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Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review. BMC Womens Health 2024; 24:325. [PMID: 38840156 PMCID: PMC11151574 DOI: 10.1186/s12905-024-03177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs). METHODS In this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O'Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method. RESULTS The main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services. CONCLUSIONS The evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.
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Affiliation(s)
- Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyede Maryam Najibi
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Razavi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
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Ladak Z, Grewal N, Kim MO, Small S, Leber A, Hemani M, Sun Q, Hamza DM, Laur C, Ivers NM, Falenchuk O, Volpe R. Equity in prenatal healthcare services globally: an umbrella review. BMC Pregnancy Childbirth 2024; 24:191. [PMID: 38468220 PMCID: PMC10926563 DOI: 10.1186/s12884-024-06388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. METHODS For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. RESULTS The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. CONCLUSIONS This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.
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Affiliation(s)
- Zeenat Ladak
- University of Toronto, Toronto, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada.
| | | | | | | | | | | | - Qiuyu Sun
- University of Alberta, Edmonton, Canada
| | | | - Celia Laur
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
| | - Noah M Ivers
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
- Women's College Hospital, Toronto, Canada
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Khalid A, Haider KA, Ahmer H, Noorani S, Hoodbhoy Z. Why do women still give birth at home; perceptions of Pakistani women and decision-makers from marginalized communities. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002217. [PMID: 37831638 PMCID: PMC10575520 DOI: 10.1371/journal.pgph.0002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/10/2023] [Indexed: 10/15/2023]
Abstract
In low- and middle-income countries (LMICs), maternal and newborn mortality is high due to the high prevalence of home births. Understanding the reasons behind this behavior is essential for improving maternal and newborn outcomes. Therefore, a qualitative exploratory study was conducted in a peri-urban community in Karachi, Pakistan to understand the perceptions of pregnant women who delivered at home despite receiving antenatal care and the perceptions of their decision-makers regarding this behavior. In-depth interviews were conducted with 15 randomly sampled women who chose to deliver at home after receiving antenatal care at a health facility, as well as 15 family members who were purposively identified as decision-makers by the women themselves. Thematic analysis was performed to explore the perceptions, myths, and cultural beliefs about homebirths as well as women's decision-making power related to childbirth. The three main themes identified showed that traditional beliefs and practices, poverty and gender inequality, and poor healthcare systems significantly influence the preference for childbirth. Traditional beliefs and practices, including religious and cultural beliefs, played a role in perceiving childbirth as a natural process best managed at home. The presence of traditional birth attendants who provide personalized care and emotional support further reinforced this preference. Gender inequalities, including limited access to mobile phones and women's caregiving roles, were identified as barriers to seeking formal healthcare at the time of delivery. Additionally, poor experiences with the formal healthcare system, such as the poor attitude of formal healthcare workers and fear of medical interventions, also contributed to the decision to deliver at home. The study highlighted the complex interplay between traditional/religious beliefs, gender inequalities, and healthcare experiences in shaping the decision to deliver at home despite receiving ANC services in marginalized settings. Addressing these factors is necessary for promoting facility-based delivery and improving maternal and neonatal outcomes in LMICs.
