Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan

Tappis, Hannah; Koblinsky, Marge; Doocy, Shannon; Warren, Nicole; Peters, David H.

doi:10.1111/jmwh.12359

Cited by 24 publications

(21 citation statements)

References 44 publications

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“…The higher odds of bypassing might reflect mothers’ and their families’ increased awareness of the need for specialized care that might not be available at their nearest point of OC. Higher level of maternal education was also associated with bypassing in this setting, which is consistent with the findings from a study conducted in Afghanistan (4). Mothers with higher educational levels might have a better socioeconomic status, which allowed them to cover the extra expense associated with bypassing their nearest facility for childbirth.…”

Section: Discussionsupporting

confidence: 91%

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Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Salazar

Vora

Costa

2016

Global Health Action

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Background: Bypassing available facilities for childbirth has important implications for maternal health service delivery and human resources within a health system. The results are the additional expenses imposed on the woman and her family, as well as the inefficient use of health system resources. Bypassing often indicates a lack of confidence in the care provided by the facility nearest to the mother, which implies a level of dysfunctionality that the health system needs to address. Over the past decade, India has experienced a steep rise in the proportion of facility births. The initiation of programs promoting facility births resulted in a rise from 39% in 2005 to 85% in 2014. There have been no reports on bypassing facilities for childbirth from India. In the context of steeply rising facility births, it is important to quantify the occurrence of and study the relative contributions of maternal characteristics and facility functionality to bypassing. Objectives: 1) To determine the extent of bypassing health facilities for childbirth among rural mothers in three districts of Gujarat, India, 2) to identify associations between the functionality of an obstetric care (OC) facility and it being bypassed, and 3) to assess the relative contribution of maternal and facility characteristics to bypassing. Design: A cross-sectional survey of 166 public and private OC facilities reporting ]30 births in the 3 months before the survey was conducted in three purposively selected districts (Dahod, Sabarkantha, and Surendranagar) in the state of Gujarat, India. Besides information on each facility, data from 946 women giving birth at these facilities were also gathered. Data were analyzed using a multilevel mixed-effects logistic regression model. Results: Off all mothers, 37.7% bypassed their nearest facility for childbirth. After adjusting for maternal characteristics, for every one-unit increase in the facility's emergency obstetric care (EmOC) signal functions, the odds of bypassing a facility for childbirth decreased by 37% (adjusted odds ratio [AOR] 0.63, 95% confidence interval [CI]: 0.53Á0.76). Conclusions: This study shows that independent of maternal characteristics, in our setting, women will bypass obstetric facilities that are not adequately functional, and travel further to others that are more functional. It is important that the health system should focus on facility functionality, especially in the context of sharply rising hospital births.

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Section: Discussionsupporting

confidence: 91%

“…Studies from Nepal (1), Tanzania (2, 3), Afghanistan (4), and Uganda (5) have shown that women often circumvent their nearest obstetric care (OC) facility for childbirth. Reports suggest that bypassing by parturients varies in different settings.…”

Section: Introductionmentioning

confidence: 99%

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Salazar

Vora

Costa

2016

Global Health Action

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“…A growing literature, including but also going beyond the database used in this study, points to inequitable usage of health facilities in terms of the SES and urban/rural characteristics of users [23,34,39]. …”

Section: Discussionmentioning

confidence: 99%

“…The need for alternative approaches beyond health facilities to achieve equity in and in fact universal coverage for child health are the following: (i) there is an exponential decline in the utilization of health facilities with increasing distance to the health facility (particularly more than 5 km or 1 hour walk away) [35], and (ii) there is a need for available and affordable public transportation in order to reach health facilities, which is often absent [33,39]. What is lacking from the literature are in–depth assessments of equity of health care utilization in terms of distance from a health facility and the effect of distance from health facilities on health status, taking into account also whether community–based care is available to those further away from those facilities.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 5. equity effects for neonates and children

Schleiff

Kumapley

Freeman

et al. 2017

Journal of Global Health

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BackgroundThe degree to which investments in health programs improve the health of the most disadvantaged segments of the population—where utilization of health services and health status is often the worst—is a growing concern throughout the world. Therefore, questions about the degree to which community–based primary health care (CBPHC) can or actually does improve utilization of health services and the health status of the most disadvantaged children in a population is an important one.MethodsUsing a database containing information about the assessment of 548 interventions, projects or programs (referred to collectively as projects) that used CBPHC to improve child health, we extracted evidence related to equity from a sub–set of 42 projects, identified through a multi–step process, that included an equity analysis. We organized our findings conceptually around a logical framework matrix.ResultsOur analysis indicates that these CBPHC projects, all of which implemented child health interventions, achieved equitable effects. The vast majority (87%) of the 82 equity measurements carried out and reported for these 42 projects demonstrated “pro–equitable” or “equitable” effects, meaning that the project’s equity indicator(s) improved to the same degree or more in the disadvantaged segments of the project population as in the more advantaged segments. Most (78%) of the all the measured equity effects were “pro–equitable,” meaning that the equity criterion improved more in the most disadvantaged segment of the project population than in the other segments of the population.ConclusionsBased on the observation that CBPHC projects commonly provide services that are readily accessible to the entire project population and that even often reach down to all households, such projects are inherently likely to be more equitable than projects that strengthen services only at facilities, where utilization diminishes greatly with one’s distance away. The decentralization of services and attention to and tracking of metrics across all phases of project implementation with attention to the underserved, as can be done in CBPHC projects, are important for reducing inequities in countries with a high burden of child mortality. Strengthening CBPHC is a necessary strategy for reducing inequities in child health and for achieving universal coverage of essential services for children.

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“…[14][15][16] The findings of the studies conducted between 2001 and 2011 that there is a need to improve health facilities, and to increase the number of professionals in both urban and rural areas in order to improve maternal health. [17][18][19][20][21][22][23][24][25][26] Published research suggests that the provision of expanded health services alone would not lead to the increased utilization of Bartlett et al found that 93% of women who died due to maternity-related causes were illiterate. 3 …”

Section: Health Carementioning

confidence: 99%

Social Determinants of Maternal Health in Afghanistan: A Review

Najafizada

Bourgeault

Labonté

2017

cajgh

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Introduction: Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature. Methods: This narrative review was conducted using Arksey and O'Malley's framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. Results: A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. Conclusion: Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations' long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally.

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Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan

Cited by 24 publications

References 44 publications

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 5. equity effects for neonates and children

Social Determinants of Maternal Health in Afghanistan: A Review

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