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Kim S, Kim C, Kim JH. Antenatal care inequalities in South Korea: An analysis of health insurance claims data (2013-2022) in a high-resource, high-use country. Int J Gynaecol Obstet 2024. [PMID: 38494879 DOI: 10.1002/ijgo.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. METHODS We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. RESULTS Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non-Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non-Korean women, highlighting the effects of the COVID-19 pandemic. CONCLUSION Antenatal care inequalities are evident in South Korea's well-resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services.
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Affiliation(s)
- Saerom Kim
- Department of Preventive Medicine, College of Medicine, Inje University, Busan, Republic of Korea
| | - Chanki Kim
- Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jin-Hwan Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Pařízková A, Clausen JA, Balaam MC, Haith-Cooper M, Roosalu T, Migliorini L, Kasper A. Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review. Matern Child Health J 2024; 28:470-480. [PMID: 37843787 PMCID: PMC10914866 DOI: 10.1007/s10995-023-03785-3] [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] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Despite the interconnectedness of the European Union, there are significant variations in pregnant women's legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country. METHODS The study adopted a mixed-methods research design exploring policies on migrant women's access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women. RESULTS This study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation. DISCUSSION Inequities and inconsistencies in policies across European countries affect non-citizen migrant women's access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women.
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Affiliation(s)
- Alena Pařízková
- Department of Sociology and social work, Faculty of Arts, University of West Bohemia, Univerzitní 8, Plzeň, 30100, Czech Republic.
| | | | - Marie-Clare Balaam
- Research in Childbirth and Health Unit (REACH), School of Nursing and Midwifery., University of Central Lancashire, Preston, PR1 2HE 01772 893885, UK
| | - Melanie Haith-Cooper
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, West Yorkshire, UK
| | - Triin Roosalu
- School of Governance, Law and Society, Institute of International and Social Studies, Tallinn University, Uus-Sadama 5, Tallinn, 10120, Estonia
| | - Laura Migliorini
- Department of Education Sciences, University of Genoa, C.so Podestà 2, Genoa, 16156, Italy
| | - Anne Kasper
- Health Campus Göttingen - Faculty of Engineering and Health, HAWK University in Hildesheim, Holzminden and Göttingen, 31134, Hohnsen 4, Hildesheim, Germany
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van Braam EJ, McRae DN, Portela AG, Stekelenburg J, Penn-Kekana L. Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis. Reprod Health 2023; 20:101. [PMID: 37407983 PMCID: PMC10324180 DOI: 10.1186/s12978-023-01615-x] [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: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. METHODS A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. RESULTS Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. CONCLUSION This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
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Affiliation(s)
| | - Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Loveday Penn-Kekana
- Department of Maternal Health and Health Systems, London School of Hygiene and Tropical Medicine, London, UK
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Sharma E, Tseng PC, Harden A, Li L, Puthussery S. Ethnic minority women's experiences of accessing antenatal care in high income European countries: a systematic review. BMC Health Serv Res 2023; 23:612. [PMID: 37301860 PMCID: PMC10256965 DOI: 10.1186/s12913-023-09536-y] [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: 01/10/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women's experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women's perspectives. METHODS We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a 'best fit' framework, based on an existing theoretical model of health care access. RESULTS A total of 30 studies were included in this review. Women's experiences covered two overarching themes: 'provision of antenatal care' and 'women's uptake of antenatal care'. The 'provision of antenatal care' theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The 'women's uptake of antenatal care' theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes. CONCLUSION The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women's ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care. PROTOCOL AND REGISTRATION The review protocol was registered on PROSPERO (reference number CRD42021238115).
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Affiliation(s)
- Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square London, EC1V 0HB UK
| | - Leah Li
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
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Niles PM, Baumont M, Malhotra N, Stoll K, Strauss N, Lyndon A, Vedam S. Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reprod Health 2023; 20:67. [PMID: 37127624 PMCID: PMC10152585 DOI: 10.1186/s12978-023-01584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. METHODS We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. RESULTS Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65-7.45), higher respect (aOR: 5.39, 95% CI: 3.72-7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10-0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66-4.27), respect (aOR: 4.15, 95% CI: 2.81-6.14), mistreatment (aOR: 0.20, 95% CI: 0.11-0.34), time spent (aOR: 8.06, 95% CI: 4.26-15.28). CONCLUSION Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.
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Affiliation(s)
- P. Mimi Niles
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Monique Baumont
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Nisha Malhotra
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Nan Strauss
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Audrey Lyndon
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Saraswathi Vedam
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Kuforiji O, Mills TA, Lovell K. Women's experiences of care and support following perinatal death in high burden countries: A metasynthesis. Women Birth 2023; 36:e195-e202. [PMID: 35927212 DOI: 10.1016/j.wombi.2022.07.170] [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: 12/22/2021] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
PROBLEM The experiences of women in low and middle-income countries following perinatal death remains difficult and challenging, thereby increasing their susceptibility to negative psychological impact particularly with insufficient bereavement care and support. BACKGROUND Perinatal death invariably brings intense grief which significantly impacts women, and requires adequate bereavement care to limit negative outcomes in the short and long-term. AIM To develop deeper understanding of women's experience of care and support following perinatal death in high burden settings. METHODS Six electronic databases were searched with relevant terms established using the SPIDER tool, supplemented by hand search of reference lists. Studies were independently screened for inclusion by all authors. Meta-ethnography (Noblit and Hare,1988) was used to synthesise existing qualitative studies. FINDINGS Eight studies conducted in Sub-Saharan African and South Asian countries namely South Africa, Uganda, Ghana, Kenya, India and Malawi were included, and three main themes were identified; mothers' reaction to their baby's death, care and support after perinatal death, and coping strategies in the absence of care and support. Perinatal death was not appropriately acknowledged therefore care and support was inadequate and, in some cases, non-existent. Consequently, mothers resorted to adopting coping strategies as they were unable to express their grief. DISCUSSION There is insufficient care and support for women following perinatal death in high burden settings. CONCLUSIONS Further research is required into the care and support being given by healthcare professionals and families in high burden settings, thereby ultimately aiding the development of guidance on perinatal bereavement care.
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Affiliation(s)
- Omotewa Kuforiji
- Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL. United Kingdom.
| | - Tracey A Mills
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - Karina Lovell
- Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL. United Kingdom.
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Vincent CM, Spineli LΜ, Barlow P, Gross MM. Unplanned visits and midwife-led antenatal care. Eur J Midwifery 2022; 6:72. [PMID: 36591332 PMCID: PMC9773263 DOI: 10.18332/ejm/157160] [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: 05/28/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Midwives provide antenatal care to women to ensure the health of both mother and baby, according to women's needs. This study aims to investigate demographic and social, clinical and obstetrical factors that may be associated with unplanned visits to the emergency by nulliparous and multiparous women who received midwifery care during the antenatal period. METHODS This was a retrospective cohort study with data collection from medical records of the CHU Saint-Pierre hospital. A total of 971 women gave birth between 1 January and 31 December 2017 and received midwifery-led care during their pregnancy. Descriptive statistics and multivariable logistic regression models with 95% confidence intervals (95% CI) were performed separately for nulliparous and multiparous women. RESULTS For nulliparae (n=246), the odds of visiting emergency services during pregnancy were 1.45 times (95% CI: 1.08-2.27) higher in women with more previous pregnancies than women with less previous pregnancies, 3.57 times (95% CI: 1.43-11.11) more likely in women without than with high-level hypertension, and 1.09 times (95% CI: 1.01-1.25) more likely in women with less previous midwifery-led visits than women with more previous midwifery-led visits. For multiparae (n=444), the odds of visiting emergency services during pregnancy were 2.12 times (95% CI: 1.06-6.07) higher in women presenting risk factors at first consultation than women without such factors. CONCLUSIONS For nulliparous and multiparous women, some characteristics seem to be associated with unplanned visits. Spontaneous visits may be driven by a need for care perceived by women and/or their partner but not specifically by urgent or unfavorable medical conditions.
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Affiliation(s)
- Céleste M. Vincent
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Loukia Μ. Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Patricia Barlow
- Department of Obstetrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
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Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
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Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
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Escañuela Sánchez T, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: A meta-synthesis of qualitative research. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3810-e3828. [PMID: 36240064 PMCID: PMC10092326 DOI: 10.1111/hsc.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/18/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Inadequate attendance to antenatal care has been associated with negative maternal and fetal outcomes, including stillbirth. This study aimed to identify facilitators and barriers to antenatal care attendance. A systematic search was conducted in March 2019 and updated in January 2021. Qualitative studies involving pregnant or post-partum women up to 12 months from high-income countries that provided data about facilitators and barriers to antenatal care attendance were sought. Meta-ethnography was used to inform this meta-synthesis. Fifteen studies were included in the analysis. Findings indicate that inadequate antenatal care attendance is influenced at different levels. Aspects like sociodemographic factors, difficulties navigating the health system, administrative delays, lack of flexibility and tailored care, constant change of carer and communication issues also act as barriers. These issues affect women's access to knowledge and the formation of women's beliefs and feelings towards seeking care. On the contrary, having a positive attitude towards the pregnancy, encountering empathetic healthcare professionals and availing of social support acted as facilitators. The reasons why women seek or delay attending antenatal care are multifactorial and can be explained using the Social Determinants of Health Framework. Any response needs to be taken across all levels of influence and not just focused on the individual. A better understanding of the barriers and facilitators to antenatal care might contribute to informing intervention or policy development addressing this issue.