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Affiliation(s)
- Ayesha Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kaniz Amna Haider
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Hareem Ahmer
- Data and Digital Department, Vital Pakistan Trust, Karachi, Pakistan
| | - Sahir Noorani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Silva M, Anaba U, Jani Tulsani N, Sripad P, Walker J, Aisiri A. Gender-Based Violence Narratives in Internet-Based Conversations in Nigeria: Social Listening Study. J Med Internet Res 2023; 25:e46814. [PMID: 37713260 PMCID: PMC10541644 DOI: 10.2196/46814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Overcoming gender inequities is a global priority recognized as essential for improved health and human development. Gender-based violence (GBV) is an extreme manifestation of gender inequities enacted in real-world and internet-based environments. In Nigeria, GBV has come to the forefront of attention since 2020, when a state of emergency was declared due to increased reporting of sexual violence. Understanding GBV-related social narratives is important to design public health interventions. OBJECTIVE We explore how gender-related internet-based conversations in Nigeria specifically related to sexual consent (actively agreeing to sexual behavior), lack of consent, and slut-shaming (stigmatization in the form of insults based on actual or perceived sexuality and behaviors) manifest themselves and whether they changed between 2017 and 2022. Additionally, we explore what role events or social movements have in shaping gender-related narratives in Nigeria. METHODS Social listening was carried out on 12,031 social media posts (Twitter, Facebook, forums, and blogs) and almost 2 million public searches (Google and Yahoo search engines) between April 2017 and May 2022. The data were analyzed using natural language processing to determine the most salient conversation thematic clusters, qualitatively analyze time trends in discourse, and compare data against selected key events. RESULTS Between 2017 and 2022, internet-based conversation about sexual consent increased 72,633%, from an average 3 to 2182 posts per month, while slut-shaming conversation (perpetrating or condemning) shrunk by 9%, from an average 3560 to 3253 posts per month. Thematic analysis shows conversation revolves around the objectification of women, poor comprehension of elements of sexual consent, and advocacy for public education about sexual consent. Additionally, posters created space for sexual empowerment and expressions of sex positivity, pushing back against others who weaponize posts in support of slut-shaming narrative. Time trend analysis shows a greater sense of empowerment in advocating for education around the legal age of consent for sexual activity, calling out double standards, and rejecting slut-shaming. However, analysis of emotions in social media posts shows anger was most prominent in sexual consent (n=1213, 73%) and slut-shaming (n=226, 64%) posts. Organic social movements and key events (#ArewaMeToo and #ChurchToo, the #SexforGrades scandal, and the #BBNaija television program) played a notable role in sparking discourse related to sexual consent and slut-shaming. CONCLUSIONS Social media narratives are significantly impacted by popular culture events, mass media programs, social movements, and micro influencers speaking out against GBV. Hashtags, media clips, and other content can be leveraged effectively to spread awareness and spark conversation around evolving gender norms. Public health practitioners and other stakeholders including policymakers, researchers, and social advocates should be prepared to capitalize on social media events and discourse to help shape the conversation in support of a normative environment that rejects GBV in all its forms.
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Affiliation(s)
- Martha Silva
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Udochisom Anaba
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | | | - Pooja Sripad
- Population Council, Washington, DC, United States
| | | | - Adolor Aisiri
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, Abuja, Nigeria
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Adebowale AS, Palamuleni ME. Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors. BMC Womens Health 2023; 23:492. [PMID: 37715218 PMCID: PMC10504785 DOI: 10.1186/s12905-023-02640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria. METHODS This cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05). RESULTS Mean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40-49 years compared to the younger women in age group 20-29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14-1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63-2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women. CONCLUSIONS A high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.
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Affiliation(s)
- A S Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria.
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa.
| | - M E Palamuleni
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa
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Udenigwe O, Okonofua FE, Ntoimo LFC, Yaya S. Seeking maternal health care in rural Nigeria: through the lens of negofeminism. Reprod Health 2023; 20:103. [PMID: 37461037 DOI: 10.1186/s12978-023-01647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Feminist scholarship is acutely aware that health is not dependent on behavioural choices alone but on interlocking social determinants that affect people's capacity to lead healthy lives. Women are situated within social structures that impact their health. but there is limited engagement with interpretive tools such as feminist theories that centre the realities of African women, particularly in the context of maternal health. It is imperative that women's control over their reproductive health and autonomy in seeking care, particularly skilled maternal healthcare are understood within this context. This study seeks to examine pregnant women's socio-cultural realities in a Nigerian context and in congruence with articulations of African feminism. Feminist scholarship acknowledges that women are situated within social structures that impact their health. Therefore, this paper seeks to examine pregnant women's socio-cultural realities in a Nigerian context and in congruence with articulations of African feminism. METHOD This is a cross-sectional qualitative study of a total of 64 participants: 39 women and 25 men in Ewato and Okpekpe communities, two Local Government Areas of Edo State in southern Nigeria. The study presents findings from eight sex-and-age desegregated focus group discussions. This study reports on emergent data related to women's decision-making in accessing skilled maternal care. Data were transcribed and translated to English. Using the NVivo 1.6 software, data were coded and analyzed using a conventional approach to content analysis. RESULTS Findings describe ways in which women negotiate authority by ascribing the role of decision-maker to their men spouses while maintaining influence over their pregnancy healthcare decisions and actions. Negofeminism's concepts of alliance, community and connectedness were highlighted through men's constructive involvement in maternal health. Furthermore, women were shown to maneuver patriarchal norms to gain control of their healthcare decisions. CONCLUSION This study offers a different narrative from the dominant view of non-Western women, specifically African women, as oppressed passive victims who are ineffectual in taking charge of their health. From the perspective of negofeminism, women navigate patriarchal environments to yield the best possible maternal health outcomes. The current study can be useful in informing policy and programming that acknowledges women's social embeddedness.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.
