraceptive use are the facilitators of maternal healthcare utilisation. On the contrary, low levels of education, poverty, marriage during childhood, having a large number of children, belonging to socioeconomically backward castes, having difficulties related to healthcare-seeking and unwanted pregnancies are some of the major barriers to the use of maternity care. This study suggests that policymakers and public health practitioners should design proper healthcare policies and programs to provide quality reproductive healthcare services, particularly among socio-economically vulnerable women.
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Affiliation(s)
- Ankita Zaveri
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, Delhi, India
| | - Ranjan Roy
- Department of Geography and Applied Geography, University of North Bengal, Raja Rammohunpur, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
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Fan S, Koski A. The health consequences of child marriage: a systematic review of the evidence. BMC Public Health 2022; 22:309. [PMID: 35164724 PMCID: PMC8845223 DOI: 10.1186/s12889-022-12707-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/31/2022] [Indexed: 01/07/2023] Open
Abstract
Background Child marriage, defined as marriage before 18 years of age, is a violation of human rights and a marker of gender inequality. Growing attention to this issue on the global development agenda also reflects concerns that it may negatively impact health. We conducted a systematic review to synthesize existing research on the consequences of child marriage on health and to assess the risk of bias in this body of literature. Methods and findings We searched databases focused on biomedicine and global health for studies that estimated the effect of marrying before the age of 18 on any physical or mental health outcome or health behaviour. We identified 58 eligible articles, nearly all of which relied on cross-sectional data sources from sub-Saharan Africa or South Asia. The most studied health outcomes were indicators of fertility and fertility control, maternal health care, and intimate partner violence. All studies were at serious to critical risk of bias. Research consistently found that women who marry before the age of 18 begin having children at earlier ages and give birth to a larger number of children when compared to those who marry at 18 or later, but whether these outcomes were desired was not considered. Across studies, women who married as children were also consistently less likely to give birth in health care facilities or with assistance from skilled providers. Studies also uniformly concluded that child marriage increases the likelihood of experiencing physical violence from an intimate partner. However, research in many other domains, including use of contraception, unwanted pregnancy, and sexual violence came to divergent conclusions and challenge some common narratives regarding child marriage. Conclusions There are many reasons to be concerned about child marriage. However, evidence that child marriage causes the health outcomes described in this review is severely limited. There is more heterogeneity in the results of these studies than is often recognized. For these reasons, greater caution is warranted when discussing the potential impact of child marriage on health. We provide suggestions for avoiding common biases and improving the strength of the evidence on this subject. Trial registration The protocol of this systematic review was
registered with PROSPERO (CRD42020182652) in May 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12707-x.
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Affiliation(s)
- Suiqiong Fan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada. .,Institute for Health and Social Policy, McGill University, 2001 McGill College Avenue, Montreal, Quebec, H3A 1G1, Canada.
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Abstract
Child marriage, defined as marriage before 18 years of age, has harmful consequences for health and development and is an indicator of gender inequality. We used publicly available data from the 2000 and 2010 censuses to estimate the national and provincial-level prevalence of child marriage across mainland China. Between 2000 and 2010, the prevalence of child marriage rose from 2.41 percent to 2.85 percent among women and from 0.54 percent to 0.77 percent among men. The 2010 estimates are equivalent to roughly 1.8 million women and 0.5 million men. Child marriage was more common in western provinces among both girls and boys. Provincial prevalence estimates ranged from 0.44 percent in Beijing to 12.94 percent in Qinghai among girls. Among boys, estimates ranged from 0.13 percent in Beijing to 5.03 percent in Tibet. The gender gap widened across much of the country between censuses. Our results indicate that child marriage continues across mainland China despite laws that ostensibly prohibit the practice. They also draw attention to the global nature of child marriage as a threat to gender equality.
