Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries

Adolescent maternal health services utilization and associated barriers in Sub-Saharan Africa: A comprehensive systematic review and meta-analysis before and during the sustainable development goals

Introduction

Effective and adequate maternal health service utilization is critical for improving maternal and newborn health, reducing maternal and perinatal mortality, and important to achieve global sustainable development goals (SDGs). The purpose of this systematic review was to assess adolescent maternal health service utilization and its barriers before and during SDG era in Sub-Saharan Africa (SSA).

Methods

Systematic review of published articles, sourced from multiple electronic databases such as Medline, PubMed, Scopus, Embase, CINAHL, PsycINFO, Web of Science, African Journal Online (AJOL) and Google Scholar were conducted up to January 2024. Assessment of risk of bias in the individual studies were undertaken using the Johanna Briggs Institute (JBI) quality assessment tool. The maternal health service utilization of adolescent women was compared before and after adoption of SDGs. Barriers of maternal health service utilization was synthesized using Andersen's health-seeking model. Meta-analysis was carried out using the STATA version 17 software.

Results

Thirty-eight studies from 15 SSA countries were included in the review. Before adoption of SDGs, 38.2 % (95 % CI: 28.5 %, 47.9 %) adolescents utilized full antenatal care (ANC) and 44.9 % (95%CI: 26.2, 63.6 %) were attended by skilled birth attendants (SBA). During SDGs, 42.6 % (95 % CI: 32.4 %, 52.8 %) of adolescents utilized full ANC and 53.0 % (95 % CI: 40.6 %, 65.5 %) were attended by SBAs. Furthermore, this review found that adolescent women's utilization of maternal health services is influenced by various barriers, including predisposing, enabling, need, and contextual factors.

Conclusions

There was a modest rise in the utilization of ANC services and SBA from the pre-SDG era to the SDG era. However, the level of maternal health service utilization by adolescent women remains low, with significant disparities across SSA regions and multiple barriers to access services. These findings indicate the importance of developing context-specific interventions that target adolescent women to achieve SDG3 by the year 2030.

Quality of antenatal care in 13 sub-Saharan African countries in the SDG era: evidence from Demographic and Health Surveys

BACKGROUND

Maternal and neonatal mortality remains high in sub-Saharan Africa (SSA) with women having 1 in 36 lifetime risk. The WHO launched the new comprehensive recommendations/guidelines on antenatal care (ANC) in 2016, which stresses the essence of quality antenatal care. Consequently, the objective of this cross-sectional study is to investigate the quality of ANC in 13 SSA countries.

METHODS

This is a cross-sectional study that is premised on pre-existing secondary data, spanning 2015 to 2021. Data for the study was obtained from the Measure DHS Programme and included a total of 79,725 women aged 15-49 were included. The outcome variable was quality ANC and it was derived as a composite variable from four main ANC services: blood pressure taken, urine taken, receipt of iron supplementation and blood sample taken. Thirteen independent variables were included and broadly categorised into individual and community-level characteristics. Descriptive statistics were used to present the proportion of women who had quality ANC across the respective countries. A two-level multilevel regression analysis was conducted to ascertain the direction of association between quality ANC and the independent variables.

RESULTS

The overall average of women who had quality ANC was 53.8% [CI = 51.2,57.5] spanning from 82.3% [CI = 80.6,85.3] in Cameroon to 11% [CI = 10.0, 11.4] in Burundi. Women with secondary/higher education had higher odds of obtaining quality ANC compared with those without formal education [aOR = 1.23, Credible Interval [Crl] = 1.10,1.37]. Poorest women were more likely to have quality ANC relative to the richest women [aOR = 1.21, Crl = 1.14,1.27]. Married women were more likely to receive quality ANC relative to those cohabiting [aOR = 2.04, Crl = 1.94,3.05]. Women who had four or more ANC visits had higher odds of quality ANC [aOR = 2.21, Crl = 2.04,2.38]. Variation existed in receipt of quality ANC at the community-level [σ2 = 0.29, Crl = 0.24,0.33]. The findings also indicated that a 36.2% variation in quality ANC is attributable to community-level factors.