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- INFANT Centre, Cork University HospitalUniversity College CorkCorkIreland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI GalwayNational University of IrelandGalwayIreland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
- National Perinatal Epidemiology Centre (NPEC), Department of Obstetrics and GynaecologyCork University Maternity Hospital, University College CorkCorkIreland
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Schneider M, Müller CP, Knies AK. Low income and schizophrenia risk: a narrative review. Behav Brain Res 2022; 435:114047. [PMID: 35933046 DOI: 10.1016/j.bbr.2022.114047] [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: 02/25/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.
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Affiliation(s)
- Miriam Schneider
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria.
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany; Centre for Drug Research, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Andrea K Knies
- Department of Scientific Coordination and Management, Danube Private University, 3500 Krems-Stein, Austria
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Turner S, Posthumus AG, Steegers EAP, AlMakoshi A, Sallout B, Rifas-Shiman SL, Oken E, Kumwenda B, Alostad F, Wright-Corker C, Watson L, Mak D, Cheung HC, Judge A, Aucott L, Jaddoe VWV, Annesi Maesano I, Soomro MH, Hindmarsh P, Jacobsen G, Vik T, Riaño-Galan I, Rodríguez-Dehli AC, Lertxundi A, Rodriguez LSM, Vrijheid M, Julvez J, Esplugues A, Iñiguez C. Household income, fetal size and birth weight: an analysis of eight populations. J Epidemiol Community Health 2022; 76:629-636. [PMID: 35414519 DOI: 10.1136/jech-2021-218112] [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: 09/21/2021] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The age at onset of the association between poverty and poor health is not understood. Our hypothesis was that individuals from highest household income (HI), compared to those with lowest HI, will have increased fetal size in the second and third trimester and birth. METHODS Second and third trimester fetal ultrasound measurements and birth measurements were obtained from eight cohorts. Results were analysed in cross-sectional two-stage individual patient data (IPD) analyses and also a longitudinal one-stage IPD analysis. RESULTS The eight cohorts included 21 714 individuals. In the two-stage (cross-sectional) IPD analysis, individuals from the highest HI category compared with those from the lowest HI category had larger head size at birth (mean difference 0.22 z score (0.07, 0.36)), in the third trimester (0.25 (0.16, 0.33)) and second trimester (0.11 (0.02, 0.19)). Weight was higher at birth in the highest HI category. In the one-stage (longitudinal) IPD analysis which included data from six cohorts (n=11 062), head size was larger (mean difference 0.13 (0.03, 0.23)) for individuals in the highest HI compared with lowest category, and this difference became greater between the second trimester and birth. Similarly, in the one-stage IPD, weight was heavier in second highest HI category compared with the lowest (mean difference 0.10 (0 .00, 0.20)) and the difference widened as pregnancy progressed. Length was not linked to HI category in the longitudinal model. CONCLUSIONS The association between HI, an index of poverty, and fetal size is already present in the second trimester.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Anke G Posthumus
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Amel AlMakoshi
- Child Health, University of Aberdeen, Aberdeen, UK.,Maternal-Fetal medicine, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bahauddin Sallout
- Medical Service Directorate, Ministry of Defence, Riyadh, Saudi Arabia
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ben Kumwenda
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | | | - Laura Watson
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Diane Mak
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | - Alice Judge
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trial, University of Aberdeen, Aberdeen, UK
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Annesi Maesano
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | - Munawar Hussain Soomro
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | | | - Geir Jacobsen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Isolina Riaño-Galan
- AGC de Pediatría, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain.,IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Cristina Rodríguez-Dehli
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Service, Hospital Universitario San Agustín, Avilés, Spain.,Servicio de Salud del Principado de Asturias (SESPA), IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Aitana Lertxundi
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, (UPV/EHU), Spain
| | - Loreto Santa Marina Rodriguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Health Department of Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, PRBB, Barcelona, Catalonia, Spain.,Universitat Pompeau Fabra (UPF), Barcelona, Spain
| | - Jordi Julvez
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Spain.,Instituto de Salud Global, Barcelona, Spain.,Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Ana Esplugues
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Joint Research Unit of Epidemiology and Environmental Health, FISABIO, Valencia, Spain
| | - Carmen Iñiguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Statistics and Operational Research, Universitat de València, València, Spain
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12
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Ekanem OJ, Woods P. Effectiveness of Nonsuicidal Self-Injury Interventions among Incarcerated Women in Correctional Facilities and Secure Settings: An Integrative Review. Issues Ment Health Nurs 2022; 43:220-238. [PMID: 34499564 DOI: 10.1080/01612840.2021.1967532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) is prevalent among incarcerated women in correctional facilities. This poses a challenge in selecting appropriate intervention. This integrative review aimed to identify effective interventions for managing NSSI among incarcerated women. Whittemore and Knafl's framework for integrative reviews was used, and eight databases were searched with 11 papers meeting the inclusion criteria. Six interventions for NSSI for incarcerated women were identified as promising in reducing the rate of NSSI. Data did not support the effectiveness of gender-specific interventions for incarcerated women. There is a need for further research to identify appropriate interventions to target NSSI among incarcerated women.
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Affiliation(s)
| | - Phil Woods
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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13
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Grand-Guillaume-Perrenoud JA, Origlia P, Cignacco E. Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review. Midwifery 2022; 105:103237. [PMID: 34999509 DOI: 10.1016/j.midw.2021.103237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with social disadvantage have poorer perinatal outcomes compared to women in advantaged social positions, which may be linked to poorer healthcare utilisation. Disadvantaged groups may experience a greater diversity of barriers (e.g., feeling embarrassed about pregnancy, lack of transportation) or barriers judged to be particularly difficult (e.g., embarrassment about pregnancy). They may also experience barriers more frequently (e.g., depression). Using Levesque et al.'s (2013) framework of healthcare access, our review identifies the barriers and facilitators that affect maternal healthcare utilisation in the perinatal period among women with social disadvantage in high-income nations. OBJECTIVES Our review searches for the barriers and facilitators affecting maternal healthcare utilisation in the perinatal period, from pregnancy to the first year postpartum, among women with social disadvantage (Prospero registration CRD42020151506). DESIGN We conducted a theory-guided systematic review. PubMed, Embase, MEDLINE, PsycINFO, and Social Science Citation Index databases were searched for publications between 1999 and 2018. FINDINGS 37 articles out of 12'972 were included in the qualitative synthesis. 19 domains of barriers and facilitators were extracted. Domains on the provider side includes 'information regarding available treatments' and 'trustful relationships.' On the user-side, domains include 'awareness of pregnancy' and 'unplanned/unwanted pregnancy' KEY CONCLUSIONS: Provider- and user-side characteristics interact to affect access. User-side characteristics that pose a barrier can be offset by provider-side characteristics that lower barriers to access. IMPLICATIONS FOR PRACTICE User-side characteristics (e.g., lack of awareness of pregnancy) play an important role in the initial steps toward access. Among women with social disadvantage, reducing barriers may require active outreach on the part of providers.
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Affiliation(s)
| | - Paola Origlia
- Bern University of Applied Sciences, Department of Health Professions, Division of Midwifery, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Eva Cignacco
- Bern University of Applied Sciences, Department of Health Professions, Division of Midwifery, Murtenstrasse 10, 3008 Bern, Switzerland.
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14
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Dada S, Tunçalp Ö, Portela A, Barreix M, Gilmore B. Community mobilization to strengthen support for appropriate and timely use of antenatal and postnatal care: A review of reviews. J Glob Health 2022; 11:04076. [PMID: 35003714 PMCID: PMC8710228 DOI: 10.7189/jogh.11.04076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Antenatal care (ANC) and postnatal care (PNC) are critical opportunities for women, babies and parents/families to receive quality care and support from health services. Community-based interventions may improve the accessibility, availability, and acceptance of this vital care. For example, community mobilization strategies have been used to involve and collaborate with women, families and communities to improve maternal and newborn health. Objective To synthesize existing reviews of evidence on community mobilization strategies that strengthen support for appropriate and timely use of ANC and PNC. Methods Six databases (MEDLINE, Embase, CINAHL, PsychINFO, Cochrane Library, PROSPERO) were searched for published reviews that describe community mobilization related strategies for ANC and/or PNC. Reviews were eligible for inclusion if they described any initiatives or strategies targeting the promotion of ANC and/or PNC uptake that included an element of community mobilization in a low- or middle-income country (LMIC), published after 2000. Included reviews were critically appraised according to the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Evidence Syntheses. This review of reviews was conducted following JBI guidelines for undertaking and reporting umbrella reviews. Results In total 23 papers, representing 22 reviews were included. While all 22 reviews contained some description of community mobilization and ANC/PNC, 13 presented more in-depth details on the community mobilization processes and relevant outcomes. Seventeen reviews focused on ANC, four considered both ANC and PNC, and only one focused on PNC. Overall, 16 reviews reported at least one positive association between community mobilization activities and ANC/PNC uptake, while five reviews presented primary studies with no statistically significant change in ANC uptake and one included a primary study with a decrease in use of antenatal facilities. The community mobilization activities described by the reviews ranged from informative, passive communication to more active, participatory approaches that included engaging individuals or consulting local leaders and community members to develop priorities and action plans. Conclusions While there is considerable momentum around incorporating community mobilization activities in maternal and newborn health programs, such as improving community support for the uptake of ANC and PNC, there is limited evidence on the processes used. Furthermore, the spectrum of terminology and variation in definitions should be harmonized to guide the implementation and evaluation efforts.
