Improving Maternal and Reproductive Health in South Asia: Drivers and Enablers

El-Saharty, Sameh; Chowdhury, Sadia; Ohno, Naoko; Sarker, Intissar

doi:10.1596/978-1-4648-0963-7

Cited by 9 publications

(7 citation statements)

References 172 publications

(400 reference statements)

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“…Those services include, but are not limited to: immunizations, oral rehydration, well-baby checkups, preventive care, malaria treatment, and other future care for her child [9, 10]. Annually worldwide, about 300,000 women die as a result of pregnancy or childbirth, as do 9 million children younger than 5 years [11]; about 18,000 of those maternal deaths and 400,000 of those child deaths are in southeast Asia. Although maternal and child mortality are on the decline in southeast Asia, there are still significant disparities, and greater equity is the key to further mortality reduction [12].…”

Section: Introductionmentioning

confidence: 99%

Increasing health facility deliveries in Cambodia and its influence on child health

Pierce

2019

Int J Equity Health

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Background A growing number of women in Cambodia are seeking support from health facilities during delivery, up from 8% in 2000 to 82% in 2014. This growth may be attributed to increased national level attention to incentivize hospital births and reduce potential barriers. This paper address three related questions regarding the impact of increased utilization of health care in Cambodia. First, did increasing health facility deliveries occur most among disadvantaged women? Second, as health facility utilization increased, did the benefit of delivery location on child health outcomes weaken? Finally, did socioeconomic disparities in child outcomes decline as a result of increased health facility deliveries? Methods Data is from the 2010 and 2014 Cambodian Demographic and health surveys. Regression models include logistic regression to predict utilization of a health facility, linear regression to predict child nutritional status and Cox regression to measure child survival. Propensity score matching was used to account for selectivity. Results Analysis shows that health facility delivery is associated with better nutritional status and survival and the effectiveness of a health center delivery remains with this rapidly increasing care. However, the largest increases in delivery at a health facility did not occur among less educated, less wealthy, and rural Cambodian women, and inequalities in child health outcomes remain. Conclusions Cambodian women have participated in a rapid increase in health center deliveries and those health facility deliveries remain beneficial for future child outcomes. However, initiatives to increase care are not addressing inequity in access to care among disadvantaged women. Additionally, disparities in children’s health outcomes remain, suggesting that health facility births are not sufficient in reducing disparities among children of disadvantaged mothers. Moving forward, current initiatives are rapidly increasing facility deliveries and maintaining their efficacy, but further efforts need to be placed on targeting disadvantaged women and their children.

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Section: Introductionmentioning

confidence: 99%

Increasing health facility deliveries in Cambodia and its influence on child health

Pierce

2019

Int J Equity Health

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“…Various studies have identified the effective utilization and enhancement of healthcare services among populations covered by any social program (Wang et al, 2017). Moreover they are also consistent with reducing the inequality in maternal healthcare as identified by the research (El-Saharty et al, 2016). A significant improvement has been identified in various developing countries like India, Cambodia, Bangladesh including Rwanda (Antunes et al, 2009;Chham et al, 2021;Joarder et al, 2019;Prinja et al, 2017).…”

Section: Maternal Health Service and Health Insurancementioning

confidence: 57%

Health insurance coverage and maternal health services in Rwanda: a policy paradox

Malik

Alemu

2023

IJSE

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PurposeResearch has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.Design/methodology/approachUsing a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.FindingsThe results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).Originality/valueRwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

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“…Concerns about the rising CS rate in Bangladesh surfaced in the early 2010s. National Safe Motherhood Guidelines and the Maternal Health Voucher Scheme were developed in response, followed by initiatives like enhanced skills training for healthcare professionals, public awareness campaigns, and financial incentives for promoting vaginal delivery [30, 38]. However, these programs yielded limited success in curbing the CS surge, coinciding with the increasing role of private healthcare facilities in providing CS [15].…”

Section: Discussionmentioning

confidence: 99%

Trends, District-Level Variations, and Socioeconomic Disparities in Cesarean Section Delivery and its Association with Neonatal Mortality in Bangladesh

Khan,

Alam,

Khanam

et al. 2024

Preprint

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Background: Cesarean section (CS) rates have risen dramatically worldwide, with a majority of the countries exceeding the World Health Organization's (WHO) preferred rate of 10-15%. However, disparities exist, with evidence suggesting that socioeconomic disadvantage and geographic location play significant roles. Despite this, comprehensive estimates, especially in Bangladesh, remain scarce. This study aims to determine trends, district-level variations, and socioeconomic disparities in CS rates in Bangladesh. Methods: Data from six rounds of Bangladesh Demographic and Health Surveys were analyzed. The considered outcome variables were the occurrence of CS delivery in relation to the mode of delivery and delivery place. Neonatal mortality was also assessed as another outcome variable. Explanatory variables included districts, wealth quintiles, and socio-demographic characteristics. Descriptive statistics were used to provide an over-the-year trend and variation in CS delivery in Bangladesh. Multilevel mixed-effects binary logistic regressions were used to explore predictors of CS delivery and the association between CS and neonatal mortality. Results: Between 1999/2000 and 2017/18, hospital births in Bangladesh increased by 42%, primarily driven by a substantial rise in CS delivery, from 30% to 66%. Private healthcare facilities played a significant role, contributing 80% of the country's total CS delivery in 2017/18, a substantial increase from 45.5% in 1999/2000. In contrast, CS delivery rates in government healthcare facilities decreased from 49.7% to 15.5% during the same period. Deficient use of CS was reported by women in border and hilly districts, as well as those in the poorest wealth quintile. A clear link between a CS delivery and neonatal mortality was not found. Conclusion: The uneven distribution of CS delivery across districts and socioeconomic groups underscores the need for a more nuanced approach to childbirth. While government efforts to curb unnecessary use of CS have fallen short, this study suggests a one-size-fits-all strategy could worsen disparities. Instead, the focus should shift from mere accessibility to ensuring justified and appropriate utilization, with public healthcare facilities playing a key role in offering safe alternatives.

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Improving Maternal and Reproductive Health in South Asia: Drivers and Enablers

Cited by 9 publications

References 172 publications

Increasing health facility deliveries in Cambodia and its influence on child health

Increasing health facility deliveries in Cambodia and its influence on child health

Health insurance coverage and maternal health services in Rwanda: a policy paradox

Trends, District-Level Variations, and Socioeconomic Disparities in Cesarean Section Delivery and its Association with Neonatal Mortality in Bangladesh

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