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Affiliation(s)
- Suiqiong Fan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Yue Qian
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute for Health and Social Policy, McGill University, Montreal, Canada
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Istifa MN, Efendi F, Wahyuni ED, Ramadhan K, Adnani QES, Wang JY. Analysis of antenatal care, intranatal care and postnatal care utilization: Findings from the 2017 Indonesian Demographic and Health Survey. PLoS One 2021; 16:e0258340. [PMID: 34637462 PMCID: PMC8509866 DOI: 10.1371/journal.pone.0258340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background and objective Maternal healthcare utilization by young women and adolescent girls is associated with maternal health outcomes and plays a critical role in reducing maternal mortality rates in low- and middle-income countries. This study sought to analyze current data on antenatal care (ANC), intranatal care (INC), and postnatal care (PNC) utilization with a focus on mothers aged 15–24 years in Indonesia. Methods This study was a secondary analysis of data from the 2017 Indonesian Demographic and Health Survey. The unit data analyzed 2,584 mothers aged 15–24 years who had delivered babies within the five-year period preceding the survey. Bivariate analysis and multiple logistic regression utilizing descriptive statistics were used to explore correlations between the independent variables and ANC, INC, and PNC visits. Results Among the mothers included in the study, the prevalence of service utilization was 90.9% for ANC, 79.4% for INC, and 68.9% for PNC. Women’s age, education level, number and birth order of children, difference in age between the mother and her husband, her husband’s occupation, wealth index, access to the health service, and regional factors were significantly associated with the utilization of ANC, INC, and PNC services. Conclusion This study provides insights for policymakers on how to strengthen healthcare policies and laws with the aim to improve maternal healthcare services for mothers aged 15–24 years. To improve maternal healthcare utilization among young mothers, national policy should focus on service equality, accessibility, and reliable implementation.
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Affiliation(s)
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | | | - Kadar Ramadhan
- Department of Midwifery, Poltekkes Kemenkes Palu, Palu, Indonesia
| | | | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Elnakib S, Hunersen K, Metzler J, Bekele H, Robinson WC. Child marriage among Somali refugees in Ethiopia: a cross sectional survey of adolescent girls and adult women. BMC Public Health 2021; 21:1051. [PMID: 34078326 PMCID: PMC8173891 DOI: 10.1186/s12889-021-11080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite child marriage receiving increased attention over the past two decades, research on child marriage in humanitarian settings remains scarce. This study sought to quantify child marriage among Somali adolescent girls residing in Kobe refugee camp in Ethiopia and to identify its correlates and consequences. METHODS A cross-sectional survey was conducted using multi-stage cluster-based sampling with probability proportional to size. We randomly sampled households that have at least one female aged 15-49 and at least one adolescent female aged 10-19. In addition to calculating the proportion of girls married under age 18, we used survival methods - namely Kaplan Meier graphs and Cox proportional hazard models - to identify risk factors associated with child marriage in this context. We also used descriptive statistics to describe marital age preferences among female adults and presented measures of important sexual and reproductive health indicators among married adolescent girls. RESULTS A total of 603 adult women were surveyed and a household roster was created with information on 3319 household members, of whom 522 were adolescent girls aged 15-19. Of those, 14% were currently married (95% Confidence Interval [CI] 0.11-0.18), and 11% were ever married under age 18 (95% CI 8-15%). Several variables were found to be significantly associated with hazard of child marriage including schooling, sex and employment status of head of household, as well as number of girls under age 18 in the childhood home.. Adult women tended to incorrectly identify minimum legal age at marriage and preferred low marital age for boys and girls - particularly in households of child brides. Among married adolescent girls, contraceptive use was very low (11%; 95% CI 4.94-22.40), and early childbearing was common (60%; 95% CI 45.56-72.89). CONCLUSIONS This research contributes to the evidence base on child marriage in humanitarian settings. Insights generated from this study have the potential to inform programs and interventions aiming to prevent and mitigate the impacts of this harmful practice.