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Affiliation(s)
- Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - María Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.,School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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15
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Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland. J Migr Health 2022; 6:100122. [PMID: 35677660 PMCID: PMC9168177 DOI: 10.1016/j.jmh.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Migrants from conflict-affected areas had a 3.5-fold risk for delayed prenatal care. Less prenatal visits prior to term birth compared with country-born parturients. No differences in prepartum hospitalization between migrants and country-born parturients.
Background The 2015 refugee crisis led into a forced migration of millions of people globally. As a consequence, many countries experienced a quick change in the proportion of conflict-area born migrants. This group being stated as an especially vulnerable group for suboptimal maternal health, a timely inspection of preventive maternity care was required. This study investigated prenatal care in terms of gestation trimester at the first prenatal visit, number of check-ups prior to birth, and prepartum hospitalization in conflict-country born migrants and Finnish parturients in Finland. Material and methods Cross-sectional study included all pregnancies of migrants born in conflict-affected countries (n = 3 155) and country-born parturients (n = 93 600) in Finland in 2015–16. The data were obtained through Medical Birth Registry and Population Information System. Statistical analysis employed T-test, Chi-square test, and logistic regression analysis. Odds ratios with 95% Confidence Intervals (CI) were adjusted for sociodemographic and health-related background variables. Results Migrant parturients had a higher probability for delayed enter in prenatal care compared with Finnish-born parturients (adjusted odds ratio aOR = 3.46; 95% Confidence Interval CI 3.06, 3.91). Recommended minimum number of check-ups was participated by 95.3% of the migrant, and 96.4% of the Finnish-born group (P <0.000). Migrants’ probability for more than ten visits prior to term birth was significantly lower (aOR = 0.58; 95% CI 0.51, 0.66). No significant differences in prepartum hospitalization yielded between the groups. Conclusions Migrant parturients had significantly smaller number of check-ups and later entry in care compared with the country-born parturients. These findings add to earlier reported challenges in the organizing of conflict-affected country born migrants’ prenatal care in a high-income setting, in which the proportion of conflict-area born migrants has risen rapidly and unexpectedly.
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Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Corresponding author.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Kuopio University Hospital, Finland
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16
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Dawson P, Auvray B, Jaye C, Gauld R, Hay-Smith J. Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075913. [PMID: 35109729 PMCID: PMC8819758 DOI: 10.1177/17455065221075913] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity.
We examined the relationships between adverse outcomes in a total population
sample of births and a range of social determinant variables representing
barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of
linked administrative data sets, adverse maternal and perinatal outcomes
(mortality and severe morbidity) were linked to socio-economic and health
variables for 97% of births in New Zealand between 2003 and 2018 (~970,000
births). Variables included housing, economic, health, crime and family
circumstances. Logistic regression examined the relationships between
adverse outcomes and social determinants, adjusting for demographics
(socio-economic deprivation, education, parity, age, rural/urban residence
and ethnicity). Results: Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18–1.23) and
Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36–1.43)
had poorer maternal or perinatal outcomes compared to New Zealand
European/European women. High use of emergency department (adjusted odds
ratio = 2.68, 95% confidence interval = 2.53–2.84), disability (adjusted
odds ratio = 1.98, 95% confidence interval = 1.83–2.14) and lack of
engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence
interval = 1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of
socio-economic and health determinants. While some of these factors can be
targeted for interventions, the study highlights larger structural and
systemic issues that affect maternal and perinatal health.
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17
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Slade P, Dembinsky M, Bristow K, Garthwaite K, Mahdi A, James A, Rahman A, Downe S. Facilitating Perinatal Access to Resources and Support (PeARS): a feasibility study with external pilot of a novel intervention. BMC Pregnancy Childbirth 2021; 21:769. [PMID: 34772367 PMCID: PMC8588611 DOI: 10.1186/s12884-021-04112-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Up to 50% of women in areas of high socio-economic deprivation are at risk of developing depressive symptoms in pregnancy. Feeling well supported, can facilitate good mental health perinatally. A brief, innovative intervention to facilitate access to support and resources was developed and tested. This included one antenatal and one postnatal session, each with three evidence-based components: i) support from a non-professional peer to enable a woman to identify her needs; ii) information about local community services and signposting; and iii) development of a personalised If–Then plan to access that support. The aims were to evaluate the intervention and research methods for feasibility and acceptability for perinatal women, maternity care providers and peers, and provide preliminary effectiveness indications. Methods Pregnant women living in an area of high deprivation were recruited from community-based antenatal clinics and randomised to intervention or control condition (a booklet about local resources). Outcome measures included women’s use of community services by 34 + weeks gestation and 6 months postnatally; mental health and wellbeing measures, and plan implementation. Interviews and focus groups were conducted with women participants, providers, and peers. Data were analysed using framework analysis. Recruitment and retention of peers and participants, intervention fidelity, and acceptability of outcome measures were recorded. Results Peer facilitators could be recruited, trained, retained and provide the intervention with fidelity. One hundred twenty six women were recruited and randomised, 85% lived in the 1% most deprived UK areas. Recruitment constituted 39% of those eligible, improving to 54% after midwifery liaison. Sixty five percent were retained at 6 months postnatally. Women welcomed the intervention, and found it helpful to plan access to community services. Providers strongly supported the intervention philosophy and integrated this easily into services. The study was not powered to detect significant group differences but there were positive trends in community service use, particularly postnatally. No differences were evident in mental health and wellbeing. Conclusions This intervention was well received and easily integrated into existing services. Women living in highly deprived areas could be recruited, randomised and retained. Measures were acceptable. Peer facilitators were successfully trained and retained. Full effectiveness studies are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04112-w.
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Affiliation(s)
- Pauline Slade
- Institute of Population Health, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Melanie Dembinsky
- Health Sciences Stirling, University of Stirling, Stirling, FK9 4LA, UK
| | - Katie Bristow
- NIHR CLAHRC North West Coast, Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Brownlow street, Liverpool, L69 3GL, UK
| | - Kim Garthwaite
- Liverpool City Council, 1 Municipal Buildings, Dale St, Liverpool, l2 2DH, UK
| | - Amy Mahdi
- Liverpool Women's Hospital NHS Foundation Trust, Crown St, Liverpool, L8 7SS, UK
| | - Annette James
- Head of Children's Health Improvement, Liverpool Public Health, Liverpool City Council Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Waterhouse Building, Brownlow street, Liverpool, L69 3GL, UK
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, PR1 2HE, UK
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18
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Khan M, Brown HK, Lunsky Y, Welsh K, Havercamp SM, Proulx L, Tarasoff LA. A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada. Womens Health Issues 2021; 31:550-559. [PMID: 34556400 PMCID: PMC8595790 DOI: 10.1016/j.whi.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD). METHODS Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis. RESULTS Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences. CONCLUSIONS Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.
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Affiliation(s)
- Momina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | | | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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19
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Boyd LM, Mehra R, Thomas J, Lewis JB, Cunningham SD. Features and Impact of Trust-Based Relationships Between Community Health Workers and Low-Resource Perinatal Women with Chronic Health Conditions. Matern Child Health J 2021; 25:1866-1874. [PMID: 34674101 DOI: 10.1007/s10995-021-03242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Community health worker (CHW) programs are a promising strategy to improve maternal and child health outcomes, particularly among low-resource women. Yet, little is known about which aspects of CHW-client relationships are most salient for promoting positive change. This paper examines features of the CHW-client relationship that perinatal women with chronic conditions reported as being beneficial for their experience of prenatal care and pregnancy. METHODS Focus groups and interviews were conducted with 18 CHWs and 39 clients from three Merck for Mothers-funded programs in the Eastern United States. Data were analyzed using a grounded theory-informed thematic approach. RESULTS CHWs built trust-based relationships through emotional attendance, authenticity, and prioritization of clients' needs. They provided instrumental, informational, and emotional support that clients reported facilitated greater engagement with the healthcare system, improved health behaviors, and reduced stress. CHWs and clients alike viewed their relationships as having long-lasting impacts, made possible by the trust-based bond between them. DISCUSSION Strong, trusting relationships with CHWs may be one avenue through which to improve maternal and infant health for vulnerable perinatal women. Community health care programs should promote trust-building as an explicit program goal. Trust-based CHW-client relationships may serve as an exemplar for transforming traditional care relationships between providers and clients, leading to greater client engagement in care and improved health.
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Affiliation(s)
- Lisa M Boyd
- Yale School of Medicine, PO Box 208058, New Haven, CT, 06519, USA
| | - Renee Mehra
- Yale School of Public Health, 135 College St, New Haven, CT, 06510, USA
| | - Jordan Thomas
- University of California at Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Jessica B Lewis
- Yale School of Public Health, 135 College St, New Haven, CT, 06510, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, 263 Farmington Ave, Farmington, CT, 06030, USA.
