Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio‐economically disadvantaged migrants in <scp>D</scp>elhi, <scp>I</scp>ndia

Kusuma, Yadlapalli S.; Kumari, Rita; Kaushal, Sonia

doi:10.1111/tmi.12166

Cited by 49 publications

(77 citation statements)

References 16 publications

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“…Population movement has received much attention in the context of the HIV epidemic . Migration and mobility may be associated with HIV acquisition and providing HIV care to mobile populations presents particular challenges . In South Africa, movement between rural and urban areas for employment, education, healthcare, cultural and family reasons occurs frequently, involving all demographic groups, including women of reproductive age .…”

Section: Introductionmentioning

confidence: 99%

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

et al. 2018

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IntroductionLinkage to care and mobility postpartum present challenges to long‐term retention after initiating antiretroviral therapy (ART) in pregnancy, but there are few insights from sub‐Saharan Africa. We aimed to describe postpartum linkage to care, mobility, retention and viral suppression after ART initiation in pregnancy.MethodsUsing routine electronic data we assessed HIV‐specific health contacts and clinic movements among women initiating ART in an integrated antenatal care (ANC) and ART clinic in Cape Town, South Africa. The local care model includes mandatory transfer to general ART clinics postpartum. We investigated linkage to care after leaving the integrated clinic and mobility to new clinics until 30 months on ART. We used Poisson regression to explore predictors of linkage, retention (accessing care at least once at both 12 [6 to <18] and 24 [18 to <30] months on ART), and viral suppression (HIV viral load [VL] ≤50 and ≤1000 copies/mL after 12 months on ART).ResultsAmong 617 women, 23% never linked to care; 71% and 65% were retained at 12 and 24 months on ART respectively, with 59% retained in care at both times. Those who linked (n = 485) accessed HIV care at 98 different clinics and 21% attended ≥2 clinics. Women >25 years, married/cohabiting or presenting early for ANC were more likely to link. Younger and unemployed women were more likely to attend ≥2 clinics (adjusted risk ratio [aRR] 1.10 95% confidence interval [CI] 1.02 to 1.18 and aRR 1.06 95% CI 0.99 to 1.12 respectively). Age >25 years (aRR 1.17 95% CI 1.02 to 1.33) and planned pregnancy (aRR 1.20 95% CI 1.09 to 1.33) were associated with being retained. Among 338 retained women with VL available, attending ≥2 clinics reduced the likelihood of viral suppression when defined as ≤50 copies/mL (aRR 0.81 95% CI 0.69 to 0.95). Distance moved was not associated with VL.ConclusionsThese data show that a substantial proportion of women do not link to postpartum ART care in this setting and, among those that do, long‐term retention remains a challenge. Women move to a variety of clinics and young women appear particularly vulnerable to attrition. Interventions promoting linkage and continued retention for women initiating ART during pregnancy warrant urgent consideration.

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Section: Introductionmentioning

confidence: 99%

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

et al. 2018

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“…11 Kusuma et al also reported that though 44.0% migrant women in Delhi availed at least one antenatal visit, the reception of various components of ANC was largely inadequate. 12 In the present study 90.3% of the women who had no ANC had no felt need. Out of the women who availed ANC, the majority (69.3%) depended on private practitioners, including unqualified practitioners.…”

Section: Discussionmentioning

confidence: 79%

“…13 In a study in Delhi, seeking ANC was reported to have a strong influence on place of delivery, 70% of women with inadequate ANC had home delivery. 12 The vaccine coverage in the 12-23 month old children was highest for the birth dose vaccines OPV-0 and BCG while it was lowest for measles. Only one-third received protection against all six VPDs though the coverage with UIP vaccines at that age should have been 100%.…”

Section: Discussionmentioning

confidence: 99%

Status of maternal and child health services amongst migrants in Ludhiana slums – how far from the MDG targets?

Sengupta

Benjamin

Babu

2017

Int J Community Med Public Health

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Background: It is essential to monitor the coverage of health interventions in subgroups of populations, especially the marginalized and those at higher risk, because national averages can hide important inequalities. This study was carried out to find out the utilization and coverage of MCH services among migrants in the slums of Ludhiana, Punjab.Methods: Cross-sectional sample study. 370 women, who had childbirth within two years prior to the survey, were randomly selected from the 3947 newer migrant households in 30 slum settlements in Ludhiana surveyed for provision of health care, and information obtained from them with regard to MCH services availed by them for their last pregnancy and childbirth. Their children 12-23 months old, 195 in number, were studied for child health services.Results: Antenatal care (ANC) was availed by 44.0% of the women, with 24.6% of them going for minimum 4 antenatal visits and 29.1% having an institutional delivery but only 35.9% by trained health personnel. Place of delivery was found to be a significant predictor of antenatal care. Women staying in Ludhiana availed the least ANC. Complete immunization coverage in the 12-23 month olds was 37.4%. Government health worker visited 7.8% of the homes.Conclusions: Despite the relative proximity and concentration of health centers in urban compared to rural areas, migrant slum-dwellers are still not able to access quality MCH care. The problem of non-availability of essential healthcare and uneven distribution of skilled health care providers is the central challenge in meeting our health goals.

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“…One study in Malaysia found that while few migrant women never received any prenatal care during their pregnancy, they tended to initiate prenatal care as late as 7 months compared to local citizens starting prenatal care early in the first trimester [37]. Another study of migrant women in India indicated that only 37% of rural to urban migrants had adequate prenatal care and that recent migrants had prenatal visits significantly less than those who were more settled (35% VS. 39%) [38]. …”

Section: Discussionmentioning

confidence: 99%

Prenatal care among rural to urban migrant women in China

Zong

Huang

Sun

et al. 2018

BMC Pregnancy Childbirth

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BackgroundThere is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants.Methods5372 married rural to urban migrant women aged 20–34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits.Results12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care.ConclusionsMany internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.

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Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio‐economically disadvantaged migrants in Delhi, India

Cited by 49 publications

References 16 publications

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

Status of maternal and child health services amongst migrants in Ludhiana slums – how far from the MDG targets?

Prenatal care among rural to urban migrant women in China

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