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Affiliation(s)
- Shatha Elnakib
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Kara Hunersen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Hailu Bekele
- International Medical Corps, Addis Ababa, Ethiopia
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Solanke BL, Awoleye AF, Ikotun FF, Ogunjuyigbe PO. Timing of first marriage and women’s ability to negotiate safer sex in Nigeria. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1900559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Bola Lukman Solanke
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Abayomi Folorunso Awoleye
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Florence Folake Ikotun
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Peter Olasupo Ogunjuyigbe
- Faculty of Social Sciences, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Radu MC, Dumitrescu AI, Zaharia C, Boeru C, Pop-Tudose ME, Iancu CF, Chivu RD. Teenage Pregnancies and Childbirth Experience in Romania From the Midwives Point of View. Cureus 2021; 13:e13851. [PMID: 33717773 PMCID: PMC7954514 DOI: 10.7759/cureus.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/05/2022] Open
Abstract
In Romania, in 2017, the infant mortality rate was eight per thousand; with 41,000 women who had no medical visits during pregnancy; 18,500 were teenagers. Our objective was to analyze how many teen pregnancies were in an Obstetrics and Gynaecology Hospital from Romania over a two-year period and underline the role that midwives have in preventing teenage pregnancies. A descriptive study of a group of 343 childbearing teenagers out of 7020 childbearing women who gave birth in 2017-2018 is presented. The teenagers were evaluated by age, the number of pregnancies, birth complications, way of delivery, and place of origin. The involvement of the midwife was highlighted. From the total of 7020 analyzed cases, 4.8% (n=343) were teen pregnancies. Within this group, 4.37%(n=15)were already at the third birth and 89.79 (n=308)were un-investigated during the entire pregnancy. Sixty-eight point fifty-one percent (68.51%; n=235)of the teenagers gave birth with the aid of a midwife while 4.66 (n=16) gave birth with no medical attendance and experienced homebirth. All the teenagers that gave birth at home were from rural areas and not married. High teenage pregnancy rates are determined in Romania by the low level of information about sexuality and family planning at young ages. The midwives have the ability to help to resolve these problems if they were more allowed to be involved in these programs, especially in rural areas.
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Affiliation(s)
- Mihaela C Radu
- Birth Block, Obstetrics and Gynecology Hospital, Ploiesti, ROU
| | - Anca I Dumitrescu
- Physics and Pharmaceutical Informatics, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Corneliu Zaharia
- Biophysics Laboratory, "Stefan S Nicolau" Institute of Virology, Bucharest, ROU
| | - Calin Boeru
- Birth Block, Obstetrics and Gynecology Hospital, Ploiesti, ROU
| | - Melania E Pop-Tudose
- Obstetrics and Gynaecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Claudia F Iancu
- Nursing, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Razvan D Chivu
- Public Health Sciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
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Singh P, Singh KK, Singh P. Maternal health care service utilization among young married women in India, 1992-2016: trends and determinants. BMC Pregnancy Childbirth 2021; 21:122. [PMID: 33568078 PMCID: PMC7877063 DOI: 10.1186/s12884-021-03607-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. However, there is a paucity of studies focusing on young women in this context. This paper, therefore, aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India. METHODS The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992-93, 1998-99, 2005-06 and 2015-16. Young married women aged 15-24 years with at least one live birth in the 3 years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services. The significance level for all analyses was set at p ≤ 0.05. RESULTS The use of full ANC among young mothers increased from 27 to 46% in India, and from 9 to 28% in EAG (Empowered Action Group) states during 1992-2016. SBA utilization was 88 and 83% during 2015-16 by showing an increment of 20 and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed a significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, women belonging to scheduled caste (SC)/ scheduled tribe (ST) social group, and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time. CONCLUSIONS In India coverage of full ANC among young mothers remained unacceptably low, with a wide and persistent gap in utilization between EAG and non-EAG states since 1992. Targeted health policies should be designed to address low coverage of ANC and SBA among underprivileged young mothers and increased efforts should be made to ensure effective implementation of ongoing programs, especially in EAG states.