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20
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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21
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Fox H, Topp SM, Lindsay D, Callander E. Ethnic, socio-economic and geographic inequities in maternal health service coverage in Australia. Int J Health Plann Manage 2021; 36:2182-2198. [PMID: 34270134 DOI: 10.1002/hpm.3277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. METHODS This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n = 186,789), plus their resultant babies (n = 189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. RESULTS The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. CONCLUSION Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.
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Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Phanwichatkul T, Schmied V, Liamputtong P, Burns E. The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study. Women Birth 2021; 35:e356-e368. [PMID: 34272187 DOI: 10.1016/j.wombi.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/19/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Across the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women's access to and experience of maternity services when they have migrated from a low- to a middle-income country. AIM To examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women's experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand. METHODS Ethnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis. FINDINGS The healthcare professionals' practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, "The system is in control' was identified, and comprised three sub-themes (1) 'Being processed' (2) 'Insensitivity to cultural practices' and, (3) 'The space to care'. DISCUSSION AND CONCLUSIONS The health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women's decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.
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Affiliation(s)
- Titaree Phanwichatkul
- School of Nursing and Midwifery, Faculty of Nursing, Suratthani Rajabhat University, 272 Moo 9 Surat-Nasan Road, Muang, Surat Thani 84100, Thailand.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, NSW, Australia.
| | | | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, NSW, Australia.
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23
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Rajbanshi S, Norhayati MN, Nik Hazlina NH. Perceptions of Good-Quality Antenatal Care and Birthing Services among Postpartum Women in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6876. [PMID: 34206868 PMCID: PMC8297004 DOI: 10.3390/ijerph18136876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
Patient complaints and dissatisfaction should be taken seriously and used as an opportunity to provide acceptable services. Mounting evidence shows that the perception of the quality of healthcare services impacts health-seeking behaviors. This study explores the perceptions of good-quality antenatal and birthing services among postpartum women. A qualitative study using phenomenological inquiry was conducted in the Morang district, Nepal. The study participants were postpartum women with at least one high-risk factor who refused the referral hospital's birth advice. A total of 14 women were purposively selected and interviewed in-depth. NVivo 12 Plus software was used for systematic coding, and thematic analysis was performed manually. Three themes emerged: (i) women's opinions and satisfactory factors of health services, (ii) expectations of the health facility and staff, and (iii) a lack of suggestions to improve the quality of care. Women did not have many expectations from the healthcare facility or the healthcare providers and could not express what good quality of care meant for them. Women from low socioeconomic status and marginalized ethnicities lack knowledge of their basic reproductive rights. These women judge the quality of care in terms of staff interpersonal behavior and personal experiences. Women will not demand quality services if they lack an understanding of their basic health rights.
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Affiliation(s)
- Sushma Rajbanshi
- Women’s Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan 16150, Malaysia; (S.R.); (N.H.N.H.)
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan 16150, Malaysia
| | - Nik Hussain Nik Hazlina
- Women’s Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan 16150, Malaysia; (S.R.); (N.H.N.H.)
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24
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McLeish J, Redshaw M. 'She come like a sister to me': a qualitative study of volunteer social support for disadvantaged women in the transition to motherhood in England. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200023. [PMID: 33938283 PMCID: PMC8090821 DOI: 10.1098/rstb.2020.0023] [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] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 11/12/2022] Open
Abstract
This qualitative study explores the ways in which disadvantaged women benefit from social support from a trained volunteer during pregnancy and the postnatal period, using the theoretical frameworks of stress and coping and a multi-dimensional model of social support. Forty-seven mothers took part in semi-structured interviews. The mothers, who had received social support through nine volunteer projects in England, faced many potentially stressful challenges besides having a baby (such as poverty, poor housing, histories of abuse, motherhood at a young age, living with physical or mental health difficulties, migration and insecure immigration status). Analysis was in two distinct stages: first, an inductive thematic analysis of mothers' experiences, and second, mapping of the results onto the theoretical frameworks chosen. Volunteers built relationships of trust with mothers and gave skilled emotional support, positive appraisal support, informational support and practical support according to mothers' individual needs, thereby assisting mothers exposed to multiple stressors with problem-focused, emotion-focused and perception-focused coping. This helped to reduce social isolation, increase effective access to services and community resources, and build mothers' confidence, self-esteem and self-efficacy. Volunteer social support may have particular salience for mothers who lack structural support and need skilled functional support. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Jenny McLeish
- NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK
| | - Maggie Redshaw
- NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK
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25
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Meaney S, Leitao S, Olander EK, Pope J, Matvienko-Sikar K. The impact of COVID-19 on pregnant womens' experiences and perceptions of antenatal maternity care, social support, and stress-reduction strategies. Women Birth 2021; 35:307-316. [PMID: 33994134 PMCID: PMC9051126 DOI: 10.1016/j.wombi.2021.04.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/06/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
Abstract
Background The COVID-19 pandemic has impacted on maternity care, supports and women’s mental health. Aim The aim of this study was to assess pregnant women’s satisfaction with antenatal care and social support and to examine stress-reduction strategies women used during the pandemic. Methods An online survey was conducted between June and July 2020. Pregnant women, aged over 18 years were recruited. The survey included closed and open-ended questions to assess women’s perceptions and satisfaction with their antenatal care, social support, and stress-reduction strategies. Descriptive statistics and multivariate analysis were used for quantitative analyses; qualitative content analysis was used for open-ended questions. Findings 573 pregnant women completed the survey. Women reported low levels of social support which was predicted by women’s mental health and demographic factors and was related to public health and maternity service restrictions. Women reported that restrictions implemented in the maternity services limited their face-to face interactions with healthcare professionals and meant their partners could not attend antenatal appointments or support them in the postpartum period in the maternity setting. The lack of information on COVID-19 and pregnancy meant women had greater uncertainty about pregnancy and birth. Discussion Our findings indicate how the lack of access to antenatal care and reduced perceived social support as a result of the restrictions implemented in response to the COVID-19 pandemic, potentially intensifies pregnancy specific stress. Conclusions There is a need for the provision of supportive care, both formally and informally, particularly with women who may be more vulnerable during a pandemic.
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Affiliation(s)
- Sarah Meaney
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Sara Leitao
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Johanna Pope
- School of Public Health, University College Cork, Ireland
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26
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Interventions to reduce preterm birth in pregnant women with psychosocial vulnerability factors-A systematic review. Midwifery 2021; 100:103018. [PMID: 33979766 DOI: 10.1016/j.midw.2021.103018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Pregnant women with psychosocial vulnerability factors face a higher risk of preterm birth, a heavier burden of perinatal morbidity and mortality and less social health equity. Prevention of preterm birth in this group has proved difficult, and more knowledge is needed to ensure evidence-based care and improve prevention. This study aimed to determine the effectiveness of preventive interventions to reduce preterm birth among pregnant women with psychosocial vulnerability factors. DESIGN A systematic review of preventive interventions was conducted, searching the databases Cinahl, Cochrane Library, Embase, ProQuest, PsycInfo, PubMed and Scopus to identify RCT's. The search was completed on October 14, 2019. Using the Cochrane Collaboration tools, quality assessments were made, and independent single-data extraction was conducted. Due to heterogeneity in, e.g., participant characteristics, intervention content and duration, the data were synthesised qualitatively. Included studies were ranked in evidence-based hierarchical order, elucidating the risk of bias of each individual study, all of which were ranked as having a medium or low level of evidence. FINDINGS We identified 1,562 articles, of which five focused on prevention of preterm birth, met our predefined criteria for inclusion and quality assessment, and were therefore included. Interventions consisted of home visits in two studies, group meetings in one study, phone calls in one study, and physical massage in the last study. Four transverse themes arose: intervention intensity, initiation, continuity of care, and the healthcare professionals' educational background. KEY CONCLUSIONS The evidence base for interventions aiming to prevent preterm birth among pregnant women with psychosocial vulnerabilities is limited. Interventions based on ten antenatal group meetings initiated during the second trimester and facilitated by the same midwife have the greatest likelihood of being effective. Continuity in intervention delivery and healthcare professional's educational background may positively impact the efficiency of the intervention. Further research is needed to address questions about the impact of intervention initiation and intensity and its degree of continuity and mode of delivery.
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27
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Frederiksen MS, Schmied V, Overgaard C. Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position. J Clin Nurs 2021; 30:2386-2398. [PMID: 33870548 DOI: 10.1111/jocn.15778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive. OBJECTIVES This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care. DESIGN Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi-structured interviews with parents and 51 field visits during parent-professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used. RESULTS The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured. CONCLUSION Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non-judgmental way. RELEVANCE TO CLINICAL PRACTICE Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period.