| | - Friday E Okonofua
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
- Centre for Excellence in Reproductive Health Innovation, Benin City, Nigeria
| | - Lorretta F C Ntoimo
- Federal University Oye-Ekiti, Km 3 Oye-Are Road, P. M. B. 373, Oye-Ekiti, Ekiti State, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Tesha J, Fabian A, Mkuwa S, Misungwi G, Ngalesoni F. The role of gender inequities in women's access to reproductive health services: a population-level study of Simiyu Region Tanzania. BMC Public Health 2023; 23:1111. [PMID: 37296416 PMCID: PMC10251643 DOI: 10.1186/s12889-023-15839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Amref Health Africa, with support from Global Affairs Canada, examines if women's access to reproductive health services in Tanzania is affected by Gender social norms, decision-making power, roles and responsibility, and access to resources in relation to the utilization of reproductive Health Services in Tanzania. A Gender Need Assessment (GNA) was conducted in five districts in ' 'Tanzania Simiyu Region to improve the infrastructure, supply, quality, and demand for integrated Reproductive, Maternal, Newborn, and Child and Adolescent Health (RMNCAH), Nutrition, and Water, Sanitation, and Hygiene (WASH) services. The analysis identifies gender as a fundamental maternal and child health driver through existing gender inequality at the household and community levels that dictates women's status. METHODS The qualitative assessment involved data collected from gender- and age-desegregated focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants in three districts; Bariadi, Busega, and Meatu, in Simiyu region, Tanzania. Participants comprised 8-10 married women and men, unmarried women and men, and adolescent boys and girls. A total of 129 participants were involved in the FGDs. RESULTS This paper reports the critical drivers influencing gender inequality in Simiyu by detailing how Gender inequality affected women's access to reproductive health care in relation to; gender social norms, decision-making power, access to resources at the household and community level, roles and responsibilities, including men's and 'boys' roles are more valued than the roles and responsibilities of women and girls resulted to limited free time to do things for themselves, such as visiting the health facilities for RMNCAH. CONCLUSIONS This paper explored gender-based enablers and/or barriers influencing women and girls' realization of their sexual and reproductive health and rights. It was found that social norms, decision-making powers, and lack of access to and control over resources presented as key barriers. In contrast, continuous community sensitization and increased scope of women's participation in decision-making served as enabling environment to overcome gender inequities that influence woman's use of RMNCAH services in Tanzania. Such insights will shape interventions geared towards valuing differences in a manner that overcome gender inequities that influence woman's use of RMNCAH services in Tanzania.
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Affiliation(s)
- Jane Tesha
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Agatha Fabian
- Department of Public Health, College of Health Sciences, Dodoma University, P.O.Box 395, Dodoma, Tanzania
| | - Serafina Mkuwa
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Gaspery Misungwi
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Frida Ngalesoni
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
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Ouahid H, Mansouri A, Sebbani M, Nouari N, Khachay FE, Cherkaoui M, Amine M, Adarmouch L. Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study. BMC Pregnancy Childbirth 2023; 23:407. [PMID: 37268874 DOI: 10.1186/s12884-023-05724-0] [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: 12/15/2022] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services. METHOD A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis. RESULTS The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns. CONCLUSION Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.