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Affiliation(s)
- Pooja Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Kaushalendra Kumar Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Pragya Singh
- Department of Statistics, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
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Saha R, Paul P. Institutional deliveries in India's nine low performing states: levels, determinants and accessibility. Glob Health Action 2021; 14:2001145. [PMID: 34914883 PMCID: PMC8682830 DOI: 10.1080/16549716.2021.2001145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the implementation of several national-level interventions, institutional delivery coverage remains unsatisfactory in India’s low performing states (LPS), leading to a high burden of maternal mortality. Objective This study investigates the levels, differentials, and determinants of institutional deliveries in LPS of India. The study also delineates a holistic understanding of barriers to delivery at health facilities and the utilization of the Janani Suraksha Yojana (JSY) specifically designed to improve maternal and child health of disadvantaged communities. Methods A cross-sectional study was conducted using data from the National Family Health Survey (NFHS)-4, 2015–16. The study was carried out over India’s nine LPS utilizing 112,518 women who had a living child in the past five years preceding the survey. Bivariate and multivariate regression analysis techniques were used to yield findings. Results Of the study sample, nearly three-quarters (74%) of women delivered in a health institution in the study area, with the majority delivered in public health facilities. The multivariate analysis indicates that women who lived in rural areas, belonged to disadvantaged social groups (e.g. Scheduled caste/tribes and Muslims), and those who married early (before 18 years) were less likely to utilize institutional delivery services. On the other hand, women’s education, household wealth, and exposure to mass media were found to be strong facilitators of delivering in a health facility. Meeting with a community health worker (CHW) during pregnancy emerged as an important predictor of institutional delivery in our study. Further, interaction analysis shows that women who reported the distance was a ‘big problem’ in accessing medical care had significantly lower odds of delivering at a health facility. Conclusions The study suggests emphasizing the quality of in-facility maternal care and awareness about the importance of reproductive health. Furthermore, strengthening sub-national policies specifically in underperforming states is imperative to improve institutional delivery coverage.
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Affiliation(s)
- Ria Saha
- Public Health Consultant, London, UK
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
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Barman B, Roy A, Zaveri A, Saha J, Chouhan P. Determining factors of institutional delivery in India: A study from National Family Health Survey-4 (2015–16). CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Socio-demographic factors influencing utilization of maternal health care services in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.12.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Solanke BL, Salau OR, Rahman SA, Popoola OE. Do the prevalence and correlates of adverse reproductive health outcomes differ by marriage cohorts? Evidence from a study of two marriage cohorts in Nigeria. Health Care Women Int 2020; 42:462-484. [PMID: 32865482 DOI: 10.1080/07399332.2020.1803874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The researchers examined the prevalence and correlates of adverse reproductive health outcomes among two cohorts of married women in Nigeria based on the 2018 Nigeria Demographic and Health Survey. A weighted sample size of 8,704 and 6,076 women were analyzed respectively for the child and delayed marriage cohorts. Our results showed differences in adverse reproductive health outcomes by marriage cohorts with higher prevalence in the child marriage cohort and also differences in the correlates of adverse reproductive health outcomes. Strategies to promote the uptake of reproductive health services, gender equity and women's empowerment across the different marriage cohorts are required.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Semiu Adebayo Rahman
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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25
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Duong DTT, Van Minh H, Long KQ, Ha NT, Trang NTT, Quang CH, Duc DM, Anh BTM, Hung PT, Nga NT, Ha BTT. The Utilization of Maternal Healthcare Services Among Ethnic Minority Populations in Vietnam. J Racial Ethn Health Disparities 2020; 8:723-731. [PMID: 32757144 DOI: 10.1007/s40615-020-00832-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have observed lower utilization of maternal healthcare services by ethnic minority groups in Vietnam compared with the majority Kinh community. This study sought to assess the utilization of maternal healthcare service-associated factors within 12 ethnic minority groups. METHOD The cross-sectional study enrolled 996 women from 12 ethnic minority groups in Vietnam in 2019. Women had pregnancy outcomes in the last 5 years. The two variables for maternal healthcare utilization were [1] a minimum of four antenatal contacts and [2] health facility-based delivery. We examined the association of individual characteristics of maternal healthcare services using multilevel modeling. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS This nationally representative study found that 34.1% of women from ethnic minority backgrounds had four or more antenatal contacts during pregnancy, ranging from 8.3% in Mong community to 80.2% in Cham An Giang. Most of the women (94.4%) delivered at health facilities. Factors independently correlated with having fewer than four antenatal contacts included being illiterate, early marriage, unemployment, religious affiliation, household economy, and distance to the nearest health facility. Factors significantly associated with home delivery were living in the most disadvantaged areas and having fewer than four antenatal contacts. CONCLUSION Substantial inequity exists in antenatal coverage both within ethnic minority groups and between socio-economic groups. The low coverage of having at least four antenatal contacts and its' correlates with facility-based delivery suggests that the government should focus efforts on increasing the number of antenatal contacts for ethnic minority women.