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Affiliation(s)
- Marianne Stistrup Frederiksen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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28
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Wakibi S, Ferguson L, Berry L, Leidl D, Belton S. Teaching evidence-based nursing practice: A systematic review and convergent qualitative synthesis. J Prof Nurs 2021; 37:135-148. [PMID: 33674084 DOI: 10.1016/j.profnurs.2020.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The benefits that ensue evidence-based nursing practice (EBNP) in health care settings have been globally communicated to the nurses. However, the current clinical activities surrounding EBNP demand the involvement of nursing schools to accelerate this practice. OBJECTIVES The purpose of this study was to synthesize, describe, and explore the evidence available to teach EBNP to undergraduate student nurses, so the students can continue to integrate EBNP in clinical settings upon becoming professional nurses. DESIGN Systematic review with convergent qualitative synthesis. DATA SOURCES Five electronic databases were searched; CINAHL, MEDLINE, EMBASE, ERIC, and Web of Science Core Collection. REVIEW METHODS This study followed the guidelines for writing systematic reviews by the Joanna Briggs Institute. RESULTS Two themes were generated; educational strategies, and EBNP knowledge and implementation. The latter theme had six sub-themes of timing, duration, content, delivery method, context, and prerequisites while the former theme had four sub-themes of knowledge acquisition, EBNP use and research utilization, collaborative teaching, and barriers and facilitators. CONCLUSION Well-designed educational strategies have a positive impact on students' EBNP knowledge and skills. These strategies are well suited for promoting EBNP implementation in clinical settings when students qualify as nurses.
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Affiliation(s)
| | | | - Lois Berry
- University of Saskatchewan, Saskatoon, SK, Canada.
| | - Don Leidl
- University of Saskatchewan, Saskatoon, SK, Canada.
| | - Sara Belton
- University of Saskatchewan, Saskatoon, SK, Canada.
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29
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Fryer K, Lewis G, Munoz C, Stuebe AM. Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women. N C Med J 2021; 82:7-13. [PMID: 33397748 PMCID: PMC7927271 DOI: 10.18043/ncm.82.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Early access to quality prenatal care is an essential component of improving maternal and neonatal outcomes as it allows for early intervention and risk stratification. Women who receive late or infrequent prenatal care are at high risk for complications including preterm birth, infant death, and stillbirth. We sought to better understand the barriers Spanish-speaking women face in accessing quality prenatal care and to identify facilitators in obtaining timely quality prenatal care.METHODS We recruited a homogeneous group of 11 women with Spanish as their primary language who were pregnant or had given birth within the last six months. We then conducted two focus groups in Spanish. The focus groups were recorded, translated, and transcribed, and then coded using grounded theory.RESULTS In our cohort of participants, the three major themes included desire for psychosocial support, health care system logistics, and barriers due to Latinx ethnicity.LIMITATIONS Our study has several limitations, including a small sample size and single site design.CONCLUSION Latinx women experience unique barriers to care including language barriers, a lack of cultural competency on the part of health care personnel, and ethnic discrimination. Additional research is needed to develop patient-centered interventions to address these barriers.
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Affiliation(s)
- Kimberly Fryer
- assistant professor, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida.
| | - Ginny Lewis
- program manager, Expanding Networks for Latinos through Community Engagement, The North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris Munoz
- associate professor, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison M Stuebe
- professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Jamieson B. Exposure to Interpersonal Violence During Pregnancy and Its Association With Women's Prenatal Care Utilization: A Meta-Analytic Review. TRAUMA, VIOLENCE & ABUSE 2020; 21:904-921. [PMID: 30322355 DOI: 10.1177/1524838018806511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Inadequate prenatal care utilization has been proposed as a mechanism between exposure to violence during pregnancy and adverse maternal and fetal obstetric outcomes. Adequate prenatal care is important for identifying and treating obstetric complications as they arise and connecting pregnant women to supports and interventions as needed. There is some evidence that pregnant women experiencing relational violence may delay or never enter prenatal care, though this association has not been systematically or quantitatively synthesized. The present meta-analysis investigates the relationship between interpersonal violence during pregnancy and inadequate prenatal care utilization across two dimensions: (1) no prenatal care during gestation (k = 9) and (2) delayed entry into prenatal care (k = 25). Studies were identified via comprehensive search of 9 social science and health-related databases and relevant reference lists. Studies were included if (1) participants were human, (2) violence occurred in the context of an interpersonal relationship, (3) abuse occurred during pregnancy (including abuse within 12 months before the time of assessment during pregnancy), (4) the study was empirical, peer-reviewed, and included quantitative data, (5) prenatal care utilization data were available, (6) they were in English, and (7) they were not part of an intervention study. Results from random-effects models found that women abused during pregnancy were more likely to never enter care (odds ratio [OR] = 2.62, 95% confidence interval [CI] = [1.55, 4.42]) or to delay care (OR = 1.81, 95% CI [1.48, 2.23]). Sociodemographic, abuse-related, and methodological factors emerged as moderators. Practice, policy, and research implications are discussed.
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Affiliation(s)
- Brittany Jamieson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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31
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Dahl B, Heinonen K, Bondas TE. From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8946. [PMID: 33271896 PMCID: PMC7730105 DOI: 10.3390/ijerph17238946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022]
Abstract
Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives' experiences of providing antenatal care, attending to clients' individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives' wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives' provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.
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Affiliation(s)
- Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South Eastern Norway, P.O. Box 235, N-3603 Kongsberg, Norway
| | - Kristiina Heinonen
- Metropolia University of Applied Sciences, Health Promotion, P.O. Box 4000, FI-00079 Metropolia, Helsinki, Finland;
- Department of Nursing Science, University of Eastern Finland, Finland, Yliopistonranta 1, 70210 Kuopio, Finland
| | - Terese Elisabet Bondas
- Faculty of Health Sciences, University of Stavanger, P.O. Box 8600, N-4036 Stavanger, Norway;
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Kennedy HP, Balaam MC, Dahlen H, Declercq E, de Jonge A, Downe S, Ellwood D, Homer CSE, Sandall J, Vedam S, Wolfe I. The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries. Birth 2020; 47:332-345. [PMID: 33124095 DOI: 10.1111/birt.12504] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. METHOD We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. RESULTS The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. CONCLUSIONS The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.
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Affiliation(s)
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Research in Childbirth and Health Unit (REACH) Group, University of Central Lancashire, Lancashire, UK
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Eugene Declercq
- Department of Obstetrics & Gynecology, School of Public Health, Boston University, Boston, MA, USA
| | - Ank de Jonge
- Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Research in Childbirth and Health Unit (REACH) Group, University of Central Lancashire, Lancashire, UK
| | - David Ellwood
- Department of Obstetrics & Gynaecology, Griffith University School of Medicine, Brisbane, QLD, Australia
| | - Caroline S E Homer
- Burnet Institute, Global Women's & Newborns Working Group, Melbourne, VIC, Australia
| | | | - Saraswathi Vedam
- Birth Place Lab, University of British Columbia, Vancouver, BC, Canada
| | - Ingrid Wolfe
- Kings College London, London, UK.,Children & Young People's Health Partnership, London, UK.,Child Public Health at Evelina London Children's Healthcare, London, UK
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Fryer K, Munoz MC, Rahangdale L, Stuebe AM. Multiparous Black and Latinx Women Face More Barriers to Prenatal Care than White Women. J Racial Ethn Health Disparities 2020; 8:80-87. [PMID: 32333378 DOI: 10.1007/s40615-020-00759-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Women who are late to prenatal care miss opportunities for health interventions and are at increased risk for pregnancy-related complications. Black women have the lowest rates of first trimester care compared with White or Latinx women. We sought to describe barriers to prenatal care experienced by race/ethnicity in a multi-site, prospective cohort. STUDY DESIGN We performed a secondary analysis of the Community Child Health Research Network Study, a multi-site prospective cohort study of pregnant women from 2008 to 2012. Women were recruited at the time of delivery and followed prospectively for 2 years. Participants who experienced a repeat pregnancy in the 2-year follow-up period had a prospective assessment of prenatal care barriers. A multilevel mixed effects Poisson regression was performed to evaluate the association between race/ethnicity and number of prenatal barriers. RESULTS Of the 298 participants in the sample, 43% of Black, 35% of Latinx, and 23% of White participants reported barriers to prenatal care. After adjustment for confounders, Black and Latinx women reported almost twice as many barriers to prenatal care as White women (adjusted rate ratio 1.89 [1.2, 3.0]; 2.00 [1.1, 3.8], respectively). CONCLUSION In our analysis, multiparous Black and Latinx women reported encountering more barriers to prenatal care than White women. Additional reforms and policy change are needed at the clinic, local, and state levels to support women in accessing early quality prenatal care to achieve racial equity in prenatal care.
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Affiliation(s)
- Kimberly Fryer
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
| | - Maria Christina Munoz
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Trinh LTT, Assareh H, Achat H, Chua S, Guevarra V. Caesarean section by country of birth in New South Wales, Australia. Women Birth 2020; 33:e72-e78. [DOI: 10.1016/j.wombi.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/19/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Ganann R, Sword W, Newbold KB, Thabane L, Armour L, Kint B. Influences on mental health and health services accessibility in immigrant women with post-partum depression: An interpretive descriptive study. J Psychiatr Ment Health Nurs 2020; 27:87-96. [PMID: 31444918 DOI: 10.1111/jpm.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/27/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women. Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels. To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post-partum health experiences. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insights into immigrant women's perceptions of what influences their post-partum mental health and ability to access services for PPD. Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services. Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation. Assessment approaches and organizational wait times created barriers to accessing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relationship building by providers is foundational to effective care for immigrant women with PPD. Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno-cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services. Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Abstract Introduction Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women yet face multiple barriers to care at individual and system levels. Aim To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno-cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women.