CONCLUSION

To achieve significant improvement in the coverage of quality ANC, the focus of maternal health interventions ought to prioritise uneducated women, those cohabiting, and those who are unable to have at least four ANCs. Further, ample recognition should be accorded to the existing and potential facilitators and barriers to quality ANC across and within countries.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Individual and community-level factors associated with women's utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BACKGROUND

Over time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women's utilization of postnatal care services in Uganda.

METHODS

Secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.

RESULTS

The result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78-2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01-1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.

CONCLUSION

This study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries

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.

Factors Associated with Maternal Healthcare Utilization Before and After Delivery Among Migrant Pregnant Women in China: An Observational Study

Background

Effective healthcare utilization throughout pregnancy is essential in protecting mother and child health, but the maternal healthcare utilization and its associated factors among migrant women are still underexplored.

Methods

The data came from the 2018 China Migrants Dynamic Survey. Our analysis included 6337 pregnant migrant women. Prenatal healthcare utilization comprises receiving at least 5 antenatal care (ANC) times and establishing the maternal health record within the first 12 weeks of pregnancy. Postnatal healthcare utilization refers to whether an individual received a postpartum visit and a physical health examination within 28 days and 42 days following delivery. A multivariate binary logit model was employed to investigate the factors related to maternal healthcare utilization.

Results

67.15% of the 6337 participants established health records within the first 12 weeks of pregnancy, and 88.35% received at least five ANC visits. 76.88% and 84.20% of migrant pregnant women received a postpartum visit and a health examination respectively. Age was positively correlated with receiving at least five ANC visits (OR:1.245, 95% CI: 1.038-1.493), a postpartum visit within 28 days (OR: 1.272, 95% CI: 1.107-1.460) and a physical examination within 42 days after delivery (OR=1.174, 95% CI: 1.002-1.376). Education, household income, health insurance and maternal health education were positively associated with prenatal and postnatal healthcare utilization (P<0.05). Number of Children negatively correlated with ANC times (OR: 0.742, 95% CI: 0.613-0.898) and receiving health examination after delivery (OR: 0.720, 95% CI: 0.610-0.849).

Conclusion

There is still potential for improvement in the maternal healthcare utilization, particularly in postnatal healthcare. Strengthening the follow-up, focusing on those who are younger, have lower socioeconomic status, and are members of ethnic minorities, and continuing to strengthen maternal health education for them can promote the maternal healthcare utilization before and after delivery.

Matters of Gender and Social Disparities Regarding Postnatal Care Use Among Nepalese Women: A Cross-Sectional Study in Morang District

Objective

The study compares the uses of postnatal care (PNC) and women's autonomy gradients across social caste and used intersectionality concepts to estimate odds ratio of women's autonomy and social caste on complete PNC.

Methods

A community-based cross-sectional study among 600 women aged 15-49 years who had at least one child younger than the age of 2 years in Morang District, Nepal, was conducted from April to July 2019. PNC, women's autonomy (decision-making power, freedom of movement, and control over finances) and social caste were collected by both methods. Multivariable logistic regressions were used to determine associations between women's autonomy, social caste, and complete PNC.

Results

Complete PNC totaled 13.5% of respondents. About one-fourth of respondents reported poor overall autonomy; however, non-Dalit demonstrated higher autonomy than Dalit. Non-Dalit exhibited greater odds of complete PNC by four times. Women exhibited high women's autonomy in decision-making power, control over finance, and freedom of movement and have greater odds of complete PNC than low autonomy by 17, 3, and 7 times, respectively.

Conclusion

The study raises awareness of intersectionality (gender and social caste), relating to maternal health in caste-based system countries. To improve maternal health outcomes, health care personnel should identify and systematically address barriers that women of lower-caste membership face and offer these women appropriate advice or resources to obtain care. A multilevel change program that involves different actors like husbands and community leaders is needed for improving women's autonomy and lessening stigmatized perceptions, attitudes, or practices toward non-Dalit caste-members.