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Affiliation(s)
- Doan Thi Thuy Duong
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam.
| | - Hoang Van Minh
- Faculty of Health Management and Policy, Hanoi University of Public Health, Hanoi, Vietnam
| | - Khuong Quynh Long
- Center for Population Health Center, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thanh Ha
- Faculty of Environmental and Occupational Health, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thi Thu Trang
- Department of Postgraduate Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Cao Huu Quang
- Department of Examination & Quality Assurance, Hanoi University of Public Health, Hanoi, Vietnam
| | - Duong Minh Duc
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bui Thi My Anh
- Faculty of Health Management and Policy, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phung Thanh Hung
- Faculty of Health Management and Policy, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Thi Nga
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Bui Thi Thu Ha
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
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Paul PL, Pandey S. Factors influencing institutional delivery and the role of accredited social health activist (ASHA): a secondary analysis of India human development survey 2012. BMC Pregnancy Childbirth 2020; 20:445. [PMID: 32758171 PMCID: PMC7405437 DOI: 10.1186/s12884-020-03127-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background India has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. We examined the determinants of institutional delivery and the role of the ASHA worker in shaping choice regarding place of delivery. Methods We used data from the India Human Development Survey-II conducted in 2011–12, and extracted an analytic sample of women (N = 8711) who reported having at least one child since 2005. Logistic regression was used to examine influence of socio-demographic factors, frequency of antenatal care (ANC) contacts and exposure to ASHA worker on institutional delivery. Results About 15% of the respondents had eight or more ANC contacts. The odds of having an institutional delivery were higher among those respondents who had 8 or more ANC contacts (OR = 3.39, p < 0.001, 95% CI: 2.26, 5.08), and those who had 4–7 ANC contacts (OR = 1.72, p < 0.001, 95% CI: 1.48, 1.99) as compared to those with less than 4 ANC contacts. About 26% of the respondents had any exposure to an ASHA worker. After controlling for ANC contacts, these respondents had three times the odds of institutional delivery (OR = 3.04, p < 0.001, 95% CI: 2.37, 3.89) compared to those who had no exposure to ASHA workers. Further, several sociodemographic variables were associated with institutional delivery. While age of spouse, age at marriage, level of education and urban residence were positively associated with institutional delivery; age of respondent and number of children were inversely associated with institutional delivery. Conclusions Both frequency of ANC contacts and exposure to ASHA worker independently emerge as important determinants of institutional delivery. Furthermore, ASHA workers may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and institutional delivery.
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Affiliation(s)
- Pooja L Paul
- Boston College, School of Social Work, McGuinn Hall 204, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Shanta Pandey
- Boston College, School of Social Work, McGuinn Hall 204, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Laksono AD, Rukmini R, Wulandari RD. Regional disparities in antenatal care utilization in Indonesia. PLoS One 2020; 15:e0224006. [PMID: 32053621 PMCID: PMC7018075 DOI: 10.1371/journal.pone.0224006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/11/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in ≥4 ANC visits during pregnancy in Indonesia. METHODS Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. RESULTS With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making ≥4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making ≥4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making ≥4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making ≥4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance. CONCLUSION There were disparities in ANC utilization between the various regions of Indonesia. The structured policy is needed to reach regions that have low coverage of ≥4 ANC. Policymakers need to use the results of this study to take the necessary policies. Policies that focus on service equality to reduce disparities.
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Affiliation(s)
- Agung Dwi Laksono
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
| | - Rukmini Rukmini
- National Institute of Health Research and Development, The Ministry of Health, Jakarta, The Republic of Indonesia
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