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Affiliation(s)
- Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Wendy Sword
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - K Bruce Newbold
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leigh Armour
- Aisling Discoveries Child and Family Centre, Toronto, ON, Canada
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GUTVIRTZ G, WAINSTOCK T, LANDAU D, SHEINER E. Unplanned Out-of-Hospital Birth-Short and Long-Term Consequences for the Offspring. J Clin Med 2020; 9:jcm9020339. [PMID: 31991747 PMCID: PMC7073687 DOI: 10.3390/jcm9020339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/08/2023] Open
Abstract
The unpredictable nature of childbirth infrequently results in unplanned out-of-hospital birth, in a pre-hospital setting. We evaluated the perinatal and long-term outcome of children accidentally born out-of-hospital. This was a population-based analysis of singleton deliveries occurring at a single tertiary hospital. The maternal characteristics and pregnancy outcome of unplanned out-of-hospital births were compared with in-hospital attended deliveries. Long-term cumulative incidence of hospitalizations (up to 18 years) involving respiratory, neurological, endocrine or infectious morbidity were evaluated using Kaplan-Meier survival curves and Cox regression models were used to control for confounders. In total, 243,682 deliveries were included, and 1.5% (n = 3580) were unplanned out-of-hospital births. Most occurred in multiparous women, and about a quarter of these women had inadequate prenatal care. Perinatal mortality rate was significantly higher for out-of-hospital births as compared with in-hospital births (OR = 2.9; 95% CI 2.2-3.8, p < 0.001). Kaplan-Meier survival curves demonstrated a significantly lower cumulative incidence of hospitalizations of children born out-of-hospital and the Cox models showed that hospitalization rates involving any of the above morbidities were significantly lower in children born out-of-hospital. While perinatal mortality was higher in unplanned out-of-hospital births, offspring born out-of-hospital showed a lower incidence of hospitalizations involving a variety of morbidities, possibly owing to under-utilization of healthcare services in this population.
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Affiliation(s)
- Gil GUTVIRTZ
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
- Correspondence:
| | - Tamar WAINSTOCK
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel;
| | - Daniella LANDAU
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
| | - Eyal SHEINER
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
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Styles A, Loftus V, Nicolson S, Harms L. Prenatal yoga for young women a mixed methods study of acceptability and benefits. BMC Pregnancy Childbirth 2019; 19:449. [PMID: 31779582 PMCID: PMC6883519 DOI: 10.1186/s12884-019-2564-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND High rates of psychological-distress, trauma and social complexity are reported among young pregnant women. At the Royal Women's Hospital, Australia, young pregnant women acknowledge wanting tools to improve maternal wellbeing yet remain challenging to engage in antenatal education and support. While yoga is a widely accepted and participated activity in pregnancy, with demonstrated benefits for adult pregnant women, adolescent women are often excluded from both these yoga interventions and related pregnancy studies. METHODS This mixed methods study examined the acceptability and benefits of yoga for young women. We recruited 30 participants aged under 24 years, who were offered twice a week, one-hour voluntary prenatal yoga sessions throughout their pregnancy. A medical file audit gathered baseline demographics, pre and post yoga session surveys were administered and brief individual interview were conducted with study participants. RESULTS While 26 study participants were positive about the availability of a yoga program, only 15 could attend yoga sessions (mean = 8 sessions, range 1-27). No differences were found in the demographic or psychosocial factors between those who did and did not attend the yoga sessions. The medical file audit found that 60% of all the study participants had a documented history of psychological distress. Barriers to participation were pragmatic, not attitudinal, based on the timing of the group sessions, transport availability and their own health. All study participants identified perceived benefits, and the yoga participants identified these as improved relaxation and reduction of psychological distress; labour preparation; bonding with their baby in utero; and social connectedness with the yoga group peers. CONCLUSIONS This study demonstrated yoga was acceptable to young pregnant women. For those who did participate in the sessions, yoga was found to decrease self-reported distress and increase perceived skills to assist with their labour and the birth of their baby. The provision of accessible yoga programs for pregnant young women is recommended.
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Affiliation(s)
- Amanda Styles
- Department of Social Work and the Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Virginia Loftus
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Susan Nicolson
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Louise Harms
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, 3010, Australia.
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Kluckow E, Halliday J, Poulton A, Lindquist A, Hutchinson B, Bethune M, Bonacquisto L, Da Silva Costa F, Gugasyan L, Harraway J, Howden A, Kulkarni A, Martin N, McCoy R, Menezes M, Nisbet D, Palma-Dias R, Pertile MD, Poulakis Z, Hui L. Association between timing of diagnosis of trisomy 21, 18, and 13 and maternal socio-economic status in Victoria, Australia: A population-based cohort study from 2015 to 2016. Prenat Diagn 2019; 39:1254-1261. [PMID: 31691307 DOI: 10.1002/pd.5577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the association between timing of diagnosis of common autosomal trisomies, maternal age, and socio-economic status (SES). DESIGN Retrospective study of cytogenetic diagnoses of trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13) in Victoria, Australia, in 2015 to 2016, stratified by timing (prenatal less than 17 weeks gestation, prenatal including or greater than or 17 weeks gestation, and postnatal before 12 months of age), maternal age, and SES region. Utilisation of prenatal testing following a live-born T21 infant was ascertained via record linkage. RESULTS Among 160 230 total births were 571 diagnoses of T21 and 246 of T18/T13. The overall and live birth prevalences of T21 were 3.56 and 0.47 per 1000 births, respectively. Compared with women from disadvantaged SES regions, women from high SES regions were more likely to have a prenatal diagnosis of a trisomy before 17 weeks than after (P < .01) and less likely to have a live-born T21 infant than a prenatal diagnosis (P < .01). There was a significant trend to higher live birth rates of T21 with lower SES (P = .004). The majority (68.5%) of women who gave birth to a live infant with T21 did not utilise prenatal testing. CONCLUSION There is a significant relationship between lower SES, later prenatal diagnosis of trisomy, and higher live birth rate of T21 in Victoria.
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Affiliation(s)
- Eliza Kluckow
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jane Halliday
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Alice Poulton
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anthea Lindquist
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Briohny Hutchinson
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michael Bethune
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Specialist Women's Ultrasound, Box Hill, Victoria, Australia
| | - Leonard Bonacquisto
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fabricio Da Silva Costa
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lucy Gugasyan
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | - James Harraway
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Amanda Howden
- Cytogenetics, Melbourne Pathology, Collingwood, Victoria, Australia
| | - Abhijit Kulkarni
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | | | - Richard McCoy
- Molecular Genetics, Australian Clinical Labs, Clayton, Victoria, Australia
| | - Melody Menezes
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Monash Ultrasound for Women, Richmond, Victoria, Australia
| | - Debbie Nisbet
- Women's Ultrasound Melbourne, East Melbourne, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Medicine and Radiology, University of Melbourne, Parkville, Victoria, Australia
| | - Ricardo Palma-Dias
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Women's Ultrasound Melbourne, East Melbourne, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Mark D Pertile
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Zeffie Poulakis
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Infant Hearing Screening Program, Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia.,Prevention Innovation Group, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lisa Hui
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, Victoria, Australia
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Guttmann A, Blackburn R, Amartey A, Zhou L, Wijlaars L, Saunders N, Harron K, Chiu M, Gilbert R. Long-term mortality in mothers of infants with neonatal abstinence syndrome: A population-based parallel-cohort study in England and Ontario, Canada. PLoS Med 2019; 16:e1002974. [PMID: 31770382 PMCID: PMC6879118 DOI: 10.1371/journal.pmed.1002974] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Opioid addiction is a major public health threat to healthy life expectancy; however, little is known of long-term mortality for mothers with opioid use in pregnancy. Pregnancy and delivery care are opportunities to improve access to addiction and supportive services. Treating neonatal abstinence syndrome (NAS) as a marker of opioid use during pregnancy, this study reports long-term maternal mortality among mothers with a birth affected by NAS in relation to that of mothers without a NAS-affected birth in 2 high-prevalence jurisdictions, England and Ontario, Canada. METHODS AND FINDINGS We conducted a population-based study using linked administrative health data to develop parallel cohorts of mother-infant dyads in England and Ontario between 2002 and 2012. The study population comprised 13,577 and 4,966 mothers of infants with NAS and 4,205,675 and 929,985 control mothers in England and Ontario, respectively. Death records captured all-cause maternal mortality after delivery through March 31, 2016, and cause-specific maternal mortality to December 31, 2014. The primary exposure was a live birth of an infant with NAS, and the main outcome was all deaths among mothers following their date of delivery. We modelled the association between NAS and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. All-cause mortality rates, 10-year cumulative incidence risk of death, and crude and age-adjusted hazard ratios were calculated. Estimated crude 10-year mortality based on Kaplan-Meier curves in mothers of infants with NAS was 5.1% (95% CI 4.7%-5.6%) in England and 4.6% (95% CI 3.8%-5.5%) in Ontario versus 0.4% (95% CI 0.41%-0.42%) in England and 0.4% (95% CI 0.38%-0.41%) in Ontario for controls (p < 0.001 for all comparisons). Survival curves showed no clear inflection point or period of heightened risk. The crude hazard ratio for all-cause mortality was 12.1 (95% 11.1-13.2; p < 0.001) in England and 11.4 (9.7-13.4; p < 0.001) in Ontario; age adjustment did not reduce the hazard ratios. The cumulative incidence of death was higher among NAS mothers than controls for almost all causes of death. The majority of deaths were by avoidable causes, defined as those that are preventable, amenable to care, or both. Limitations included lack of direct measures of maternal opioid use, other substance misuse, and treatments or supports received. CONCLUSIONS In this study, we found that approximately 1 in 20 mothers of infants with NAS died within 10 years of delivery in both England and Canada-a mortality risk 11-12 times higher than for control mothers. Risk of death was not limited to the early postpartum period targeted by most public health programs. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of opioid-using mothers and their children.