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Affiliation(s)
- Hajar Ouahid
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
| | - Adil Mansouri
- Clinical Research Department, Mohammed VI University Hospital, Marrakech, Morocco
| | - Majda Sebbani
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
- Clinical Research Department, Mohammed VI University Hospital, Marrakech, Morocco
- Department of Public Health, Community Medicine and Epidemiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Nadia Nouari
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Fatima Ezzahra Khachay
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Cherkaoui
- Laboratory of Pharmacology, Neurobiology, Anthropobiology, and Environment, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Amine
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
- Clinical Research Department, Mohammed VI University Hospital, Marrakech, Morocco
- Department of Public Health, Community Medicine and Epidemiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
| | - Latifa Adarmouch
- Bioscience and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
- Clinical Research Department, Mohammed VI University Hospital, Marrakech, Morocco
- Department of Public Health, Community Medicine and Epidemiology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco
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Where, why and who delivers our babies? Examining the perspectives of women on utilization of antenatal and delivery services in a developing country. BMC Pregnancy Childbirth 2023; 23:1. [PMID: 36593447 PMCID: PMC9806875 DOI: 10.1186/s12884-022-05306-6] [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: 07/16/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The differences in maternal mortality between developed and developing countries is due to differences in use of antenatal and delivery services. The study was designed to determine the views of women on utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. METHODS Community based descriptive exploratory study design was employed. Qualitative data was collected through use of pre-tested focus group discussion (FGD) guide. Eight FGDs were conducted among women who were pregnant and others who have delivered babies one year prior to the study. Four FGDs each were conducted in urban and rural communities. QDA Miner Lite v2.0.6 was used in the analysis of the data. RESULTS Most of the participants in urban and rural areas prefer the man and woman deciding on where to receive antenatal and deliver care. All the participants in urban and rural communities wish for the support of their husbands when pregnant. Perceived quality of care is the major reason the women choose a facility for antenatal and delivery services. Others reasons included cost of services and proximity to a facility. Participants in rural communities were of the opinion that traditional birth attendants deliver unique services including helping women to achieve conception. For participants in urban, traditional birth attendants are very friendly and perhaps on divine assignment. These reasons explain why women still patronize their services. The major criticism of services of traditional birth attendants is their inability to manage complications associated with pregnancy and delivery. The major reasons why women delivery at home included poverty and cultural beliefs. CONCLUSIONS All efforts should be made to reduce the huge maternal death burden in Nigeria. This may necessitate the involvement of men and by extension communities in antenatal and delivery matters. There is need to train health workers in orthodox health facilities on delivery of quality healthcare. Public enlightenment on importance of health facility delivery will be of essence. Encouraging women to deliver in health facilities should be prioritized. This may entail the provision of free or subsidized delivery services. The deficiencies of primary health centers especially in rural communities should be addressed.
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Vision-related quality of life amongst patients with low vision and blindness in a resource-limited country. Int Ophthalmol 2022; 43:1291-1302. [PMID: 36175783 DOI: 10.1007/s10792-022-02527-8] [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: 02/11/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the significance of sociodemographic and clinical variables on the quality of life of low-vision patients in a tertiary hospital in Enugu, Nigeria, and also determine the causative ocular pathologies and their vision-related quality of life. METHODS A cross-sectional study of adults 18 years and above with low vision/blindness. They were consecutively enrolled and clinically evaluated. The WHO-NEI-VFQ-25 questionnaire for quality of life was administered. Descriptive statistics were used to summarize variables. Kruskal-Wallis test, analysis of variance, and post hoc tests were done where appropriate. RESULTS Of the 400 participants, 81% were above 40 years. Mean age was 57.27 ± 16.34 years. Males (52.0%) and females (48.0%). 225 (56.25%) had Moderately Severe Visual Impairment. Low vision/blindness negatively affected the different domains of quality of life significantly, except ocular pain and dependency. Glaucoma and Cataract were the major disease conditions that affected most of the domains significantly. These conditions when poorly managed, due to poor and limited health resources, progress to low vision/blindness. Of all the socio-demographic factors and clinical variables studied, only age and severity of low vision were significant predictors of quality of life. CONCLUSION There is the need for prompt and proper treatment of low-vision patients and advocacy for the establishment of adequate and functional rehabilitation services. Quality of life which measures the overall impact of a disease on an individual was low in people with low vision and blindness. Low-vision services, which include rehabilitation, will provide comprehensive eye-care services and thus improve their quality of life.
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Sinaga SN, Siagian A, Nurmaini N, Badaruddin B. The Increase of Knowledge, Attitude, and Practice of Husbands toward the Prenatal Care of their Wives Using the Illustrations Having the Local Cultural Nuance. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The role of husbands in maternal health during pregnancy is crucial and is related to the high maternal mortality rate in Indonesia. In spite of that, the effort to involve husbands in the maternal health program is still low.
AIM: This paper aims to explain the results of the effort to produce learning assisting tools in a form of an illustration having local cultural nuance that can be used to do intervention of health education to increase the participation of husbands in maternal health.