Utilization of Maternal Healthcare Services among Adolescent Mothers in Indonesia

Providing maternal healthcare services is one of the strategies to decrease maternal mortality. Despite the availability of healthcare services, research investigating the utilization of healthcare services for adolescent mothers in Indonesia is still limited. This study aimed to examine the utilization of maternal healthcare services and its determinants among adolescent mothers in Indonesia. Secondary data analysis was performed using the Indonesia Demographic and Health Survey 2017. Four hundred and sixteen adolescent mothers aged 15-19 years were included in the data analysis of frequency of antenatal care (ANC) visits and place of delivery (home/traditional birth vs. hospital/birth center) represented the utilization of maternal healthcare services. Approximately 7% of the participants were 16 years of age or younger, and over half lived in rural areas. The majority (93%) were having their first baby, one-fourth of the adolescent mothers had fewer than four ANC visits and 33.5% chose a traditional place for childbirth. Pregnancy fatigue was a significant determinant of both antenatal care and the place of delivery. Older age (OR 2.43; 95% CI 1.12-5.29), low income (OR 2.01; 95% CI 1.00-3.74), pregnancy complications of fever (OR 2.10; 95% CI 1.31-3.36), fetal malposition (OR 2.01; 95% CI1.19-3.38), and fatigue (OR 3.63; 95% CI 1.27-10.38) were significantly related to four or more ANC visits. Maternal education (OR 2.14; 95% CI 1.35-3.38), paternal education (OR 1.62; 95% CI 1.02-2.57), income level (OR 2.06; 95% CI 1.12-3.79), insurance coverage (OR 1.68; 95% CI 1.11-2.53), and presence of pregnancy complications such as fever (OR 2.03; 95% CI 1.33-3.10), convulsion (OR 7.74; 95% CI 1.81-32.98), swollen limbs (OR 11.37; 95% CI 1.51-85.45), and fatigue (OR 3.65; 95% CI 1.50-8.85) were significantly related to the place of delivery. Utilization of maternal healthcare services among adolescent mothers was determined by not only socioeconomic factors but also pregnancy complications. These factors should be considered to improve the accessibility, availability, and affordability of healthcare utilization among pregnant adolescents.

Determinants of maternal healthcare utilisation among pregnant women in Southern Ethiopia: a multi-level analysis

BACKGROUND

Despite efforts to make maternal health care services available in rural Ethiopia, utilisation status remains low. Therefore, this study aimed to assess maternal health care services' status and determinants in rural Ethiopia.

METHODS

The study used quasi-experimental pre- and post-comparison baseline data. A pretested, semi-structured, interviewer-administered questionnaire was used to collect data. A multilevel, mixed-effects logistic regression was used to identify individual and communal level factors associated with utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). The adjusted odds ratio (AOR) and corresponding 95% confidence intervals (CI) were estimated with a p-value of less than 0.05, indicating statistical significance.

RESULTS

Seven hundred and twenty-seven pregnant women participated, with a response rate of 99.3%. Four hundred and sixty-one (63.4%) of the women visited ANC services, while 46.5% (CI: 42-50%) of births were attended by SBA, and 33.4% (CI: 30-36%) had received PNC. Women who reported that their pregnancy was planned (aOR = 3.9; 95% CI: 1.8-8.3) and were aware of pregnancy danger signs (aOR = 6.8; 95% CI: 3.8-12) had a higher likelihood of attending ANC services. Among the cluster-level factors, women who lived in lowlands (aOR = 4.1; 95% CI: 1.1-14) and had easy access to transportation (aOR = 1.9; 95% CI: 1.1-3.7) had higher odds of visiting ANC services. Moreover, women who were employed (aOR = 3.1; 95% CI: 1.3-7.3) and attended ANC (aOR = 3.3; 95% CI: 1.8-5.9) were more likely to have SBA at delivery. The likelihood of being attended by SBA during delivery was positively correlated with shorter travel distances (aOR = 2.9; 95% CI: 1.4-5.8) and ease of access to transportation (aOR = 10; 95% CI: 3.6-29) to the closest healthcare facilities. Being a midland resident (aOR = 4.7; 95% CI: 1.7-13) and having SBA during delivery (aOR = 2.1; 95% CI: 1.2-3.50) increased the likelihood of attending PNC service.

CONCLUSIONS

Overall, maternal health service utilisation is low in the study area compared with the recommended standards. Women's educational status, awareness of danger signs, and pregnancy planning from individual-level factors and being a lowland resident, short travel distance to health facilities from the cluster-level factors play a crucial role in utilising maternal health care services. Working on women's empowerment, promotion of contraceptive methods to avoid unintended pregnancy, and improving access to health care services, particularly in highland areas, are recommended to improve maternal health service utilisation.

