Background Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh (UP) and examines its determinants. Methods Data from a baseline survey of UP Community Mobilization (UPCM) project (2013) was utilized. A cross-sectional sample of currently married women (15 to 49 years) who delivered a baby 15 months prior to the survey was included. Information was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care (ANC), delivery and postnatal care (PNC) services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Results Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group (SHG) membership had no association with the utilization of maternal health services. Conclusions Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group.

The limitations of individual level interventions in changing behaviors to improve global maternal, newborn and child health have generated more interest in the patterns of social influence and decision making embedded in families, friends and communities. The purpose of this study is to expand the understanding of village dynamics in India and how first degree social and advice networks and cognitive perceptions of 185 recently delivered women (RDW) in areas with and without women's Self-Help Groups (SHGs) affect immediate breastfeeding. Data was collected in 6 blocks and 36 villages in Uttar Pradesh, India. The expansion of RDW's social worlds and creation of social capital through the organization of Self-Help Groups in their villages allowed us to examine basic relationships and advice formation as well as perceptions of interconnectedness of known groups. RDW living in SHG villages and blocks had consistently higher numbers of relationship ties, health advice ties and higher density of health advice networks than RDW living in the non-SHG areas. RDW's perceived knowing ties were also significantly higher between family and health workers in the SHG areas with related higher immediate breastfeeding rates. These results suggest that SHGs can accelerate community social capital and promote more accountability in the health system to engage with families and support the change from traditional to more evidence-based health practices.

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ObjectivesTo assess how the health coordination and emergency referral networks between women’s self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.DesignA pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.SettingThe study was conducted in 18 villages located in three districts in Uttar Pradesh, India.InterventionTo improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.ParticipantsA purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).Main outcome measuresSocial network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.ResultsThe health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.ConclusionsThe creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

BackgroundIndia is committed to improving maternal and newborn health in order to achieve the targets for India’s Millennium Development Goal 4. Considering their role as a link between community and health systems, frontline workers (FLWs) can be effectively utilized in strengthening maternal and newborn care. In this paper, we set out to examine the effect of intensity of contact with FLWs on key maternal and newborn health behaviors and to determine if this association varies by status of Self Help Group (SHG) membership.MethodsThis population-based cross-sectional study included 2208 currently married women aged 15–49 years who had delivered a baby during the last 15 months prior to the survey and selected through a multi-stage cluster sampling from rural villages and urban wards. The outcome of interest included variables related to key knowledge and practice of healthy behavior in relation to maternal and newborn health and exposure variable considered was intensity of contact with FLWs.ResultsOf the women interviewed, 1729 (78%) belonged to SHG household. For knowledge on the need for at least 3 antenatal care (ANC) check-ups, two tetanus toxoid (TT) injections and consumption of 100 or more iron-folic acid (IFA) tablets, proportion of those who were aware of these practices increased with increasing number of contacts with FLWs (P value < 0.001). Practice for TT injections showed an increasing trend with increasing number of contacts with FLW. An increase in the odds of delivering in an institution was observed in those who had higher number of contacts as compared to those with no contacts (P value < 0.001). With regard to newborn healthy behavior practice, breastfeeding within 1 h of delivery showed significant association and the odds of this practice improved in those who had ≥ 3 contacts with FLW as compared to those had no contacts. Except for consumption of 100 or more IFA tablets, there was no interaction of these associations by SHG status.ConclusionThere was an overall low prevalence of both knowledge and practice of key maternal and newborn healthy behaviors and only a few of these were associated with frequency of contacts with FLW. Findings not only highlight the urgent need for effectively leveraging FLWs to strengthen maternal and newborn care but also to improve the quality of services provided by them.Electronic supplementary materialThe online version of this article (10.1186/s41043-017-0129-6) contains supplementary material, which is available to authorized users.