METHODS: The research was conducted in Silaen Village, Silaen District in Toba Regency, North Sumatera Province. To make the teaching materials, interviews and focus group discussions were conducted for the village community figures, the village midwives, the pregnant women, and their husbands. After illustrations were made, the trial was conducted to 10 pairs of husbands and pregnant wives.
RESULTS: The illustrations made accommodating the role of husbands in maternal health can increase the knowledge, attitude, and practice (KAP) of husbands, including the KAP of their wives. The biggest increase happening in the attitude component (p < 0.05).
CONCLUSION: The educational method using an illustration adopting local culture is important to become one of the education teaching alternatives in the effort to improve husband’s KAP.
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Okonofua F, Ntoimo LF, Yaya S, Igboin B, Solanke O, Ekwo C, Johnson EAK, Sombie I, Imongan W. Effect of a multifaceted intervention on the utilisation of primary health for maternal and child health care in rural Nigeria: a quasi-experimental study. BMJ Open 2022; 12:e049499. [PMID: 35135763 PMCID: PMC8830217 DOI: 10.1136/bmjopen-2021-049499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary healthcare facilities. DESIGN The study was a separate sample pretest-post-test quasi-experimental research. SETTING The research was conducted in 20 communities and primary health centres in Esan South East and Etsako East Local Government Areas in Edo State in southern Nigeria PARTICIPANTS: Randomly selected sample of ever married women aged 15-45 years. INTERVENTIONS Seven community-led interventions implemented over 27 months, consisting of a community health fund, engagement of transport owners on emergency transport of pregnant women to primary health centres with the use of rapid short message service (SMS), drug revolving fund, community education, advocacy, retraining of health workers and provision of basic equipment. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures included the number of women who used the primary health centres for skilled pregnancy care and immunisation of children aged 0-23 months. RESULTS After adjusting for clustering and confounding variables, the odds of using the project primary healthcare centres for the four outcomes were significantly higher at endline compared with baseline: antenatal care (OR 3.87, CI 2.84 to 5.26 p<0.001), delivery care (OR 3.88, CI 2.86 to 5.26), postnatal care (OR 3.66, CI 2.58 to 5.18) and childhood immunisation (OR 2.87, CI 1.90 to 4.33). However, a few women still reported that the cost of services and gender-related issues were reasons for non-use after the intervention. CONCLUSION We conclude that community-led interventions that address the specific concerns of women related to the bottlenecks they experience in accessing care in primary health centres are effective in increasing demand for skilled pregnancy and childcare in rural Nigeria.
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Affiliation(s)
- Friday Okonofua
- Women's Health and Action Research Centre, Benin City, Nigeria
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
| | - Lorretta Favour Ntoimo
- Women's Health and Action Research Centre, Benin City, Nigeria
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Brian Igboin
- Women's Health and Action Research Centre, Benin City, Nigeria
| | | | - Chioma Ekwo
- Women's Health and Action Research Centre, Benin City, Nigeria
| | | | - Issiaka Sombie
- West African Health Organisation, Bobo-Dioulasso, Burkina Faso
| | - Wilson Imongan
- Women's Health and Action Research Centre, Benin City, Nigeria
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Haque M, Umar B, Abdullah A, Chowdhury K, Ahmad R. Does provision of antenatal care, post-natal care and perinatal care reduce maternal, neonatal and child mortality? With special attention towards bangladesh situation in global perspective. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Asi YM. Freedom of Movement as a Determinant of Women's Health: Global Analysis and Commentary. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hendrickson ZM, Tibbels N, Sidikiba S, Mills H, Vondrasek C, Gurman T. 'I can't leave everything in the hands of my husband': Economic constraints and gender roles in care-seeking in post-Ebola Guinea. Glob Public Health 2021; 17:1578-1593. [PMID: 34242118 DOI: 10.1080/17441692.2021.1953107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2014-2016 Ebola epidemic in West Africa had enduring effects on health systems and healthcare utilisation. This study explores the intersection of economic constraints and gender roles in Guinea to understand delays in care-seeking post-Ebola. In-depth interviews (n = 45) and focus group discussions (n = 24) were conducted with mothers, male heads of household, grandmothers, and health workers in rural and urban areas in Basse-Guinée and Guinée Forestière. A thematic analysis identified salient themes related to gender and economic constraints on health care-seeking. Participants, particularly men, emphasised the high cost of seeking care, which led to delays as women secured funds. Men's engagement in care-seeking included providing funds and permission, picking up medication, and giving appointment reminders. As principal actors when 'navigating' the healthcare system, women were intimately involved in economic decisions and responsible for securing funds for services - even when lacking direct financial control. Essentialist descriptions of men as 'providers' and women as 'navigators', therefore, masked nuances in care-seeking and economic responsibilities. Programmes must acknowledge men's engagement in care-seeking and address both the economic barriers women face when seeking care and their economic roles. Greater attention to the complex intersection of economic constraints and gender roles could address care-seeking delays.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natalie Tibbels