Which communication technology is effective for promoting reproductive health? Television, radio, and mobile phones in sub-Saharan Africa

The use of radio and television as means to spread reproductive health awareness in Sub-Saharan Africa has been extensive, and its impacts significant. More recently, other means of communication, such as mobile phones, have received the attention of researchers and policy makers as health communication tools. However, evidence on which of the two types of communication (i.e. passive communication from TV/radio, or active communication through phones) is more effective in fostering better reproductive health choices is sparse. This study aims to identify the potential influence of TV or radio ownership as opposed to cell phone ownership on contraceptive use and access to maternal healthcare. Cross-sectional, individual analysis from eleven high-maternal mortality Sub-Saharan African countries is conducted. A total of 78,000 women in union are included in the analysis. Results indicate that ownership of TV or radio is more weakly correlated to better outcomes than mobile phone ownership is. Results are stronger for lower educated women and robust across all levels of wealth. Interestingly, the study also finds that decision-making power is a relevant mediator of cell phone ownership on contraceptive use, but not on maternal healthcare access. A key takeaway from the study is that, while the role of television and radio appears to have diminished in recent years, mobile phones have become a key tool for empowerment and behavioural change among Sub-Saharan African women. Health communication policies should be designed to take into account the now prominent role of mobile phones in affecting health behaviours.

Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria

Introduction

Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services.

Methods

The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate.

Results

Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead.

Conclusion

The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.

Analysis of antenatal care, intranatal care and postnatal care utilization: Findings from the 2017 Indonesian Demographic and Health Survey

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.

Utilisation of Skilled Birth Attendant in Low- and Middle-Income Countries: Trajectories and Key Sociodemographic Factors

Reducing the maternal mortality ratio (MMR) in low- and middle-income countries (LMICs) remains a huge challenge. Maternal mortality is mostly attributed to low coverage of maternal health services. This study investigated the trajectories and predictors of skilled birth attendant (SBA) service utilisation in LMIC over the past two decades. The data was sourced from standard demographic and health surveys which included four surveys on women with livebirth/s from selected countries from two regions with a pooled sample of 56,606 Indonesian and 63,924 Nigerian respondents. Generalised linear models with quasibinomial family of distributions were fitted to investigate the association between SBA utilisation and sociodemographic factors. Despite a significant improvement in the last two decades in both countries, the change was slower than hope for, and inconsistent. Women who received antenatal care were more likely to use an SBA service. SBA service utilisation was significantly more prevalent amongst literate women in Indonesia (AOR = 1.39, 95% CI: 1.24–1.54) and Nigeria (AOR = 1.41, 95% CI: 1.31–1.53) than their counterparts. The disparity based on geographic region and social factors remained significant over time. Given the significant disparities in SBA utilisation, there is a strong need to focus on community- and district-level interventions that aim at increasing SBA utilisation.

The impact of national health promotion policy on stillbirth and maternal mortality in South Africa

OBJECTIVES

In 2015, the South African government implemented the national health promotion policy (NHPP), intending to reduce stillbirth and maternal mortality. This study was designed to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African population and immigrant citizens.

STUDY DESIGN

This was a panel analysis using secondary data issued by Statistic South Africa-Vital Statistics.

METHODS

The author exploited the changes in smoking status that the NHPP exerted between 2015 and 2017. The author then builds credible control and treatment groups based on smoking status for both groups. Women who quitted smoking post-NHPP implementation were considered as the treatment group. Women who persisted with smoking post-NHPP implementation were classified as the control group. The author then used a Two-stage Least Squared Model to quantify the impact of the NHPP on stillbirth and maternal mortality in both the South African and immigrant populations.

RESULTS

The model shows that NHPP averts stillbirths by 8.36% in the South African population residing in the urban areas and by 2.84% in the rural segments of the country. NHPP averts South African maternal mortalities by 20.88% in urban areas and by 15.60% in the rural segments of the country.Regarding the immigrant population, the model shows that NHPP averts immigrant's stillbirths by 7.61% in the urban areas and by 2.79% in the rural segments of the country. In addition, NHPP averts immigrant maternal mortalities by 19.22% in the urban areas and by 13.04% in the rural segments of the country.

CONCLUSIONS

NHPP reduces stillbirth and maternal mortality outcomes slightly biased toward the South African population. These inequalities reflect immigrant's lack of response to the NHPP framework and inadequate access to the South African health system.