Background Monitoring abortion rates is highly relevant for demographic and public health considerations, yet its reliable estimation is fraught with uncertainty due to lack of complete national health facility service statistics and bias in self-reported survey data. In this study, we aim to test the confidante methodology for estimating abortion incidence rates in Nigeria, Cote d’Ivoire, and Rajasthan, India, and develop methods to adjust for violations of assumptions. Methods In population-based surveys in each setting, female respondents of reproductive age reported separately on their two closest confidantes’ experience with abortion, in addition to reporting about their own experiences. We used descriptive analyses and design-based F tests to test for violations of method assumptions. Using post hoc analytical techniques, we corrected for biases in the confidante sample to improve the validity and precision of the abortion incidence estimates produced from these data. Results Results indicate incomplete transmission of confidante abortion knowledge, a biased confidante sample, but reduced social desirability bias when reporting on confidantes' abortion incidences once adjust for assumption violations. The extent to which the assumptions were met differed across the three contexts. The respondent 1-year pregnancy removal rate was 18.7 (95% confidence interval (CI) 14.9–22.5) abortions per 1000 women of reproductive age in Nigeria, 18.8 (95% CI 11.8–25.8) in Cote d’Ivoire, and 7.0 (95% CI 4.6–9.5) in India. The 1-year adjusted abortion incidence rates for the first confidantes were 35.1 (95% CI 31.1–39.1) in Nigeria, 31.5 (95% CI 24.8–38.1) in Cote d’Ivoire, and 15.2 (95% CI 6.1–24.4) in Rajasthan, India. Confidante two’s rates were closer to confidante one incidences than respondent incidences. The adjusted confidante one and two incidence estimates were significantly higher than respondent incidences in all three countries. Conclusions Findings suggest that the confidante approach may present an opportunity to address some abortion-related data deficiencies but require modeling approaches to correct for biases due to violations of social network-based method assumptions. The performance of these methodologies varied based on geographical and social context, indicating that performance may be better in settings where abortion is legally and socially restricted.

BackgroundAppropriate immediate newborn care is vital for neonatal survival. Antenatal period is a crucial time to impart knowledge and awareness to mothers regarding newborn care, either during facility visits or during home visits by community health workers (CHWs) especially in the rural context. In this paper, we report newborn care practices in rural Uttar Pradesh (UP) and have explored association between newborn care practices with antenatal care, contact with community health workers during pregnancy and place of childbirth.MethodsWe use cross-sectional baseline data (which is part of a larger intervention project) collected from 129 gram panchayats (GPs) from 15 administrative blocks spread over five districts of UP in 2013. From currently married women (n = 2208) of 15–49 years, who delivered 15 months prior to the survey, we collected information on women’s demographic and socio-economic characteristics, knowledge and practice of reproductive, maternal, newborn, child health and nutrition behaviours. Association of newborn practices with antenatal care, contacts by community health worker during pregnancy and place of childbirth were tested using random intercept logistic regression, adjusting for socio-economic and demographic factors and accounting for clustering at the GP and block levels.ResultsEighty-three percent of 2208 mothers received ANC, but only half of the respondents received a minimum of three ANC visits. More than two thirds of respondents delivered at a health facility. Practice of newborn care was poor: merely one fourth of women practised clean cord care, one third of women followed good breastfeeding practices (initiation with an hour of birth, fed colostrum and did not give pre-lacteal feeds) and one third provided adequate thermal care (kept baby warm and delayed bathing). Only 5% followed all above practices with evidence of clustering of newborn care practices at the block and GP levels. While facility-based childbirth was strongly associated with appropriate newborn care practices, ANC visits and contacts with CHWs was not associated with all newborn care practices.ConclusionThe quality of ANC care provided needs to be improved to have an impact on newborn care practices. Our finding emphasizes the importance of facility-based birthing. There is a need for training CHWs to strengthen their counselling skills on newborn care. Variation of newborn care practices between communities should be taken into consideration while implementing any intervention to optimize benefits.

This study aimed to measure abortion safety in Nigeria, Cote d’Ivoire, and Rajasthan, India using population-based abortion data from representative samples of reproductive age women. Interviewers asked women separately about their experience with “pregnancy removal” and “period regulation at a time when you were worried you were pregnant”, and collected details on method(s) and source(s) of abortion. We operationalized safety along two dimensions: 1) whether the method(s) used were non-recommended and put the woman at potentially high risk of abortion related morbidity and mortality (i.e. methods other than surgery and medication abortion drugs); and 2) whether the source(s) used involved a non-clinical (or no) provider(s). We combined source and method information to categorize a woman’s abortion into one of four safety categories. In Nigeria (n = 1,800), 29.1% of abortions involved a recommended method and clinical provider, 5.4% involved a recommended method and non-clinical provider, 2.1% involved a non-recommended method and clinical provider, and 63.4% involved a non-recommended method and non-clinical provider. The corresponding estimates were 32.7%, 3.0%, 1.9%, and 62.4% in Cote d’Ivoire (n = 645) and 39.7%, 25.5%, 3.4%, and 31.4% in Rajasthan (n = 454). Results demonstrate that abortion safety, as measured by abortion related process data, is generally low but varies significantly by legal context. The policy and programmatic strategies employed to improve abortion safety and quality of care are likely to differ for women in different abortion safety categories.