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Affiliation(s)
- Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Blackburn
- UCL Institute of Health Informatics, London, United Kingdom
| | | | | | - Linda Wijlaars
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Natasha Saunders
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Dawson P, Jaye C, Gauld R, Hay-Smith J. Barriers to equitable maternal health in Aotearoa New Zealand: an integrative review. Int J Equity Health 2019; 18:168. [PMID: 31666134 PMCID: PMC6822457 DOI: 10.1186/s12939-019-1070-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this review was to examine the literature for themes of underlying social contributors to inequity in maternal health outcomes and experiences in the high resource setting of Aotearoa New Zealand. These ‘causes of the causes’ were explored and compared with the international context to identify similarities and New Zealand-specific differences. Method A structured integrative review methodology was employed to enable a complex cross disciplinary analysis of data from a variety of published sources. This method enabled incorporation of diverse research methodologies and theoretical approaches found in the literature to form a unified overall of the topic. Results Six integrated factors – Physical Access, Political Context, Maternity Care System, Acceptability, Colonialism, and Cultural factors – were identified as barriers to equitable maternal health in Aotearoa New Zealand. The structure of the maternal health system in New Zealand, which includes free maternity care and a woman centred continuity of care structure, should help to ameliorate inequity in maternal health and yet does not appear to. A complex set of underlying structural and systemic factors, such as institutionalised racism, serve to act as barriers to equitable maternity outcomes and experiences. Initiatives that appear to be working are adapted to the local context and involve self-determination in research, clinical outreach and community programmes. Conclusions The combination of six social determinants identified in this review that contribute to maternal health inequity is specific to New Zealand, although individually these factors can be identified elsewhere; this creates a unique set of challenges in addressing inequity. Due to the specific social determinants in Aotearoa New Zealand, localised solutions have potential to further maternal health equity.
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Affiliation(s)
- Pauline Dawson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Chrys Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand.,Centre for Health Systems and Technology, University of Otago, Dunedin, New Zealand
| | - Jean Hay-Smith
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
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Kingdon C, Roberts D, Turner MA, Storey C, Crossland N, Finlayson KW, Downe S. Inequalities and stillbirth in the UK: a meta-narrative review. BMJ Open 2019; 9:e029672. [PMID: 31515427 PMCID: PMC6747680 DOI: 10.1136/bmjopen-2019-029672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To review what is known about the relationship between stillbirth and inequalities from different disciplinary perspectives to inform stillbirth prevention strategies. DESIGN Systematic review using the meta-narrative method. SETTING Studies undertaken in the UK. DATA SOURCES Scoping phase: experts in field, exploratory electronic searches and handsearching. Systematic searches phase: Nine databases with no geographical or date restrictions. Non-English language studies were excluded. STUDY SELECTION Any investigation of stillbirth and inequalities with a UK component. DATA EXTRACTION AND SYNTHESIS Three authors extracted data and assessed study quality. Data were summarised, tabulated and presented graphically before synthesis of the unfolding storyline by research tradition; and then of the commonalities, differences and interplays between narratives into resultant summary meta-themes. RESULTS Fifty-four sources from nine distinctive research traditions were included. The evidence of associations between social inequalities and stillbirth spanned 70 years. Across research traditions, there was recurrent evidence of the social gradient remaining constant or increasing, fuelling repeated calls for action (meta-theme 1: something must be done). There was less evidence of an effective response to these calls. Data pertaining to socioeconomic, area and ethnic disparities were routinely collected, but not consistently recorded, monitored or reported in relation to stillbirth (meta-theme 2: problems of precision). Many studies stressed the interplay of socioeconomic status, deprivation or ethnicity with aggregated factors including heritable, structural, environmental and lifestyle factors (meta-theme 3: moving from associations towards intersectionality and intervention(s)). No intervention studies were identified. CONCLUSION Research investigating inequalities and stillbirth in the UK is underdeveloped. This is despite repeated evidence of an association between stillbirth risk and poverty, and stillbirth risk, poverty and ethnicity. A specific research forum is required to lead the development of research and policy in this area, which can harness the multiple relevant research perspectives and address the intersections between different policy areas. PROSPERO REGISTRATION NUMBER CRD42017079228.
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Affiliation(s)
- Carol Kingdon
- Research in childbirth and health, University of Central Lancashire, Preston, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Womens NHS Foundation Trust, Liverpool, UK
| | - Mark A Turner
- Department of Women's and Childrens Health, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Nicola Crossland
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | | | - Soo Downe
- Research in childbirth and health, University of Central Lancashire, Preston, UK
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Downe S, Finlayson K, Tunçalp Ö, Gülmezoglu AM. Provision and uptake of routine antenatal services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 6:CD012392. [PMID: 31194903 PMCID: PMC6564082 DOI: 10.1002/14651858.cd012392.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. OBJECTIVES To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. SEARCH METHODS To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. SELECTION CRITERIA We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. DATA COLLECTION AND ANALYSIS Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour. MAIN RESULTS We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies. AUTHORS' CONCLUSIONS This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.
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Affiliation(s)
- Soo Downe
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Kenneth Finlayson
- University of Central LancashireResearch in Childbirth and Health (ReaCH) unitPrestonUKPR1 2HE
| | - Özge Tunçalp
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
| | - Ahmet Metin Gülmezoglu
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerland1211
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Smith A, Burger R, Black V. Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa. Matern Child Health J 2019; 23:512-521. [PMID: 30600513 DOI: 10.1007/s10995-018-2663-2] [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] [Indexed: 10/27/2022]
Abstract
Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and < 5 months, and a quarter (26.3%) attended ≥ 5 months. For those attending ≥ 5 months, 51.8% cited late recognition of pregnancy as the major reason for delayed attendance. Supply-side barriers were not identified as large contributing factors to delayed attendance. Late antenatal care access was predominantly associated with demand-side factors. Women who accessed antenatal care ≥ 5 months were more likely to be in the poorest 40% of the wealth-index distribution (p = 0.034) and to not have completed high school (p = 0.006). They were also more likely to report alcohol consumption during pregnancy (p = 0.020) and be multiparous (p = 0.035). Having completed high school was protective of late antenatal care access in stepwise logistic regression analysis (OR 0.403, CI 0.210-0.773, p < 0.01). For women who attended ≥ 3 months, late access was associated with unwanted pregnancy (p = 0.030). Conclusions for Practice Improved access to pregnancy tests could assist in earlier pregnancy identification. Interventions to increase awareness of the importance of early antenatal care attendance among vulnerable women may help.
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Affiliation(s)
- Anja Smith
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
| | - Ronelle Burger
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Vivian Black
- Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
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Abdullah P, Landy CK, McCague H, Macpherson A, Tamim H. Factors associated with the timing of the first prenatal ultrasound in Canada. BMC Pregnancy Childbirth 2019; 19:164. [PMID: 31077167 PMCID: PMC6509859 DOI: 10.1186/s12884-019-2309-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the factors associated with the timing of the first prenatal ultrasound in Canada. Methods This was a secondary data analysis of the Maternity Experiences Survey, a cross-sectional survey covering different aspects of pregnancy, labour, birth and the post-partum period. Bivariate and multivariate multinomial logistic regressions were performed to assess the relationship between timing of first prenatal ultrasound and different independent variables. Results 68.4% of Canadian women received an optimally timed first prenatal ultrasound, 27.4% received early ultrasounds and 4.3% received late ultrasound. The highest prevalence of early ultrasound was in Ontario (33.3%) and the lowest was in Manitoba (13.3%). The highest prevalence of late ultrasound was found in Manitoba (12.1%) and the lowest was in British Columbia and Ontario (3.5% each). The highest prevalence of optimal timing of first prenatal ultrasound was in Quebec (77%) and the lowest was in Ontario (63.2%). Factors influencing the timing of ultrasound included: Early – maternal age < 20 (adjusted OR = 0.54, 95%CI:0.34–0.84), alcohol use during pregnancy (adjusted OR = 0.69, 95%CI:0.53–0.90), history of premature birth (adjusted OR = 1.41, 95%CI:1.06–1.89), multiparity (adjusted OR = 0.67, 95%CI:0.57–0.78), born outside of Canada (adjusted OR = 0.82, 95%CI:0.67–0.99), prenatal care in Newfoundland and Labrador (adjusted OR = 1.66, 95%CI:1.20–1.30), Nova Scotia (adjusted OR = 1.68, 95%CI:1.25–2.28), Ontario (adjusted OR = 2.16, 95%CI:1.76–2.65), Saskatchewan (adjusted OR = 1.50, 95%CI:1.05–2.14), Alberta (adjusted OR = 1.37, 95%CI:1.05–1.77) British Columbia (adjusted OR = 1.90, 95%CI:1.45–2.50) and Manitoba (adjusted OR = 0.66, 95%CI:0.45–0.98) Late – unintended pregnancy (adjusted OR = 1.89, 95%CI:1.38–2.59), born outside of Canada (adjusted OR = 1.75, 95%CI:1.14–2.68), prenatal care in Manitoba (adjusted OR = 2.88, 95%CI:1.64–5.05) and the Territories (adjusted OR = 4.50, 95%CI:2.27–8.93). An interaction between history of miscarriage and having ‘other’ prenatal care provider significantly affected timing of ultrasound (adjusted OR = 0.31, 95%CI:0.14–0.66). Conclusion Only 68% of Canadian women received an optimally timed prenatal ultrasound which was influenced by several factors including province of prenatal care, maternal age and country of birth, and an interaction effect between prenatal care provider and history of miscarriage. These findings establish a baseline of factors influencing the timing of prenatal ultrasound in Canada, which can be built upon by future studies.