Does exposure of mass media associate with utilisation of ANC services? A trend analysis from Nepal demographic and health surveys

The study analysed antenatal care (ANC) services usage trends related to exposure to mass media based upon data from three Nepal Demographic and Health Surveys [NDHS] conducted in 2006, 2011, and 2016. Total 12,212 women aged 15-49 having live births within five years preceding each survey included in the study. Most independent variables were found to be associated with utilisation of ANC services. For example, exposure to TV illustrated an increasing services trend. Seventy-three percent of the women had exposure to Radio followed by TV (65%), and newspaper (25%). All three media were significantly associated with ANC services in all surveys (p < 0.05). High exposure to Newspapers were (2.5 times, 95%CI: 1.93-3.19), Radio (1.3 times, 95%CI: 1.13-1.46), and TV (1.6 times, 95%CI: 1.36-1.76) more likely to result in adequate (≥4) ANC visits. Age and age at marriage; caste and educational status of women; place of residence; wealth status; and women's decision-making autonomy were significant predictors for adequate ANC visits. ANC services utilisation trends increased gradually, but not satisfactory. Most socio-demographic variables were also significant predictors for utilizing ANC services. All these predictors should be used to guide ANC services promotion policies and interventions.

The determinant of healthcare childbirth among young people in Indonesia

Background: Young people is a vulnerable period of the emergence of various problems that may occur especially to those who are pregnant. The study was aimed to analyze the determinants of healthcare childbirth among young people in Indonesia in 2017. Design and Methods: The samples of this study were young people (15-24 yo.) who labored in the last 5 years, and there were 3,235 female young people involved. The study analyzed some variables, such as childbirth healthcare, a type of residence, age, education, employment, marital, parity, wealth, insurance, the autonomy of family finances, the autonomy of health, knowledge of pregnancy danger signs, and ANC. The data were analyzed by binary logistic regression. Results: Young people in urban were 2.23 times more likely to attend healthcare childbirth than those in rural (95%CI 1.84-2.70). Young people who completed secondary education were 4.12 times more likely to undergo delivery care than no education (95% CI 1.51-11.23). The richest were 5.60 times more likely to experience delivery care than the poorest (95%CI 3.52-8.93). Health insurance gave 1.44 possibilities for undergoing labor and delivery care (95%CI 1.22-1.70). Besides, knowing the danger signs of pregnancy allowed 1.50 times the possibilities for them to access labor and delivery care (95%CI 1.27-1.78). Young people with ANC visits of ≥4 times had more 1.68 times possibilities for taking healthcare childbirth compared to those with that of <4 times (95%CI 1.38-2.06). Conclusions: The study concluded that the determinants of healthcare childbirth among female adolescents in Indonesia included a residence, education, wealth, insurance, knowledge of pregnancy danger signs, and ANC.

Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman's right to safe delivery is critical for reducing the maternal mortality rate, especially in Indonesia. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence (OR: 0.49, 95% CI: 0.36-0.66), good composite labor force participation (OR: 1.47, 95% CI: 1.15-1.89), and a good attitude towards domestic violence (OR: 1.33, 95% CI: 1.04-1.69) were found to be significantly associated with facility-based delivery. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), husband/partner having a non-agricultural occupation (OR: 1.35, 95% CI: 1.00-1.81), being in the richest wealth quintile (OR: 15.69, 95% CI: 5.53-44.50), and three other factors were found to be significantly associated with skilled assistance delivery. Conclusions: Safe delivery and facility-based delivery among women in the eastern part of Indonesia were determined by several individual and household factors. An open innovation and partnership process that engages the full range of stakeholders should be developed based on local needs.

Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman's right to safe delivery is critical for reducing the maternal mortality rate. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used a secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence, good composite labor force participation, and a good attitude towards domestic violence were found to be significantly associated with delivery at health facility. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), being in the richest wealth quintile, and four other factors were found to be significantly associated with the assistance of skilled birth attendants. Conclusions: This research extends our knowledge on the determinants of safe delivery among women in the eastern part of Indonesia. This study revealed that the economic status of household remains an important issue in improving safe delivery among women in eastern part of Indonesia. An open innovation and partnership process to improve safe delivery program that engages the full range of stakeholders should be developed based on economic situation.