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sidibé Sidikiba
- Public Health Department, Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Université Gamal Abdel Nasser de Conakry , Conakry, Guinea
| | - Hannah Mills
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudia Vondrasek
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tilly Gurman
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zegeye B, Keetile M, Ahinkorah BO, Ameyaw EK, Seidu AA, Yaya S. Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis. Trop Med Health 2021; 49:53. [PMID: 34193313 PMCID: PMC8247116 DOI: 10.1186/s41182-021-00343-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. METHODS We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). RESULTS The pooled results showed that about 50.7% (95% CI 48.2-53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0-69.1%) and West Africa (24.3%, 95% CI 22.4-26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32-2.84), women with educated husbands (aOR=1.40, 95% CI 1.11-1.77), wealthier women (aOR=3.12, 95% CI 1.95-4.99), women exposed to media (aOR=1.46, 95% CI 1.18-1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24-1.83). CONCLUSIONS Enhancing women's education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Mpho Keetile
- Department of Population Studies, Faculty of Social Sciences, University of Botswana, Private Bag, UB 0022 Gaborone, Botswana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007 Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, PMB 0494 Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811 Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Yaya S, Ameyaw EK, Idriss-Wheeler D, Shibre G, Zegeye B. Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000-2016. BMC Public Health 2021; 21:763. [PMID: 33882875 PMCID: PMC8059022 DOI: 10.1186/s12889-021-10729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. This study assessed the magnitude and trends of socioeconomic and area-based AFR inequalities in Ethiopia. METHODS The 2000 and 2016 Ethiopia Demographic and Health surveys (EDHS) was analyzed using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software. Adolescent fertility rates were disaggregated using three equity stratifiers (economic status, education and residence) and analyzed through four summary measures (Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF)) to assess inequality. To measure statistical significance, point estimates were constructed using a 95% Uncertainty Interval (UI). RESULTS Large socio-economic and urban-rural inequalities were observed within the 16-year period. Adolescents in less well-off socio-economic groups (PAF: -62.9 [95% UI; - 64.3, - 61.4], D: 96.4 [95% UI; 47.7, 145.1]), uneducated (R: 8.5 [95% UI; 4.8, 12.2], PAR: -76.4 [95% UI;-77.7, - 75.0]) and those from rural areas (D: 81.2 [95% UI; 67.9, 94.6], PAF: -74.2 [95% UI, - 75.7, - 72.7]) had a higher chance of pregnancy and more births than their counterparts. CONCLUSIONS Socioeconomic (education and economic status) and place of residence determine adolescents' pregnancy and childbearing. Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities. More emphasis should be placed on subpopulations with disproportionately higher adolescent pregnancy and childbirth.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Gebretsadik Shibre
- Department of Reproductive Health and Health Services Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
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Potasse MA, Yaya S. Understanding perceived access barriers to contraception through an African feminist lens: a qualitative study in Uganda. BMC Public Health 2021; 21:267. [PMID: 33530960 PMCID: PMC7852360 DOI: 10.1186/s12889-021-10315-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are many barriers that impact a woman's access to contraception in rural sub-Saharan Africa, such as financial constraints, supply shortages, stigma, and misconceptions. Through and African Feminist lens, this study examines how these perceived barriers intersect with each other, and how they negatively impact women's access to family planning and their perceived value of contraceptives in Luweero, Uganda. METHODS This qualitative study analyzed data collected from healthcare workers at one private clinic and one public clinic that offer family planning services in four focus group discussions in Luweero, Central Region, Uganda. Two focus group discussions were held in each clinic. Eligible participants spoke English, were at least 18 years of age, and had at least 3 years of experience as a healthcare worker in Luweero. Among the participants were nurses, midwives, family planning counsellors, and village health workers, both male and female. Coded transcripts were analyzed using a reflexive methodology through an African Feminist lens. RESULTS Most of the responses indicated that financial constraints experienced either by the clinic or the women significantly impact access to family planning. Certain social barriers were discussed, and the participants explained that barriers such as stigma, misconceptions, lack of knowledge, religiosity and cultural values impact women's motivation or ability to access contraceptive methods. Side effects also have a significant role to play in women's ability or motivation to navigate through these perceived social barriers. CONCLUSIONS Participants determined that increased funding for transportation for village health teams, consistent funding for free contraception, and expanded sensitization efforts that particularly target men would be some of the most impactful methods they can adapt to address some of these barriers.