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Affiliation(s)
- Peri Abdullah
- Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Christine Kurtz Landy
- Health, Nursing and Environmental Studies, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Hugh McCague
- Institute for Social Research, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Alison Macpherson
- Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Hala Tamim
- Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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Heaman MI, Martens PJ, Brownell MD, Chartier MJ, Thiessen KR, Derksen SA, Helewa ME. Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba. BMC Pregnancy Childbirth 2018; 18:430. [PMID: 30382911 PMCID: PMC6211437 DOI: 10.1186/s12884-018-2061-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care. METHODS We studied women giving birth in Manitoba from 2004/05-2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information. RESULTS Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use. CONCLUSION The rate of inadequate prenatal care in Manitoba ranged from 10.5-12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.
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Affiliation(s)
- Maureen I. Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Patricia J. Martens
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Marni D. Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Mariette J. Chartier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Kellie R. Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Shelley A. Derksen
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Michael E. Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, WR120-735 Notre Dame Avenue, Winnipeg, MB R3E 0L8 Canada
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Curtis A, Gibson L, O'Brien M, Roe B. Systematic review of the impact of arts for health activities on health, wellbeing and quality of life of older people living in care homes. DEMENTIA 2018; 17:645-669. [PMID: 30041548 DOI: 10.1177/1471301217740960] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care home populations frequently feature older people who often experience poor physical health and cognitive difficulties, along with vulnerability to psychological and social stressors. To date there has been no systematic review which focuses on the impact of arts for health activities to the care home population. Evidence was sourced from several databases and 71 studies were deemed eligible for inclusion in this review. These studies underwent data extraction and quality appraisal and the findings associated with health, wellbeing and quality of life are presented within this paper.
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Iannuzzi L, Branchini L, Clausen JA, Ruiz-Berdún D, Gillen P, Healy M, Beeckman K, Seijmonsbergen-Schermers A, Escuriet Peiró R, Morano S, Di Tommaso M, Downe S. Optimal outcomes and women's positive pregnancy experience: a comparison between the World Health Organization guideline and recommendations in European national antenatal care guidelines. ACTA ACUST UNITED AC 2018; 70:650-662. [PMID: 30291700 DOI: 10.23736/s0026-4784.18.04301-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The publication of the World Health Organization (WHO) recommendations on antenatal care in 2016 introduced the perspective of women as a necessary component of clinical guidelines in maternity care. WHO highlights the crucial role played by evidence-based recommendations in promoting and supporting normal birth processes and a positive experience of pregnancy. This paper aims to explore and critically appraise recommendations of national antenatal care guidelines across European countries in comparison with the WHO guideline. METHODS We collected guidelines from country partners of the EU COST Action IS1405. Components of the documents structure and main recommendations within and between them were compared and contrasted with the WHO guideline on antenatal care with a particular interest in exploring whether and how women's experience was included in the recommendations. RESULTS Eight out of eleven countries had a single national guideline on antenatal care while three countries did not. National guidelines mostly focused on care of healthy women with a straightforward pregnancy. The level of concordance between the national and the WHO recommendations varied along a continuum from almost total concordance to almost total dissonance. Women's views and experiences were accounted for in some guidelines, but mostly not placed at the same level of importance as clinical items. CONCLUSIONS Findings outline convergences and divergences with the WHO recommendations. They highlight the need for considering women's views more in the development of evidence-based recommendations and in practice for positive impacts on perinatal health at a global level, and on the experiences of each family.
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Affiliation(s)
- Laura Iannuzzi
- Physiological Pregnancy Pathway and Margherita Birth Center, Department of Health Care Professions, Careggi University Hospital, Florence, Italy -
| | - Lucia Branchini
- MondoDonna Onlus, Association for Support and Integration of Immigrant Populations and Vulnerable Women, Bologna, Italy
| | - Jette A Clausen
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
| | - Dolores Ruiz-Berdún
- Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Patricia Gillen
- Southern Health and Social Care Trust, Portadown, UK.,School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Maria Healy
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Katrien Beeckman
- Unit of Nursing and Midwifery Research, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Belgium
| | - Anna Seijmonsbergen-Schermers
- Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | | | - Sandra Morano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infant Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Soo Downe
- Research in Childbirth and Health Unit (ReaCH), School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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McRae DN, Janssen PA, Vedam S, Mayhew M, Mpofu D, Teucher U, Muhajarine N. Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care. BMJ Open 2018; 8:e022220. [PMID: 30282682 PMCID: PMC6169769 DOI: 10.1136/bmjopen-2018-022220] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Our aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position. SETTING This population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada. PARTICIPANTS Our study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance. PRIMARY AND SECONDARY OUTCOME MEASURES We report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks' completed gestation) and LBW (<2500 g). RESULTS Our sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54). CONCLUSION Antenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.
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Affiliation(s)
- Daphne N McRae
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah Mpofu
- Saskatoon City Hospital, Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ulrich Teucher
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Fox EL, Davis C, Downs SM, Schultink W, Fanzo J. Who is the Woman in Women's Nutrition? A Narrative Review of Evidence and Actions to Support Women's Nutrition throughout Life. Curr Dev Nutr 2018. [PMCID: PMC6349991 DOI: 10.1093/cdn/nzy076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nutrition interventions that target mothers alone inadequately address women's needs across their lives: during adolescence, preconception, and in later years of life. They also fail to capture nulliparous women. The extent to which nutrition interventions effectively reach women throughout the life course is not well documented. In this comprehensive narrative review, we summarized the impact and delivery platforms of nutrition-specific and nutrition-sensitive interventions targeting adolescent girls, women of reproductive age (nonpregnant, nonlactating), pregnant and lactating women, women with young children <5 y, and older women, with a focus on nutrition interventions delivered in low- and middle-income countries. We found that although there were many effective interventions that targeted women's nutrition, they largely targeted women who were pregnant and lactating or with young children. There were major gaps in the targeting of interventions to older women. For the delivery platforms, community-based settings, compared with facility-based settings, more equitably reached women across the life course, including adolescents, women of reproductive age, and older women. Nutrition-sensitive approaches were more often delivered in community-based settings; however, the evidence of their impact on women's nutritional outcomes was less clear. We also found major research and programming gaps relative to targeting overweight, obesity, and noncommunicable disease. We conclude that focused efforts on women during pregnancy and in the first couple of years postpartum fail to address the interrelation and compounding nature of nutritional disadvantages that are perpetuated across many women's lives. In order for policies and interventions to more effectively address inequities faced by women, and not only women as mothers, it is essential that they reflect on how, when, and where to engage with women across the life course.
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Affiliation(s)
- Elizabeth L Fox
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Claire Davis
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Shauna M Downs
- Department of Health Systems and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | | | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC
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Appleton D, Robertson N, Mitchell L, Lesley R. Our disease: a qualitative meta-synthesis of the experiences of spousal/partner caregivers of people with multiple sclerosis. Scand J Caring Sci 2018; 32:1262-1278. [PMID: 30144143 DOI: 10.1111/scs.12601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide a unique and conceptually comprehensive account of the lived experiences of caregiving spouses/partners of people with multiple sclerosis, which can be used to better enable health professionals to provide appropriate support services. METHOD A systematic review of qualitative studies reporting the experiences of caregiving spouses/partners was conducted. Relevant articles were identified and analysed using a meta-ethnographic synthesis. RESULTS Twenty studies met eligibility criteria, of which 18 were included in the final meta-synthesis. Six major concepts were identified: Acceptance and Appreciation, Commitment, Becoming the Carer, Living with Loss, Shifting Sands and Setbacks with Services. A model of carer experience is presented as a line of argument to synthesise the findings. Suggestions are made regarding the types of supportive interventions that might be effective for spousal carers. CONCLUSION The findings increase our understanding about the experiences of partners caring for people with multiple sclerosis. Spousal carers can adapt to the challenges associated with change and loss, and have the potential to develop appreciation, acceptance and hope. Services need to be sensitive to the fluctuating demands placed upon carers and be flexible in their support.
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Affiliation(s)
- Damien Appleton
- University of Leicester, Leicester, UK.,Committee for Health and Social Care, States of Guernsey, Princess Elizabeth Hospital, St Martins, Guernsey
| | | | - Laura Mitchell
- Committee for Health and Social Care, States of Guernsey, Princess Elizabeth Hospital, St Martins, Guernsey.,Oxford Institute of Clinical Psychology, Oxford, UK
| | - Rosie Lesley
- Committee for Health and Social Care, States of Guernsey, Princess Elizabeth Hospital, St Martins, Guernsey
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