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Affiliation(s)
- Meghan A. Potasse
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Udenigwe O, Okonofua FE, Ntoimo LFC, Imongan W, Igboin B, Yaya S. Perspectives of policymakers and health providers on barriers and facilitators to skilled pregnancy care: findings from a qualitative study in rural Nigeria. BMC Pregnancy Childbirth 2021; 21:20. [PMID: 33407238 PMCID: PMC7789224 DOI: 10.1186/s12884-020-03493-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The uptake of skilled pregnancy care in rural areas of Nigeria remains a challenge amid the various strategies aimed at improving access to skilled care. The low use of skilled health care during pregnancy, childbirth and postpartum indicates that Nigerian women are paying a heavy price as seen in the country’s very high maternal mortality rates. The perceptions of key stakeholders on the use of skilled care will provide a broad understanding of factors that need to be addressed to increase women’s access to skilled pregnancy care. The objective of this study was therefore, to explore the perspectives of policymakers and health workers, two major stakeholders in the health system, on facilitators and barriers to women’s use of skilled pregnancy care in rural Edo State, Nigeria. Methods This paper draws on qualitative data collected in Edo State through key informant interviews with 13 key stakeholders (policy makers and healthcare providers) from a range of institutions. Data was analyzed using an iterative process of inductive and deductive approaches. Results Stakeholders identified barriers to pregnant women’s use of skilled pregnancy care and they include; financial constraints, women’s lack of decision-making power, ignorance, poor understanding of health, competitive services offered by traditional birth attendants, previous negative experience with skilled healthcare, shortage of health workforce, and poor financing and governance of the health system. Study participants suggested health insurance schemes, community support for skilled pregnancy care, favourable financial and governance policies, as necessary to facilitate women’s use of skilled pregnancy care. Conclusions This study adds to the literature, a rich description of views from policymakers and health providers on the deterrents and enablers to skilled pregnancy care. The views and recommendations of policymakers and health workers have highlighted the importance of multi-level factors in initiatives to improve pregnant women’s health behaviour. Therefore, initiatives seeking to improve pregnant women’s use of skilled pregnancy care should ensure that important factors at each distinct level of the social and physical environment are identified and addressed.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Friday E Okonofua
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria.,Centre for Excellence in Reproductive Health Innovation, Benin City, Nigeria
| | | | - Wilson Imongan
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
| | - Brian Igboin
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
| | - 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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Al-Mujtaba M, Sam-Agudu NA, Torbunde N, Aliyu MH, Cornelius LJ. Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective. PLoS One 2020; 15:e0243611. [PMID: 33301478 PMCID: PMC7728451 DOI: 10.1371/journal.pone.0243611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In much of sub-Saharan Africa, male partners play influential roles in women's access to maternal-child healthcare, including prevention of mother-to-child transmission of HIV services. We explored male partner perspectives on women's access to maternal-child healthcare in North-Central Nigeria. METHODS Three focus groups were conducted with 30 men, purposefully-selected on the basis of being married, and rural or urban residence. Major themes explored were men's maternal-child health knowledge, gender power dynamics in women's access to healthcare, and peer support for pregnant and postpartum women. Data were manually analyzed using Grounded Theory, which involves constructing theories out of data collected, rather than applying pre-formed theories. RESULTS Mean participant age was 48.3 years, with 36.7% aged <40 years, 46.7% between 41 and 60 years, and 16.6% over 60 years old. Religious affiliation was self-reported; 60% of participants were Muslim and 40% were Christian. There was consensus on the acceptability of maternal-child health services and their importance for optimal maternal-infant outcomes. Citing underlying patriarchal norms, participants acknowledged that men had more influence in family health decision-making than women. However, positive interpersonal couple relationships were thought to facilitate equitable decision-making among couples. Financial constraints, male-unfriendly clinics and poor healthcare worker attitudes were major barriers to women's access and male partner involvement. The provision of psychosocial and maternal peer support from trained women was deemed highly acceptable for both HIV-positive and HIV-negative women. CONCLUSIONS Strategic engagement of community leaders, including traditional and religious leaders, is needed to address harmful norms and practices underlying gender inequity in health decision-making. Gender mainstreaming, where the needs and concerns of both men and women are considered, should be applied in maternal-child healthcare education and delivery. Clinic fee reductions or elimination can facilitate service access. Finally, professional organizations can do more to reinforce respectful maternity care among healthcare workers.
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Affiliation(s)
- Maryam Al-Mujtaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nguavese Torbunde
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Muktar H. Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Llewellyn J. Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, Georgia, United States of America
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Influence of women's empowerment indices on the utilization of skilled maternity care: evidence from rural Nigeria. J Biosoc Sci 2020; 54:77-93. [PMID: 33261675 DOI: 10.1017/s0021932020000681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women's empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women's empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women's empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent's education and respondent's participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent's use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women's empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women's empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.
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Plouffe V, Bicaba F, Bicaba A, Druetz T. User fee policies and women's empowerment: a systematic scoping review. BMC Health Serv Res 2020; 20:982. [PMID: 33109172 PMCID: PMC7590470 DOI: 10.1186/s12913-020-05835-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Over the past decade, an increasing number of low- and middle-income countries have reduced or removed user fees for pregnant women and/or children under five as a strategy to achieve universal health coverage. Despite the large number of studies (including meta-analyses and systematic reviews) that have shown this strategy's positive effects impact on health-related indicators, the repercussions on women's empowerment or gender equality has been overlooked in the literature. The aim of this study is to systematically review the evidence on the association between user fee policies in low- and middle-income countries and women's empowerment. METHODS A systematic scoping review was conducted. Two reviewers conducted the database search in six health-focused databases (Pubmed, CAB Abstracts, Embase, Medline, Global Health, EBM Reviews) using English key words. The database search was conducted on February 20, 2020, with no publication date limitation. Qualitative analysis of the included articles was conducted using a thematic analysis approach. The material was organized based on the Gender at Work analytical framework. RESULTS Out of the 206 initial records, nine articles were included in the review. The study settings include three low-income countries (Burkina Faso, Mali, Sierra Leone) and two lower-middle countries (Kenya, India). Four of them examine a direct association between user fee policies and women's empowerment, while the others address this issue indirectly -mostly by examining gender equality or women's decision-making in the context of free healthcare. The evidence suggests that user fee removal contributes to improving women's capability to make health decisions through different mechanisms, but that the impact is limited. In the context of free healthcare, women's healthcare decision-making power remains undermined because of social norms that are prevalent in the household, the community and the healthcare centers. In addition, women continue to endure limited access to and control over resources (mainly education, information and economic resources). CONCLUSION User fee removal policies alone are not enough to improve women's healthcare decision-making power. Comprehensive and multi-sectoral approaches are needed to bring sustainable change regarding women's empowerment. A focus on "gender equitable access to healthcare" is needed to reconcile women's empowerment and the efforts to achieve universal health coverage.
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Affiliation(s)
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- University of Montreal School of Public Health, Montreal, Canada.
- Centre de Recherche en Santé Publique, Montreal, Canada.
- Center for Applied Malaria Research and Evaluation, Tulane University, New Orleans, USA.
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Yaya S, Zegeye B, Ahinkorah BO, Oladimeji KE, Shibre G. Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009-2016. ACTA ACUST UNITED AC 2020; 78:98. [PMID: 33072317 PMCID: PMC7557032 DOI: 10.1186/s13690-020-00484-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022]
Abstract
Background Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance. Results We found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively. Conclusions This study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, Imperial College London, London, UK
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Eastern Cape, South Africa.,Center for Community Healthcare, Research and Development, Benin-City, Nigeria
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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