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Assessing the impact of antenatal care utilization on low birthweight in India: Analysis of the 2015–2016 National Family Health Survey

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... The physical growth and cognitive development of children are largely affected by mineral and trace element contents presents in mother's breast milk. Some studies showed that the trace elements and mineral contents were high in those mothers who are well-nourished compared to malnourished with Short gestation age and it is the outcome of less energy food intake during pregnancy (Kramer, 2003;Mane et al., 2018;Paul et al., 2019). Estimation also showed that various socio-economic factors such as household wealth status, parental education, place of residence also have a significant impact on U5M. ...
... The probability of U5M is significantly higher among those children whose size at birth were smaller than average or larger than average. Factors contributing to these findings could include the poor nutritional status of the mother, low birth weight, premature birth, lack of proper maternal ANC and PNC visits etc. (Dayanithi, 2018;Kalanda et al., 2009;Lau et al., 2013;Paul et al., 2019). Therefore, there is an urgent need for target-oriented policy intervention to improve maternal and child health as well as the socio-economic status of children's family that will help to reduce the complication during pregnancy, adverse birth outcomes including premature birth, LBW, etc. ...
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The witnessing phenomena of under-five mortality (U5M) of children, in major South Indian states were below the national average (36.6 per 1000 live birth) as well as the global average (39 per 1000 live birth) but despite the policy implication to reduce the U5M, it persists still at a higher rate in North-Eastern states. The present paper aims to examine the association between Socio-economic; maternal, child-related risk factors and U5M of children in Empowered Action Group states and Assam of India. A cross-sectional data (n = 38,405) from National Family Health Survey (2015-2016) was used. The result of binary logistic regression model showed that the likelihood of U5M was significantly higher among those children whose family belonged to poor wealth status, lived in rural areas, and having parents with no education or very minimum education. The U5M of children also associated with having a younger mother, being perceived as small or large size & low birth weight of new-borns by their mother, with short birth interval, short-duration breastfeeding and low gestation age. The Findings of the study suggests that community-based interventions for women are needed to avert the phenomena of U5M in EAG states and Assam.
... This finding is consistent with studies done in Ghana (36,37), India (38), Afghanistan (39),developing countries (17) and Cambodia (40). This might be due to education decreases teenage pregnancywhich can be ended up with LBW (37), teenage mothers have two folds risk of LBW (37)because of their demand for a double set of nutrition needed in completing her growth (41).Moreover, increased maternal education level improves ANC attendance (42,43),which combats the incidence of LBW (44). ...
... A recently conducted study in India revealed that women who use contraceptives are more likely to attend ANC services [16]. In an agreement with previous studies [13,17], the present study affirmed that adequate utilization of ANC was associated with a decreased risk of LBW babies. Routine examination of the mother and fetus and practicing good health habits during pregnancy may help to reduce adverse pregnancy outcomes including LBW. ...
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Objective Low birth weight (LBW) is a serious public health problem in low- and middle-income countries and a leading cause of death in the first month of life. In India, about 18% of children are born with LBW (<2500 grams) in 2015–16. In this study, we aim to examine the influence of maternal factors and socio-demographic covariates on LBW in Indian children. Methods Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. A cross-sectional study was designed using a stratified two-stage sampling technique. Cross-tabulation, Pearson’s chi-squared test, and multivariate logistic regression analyses were employed to assess the impact of maternal factors and other covariates on children’s LBW. Results Of total participants (n = 147,762), 17.5% of children were found to be born with LBW. The study revealed that women who had prior experience of stillbirth (Adjusted odds ratio [AOR]: 1.20, 95% CI: 1.04–1.38) and any sign of pregnancy complications (AOR: 1.08, 95% CI: 1.05–1.11) were more likely to have LBW children, even after adjusting for a range of covariates. Maternal food diversity was found to a protective factor against children’s LBW. Women with underweight and anemic condition were associated with an increased likelihood of LBW children. Regarding maternity care, women who attended ≥4 ANC visits (AOR: 0.84, 95% CI: 0.80–0.88), took iron tablets/syrup during pregnancy (AOR: 0.94, 95% CI: 0.90–0.98), and delivered in a public health facility (AOR: 0.84, 95% CI: 0.79–0.88) were less likely to have LBW babies. Besides, various socio-demographic factors such as place of residence, caste, religion, education, wealth quintile, and geographical region were significantly associated with LBW of children. Conclusion Interventions are needed for adequate ANC utilization, improvement in public facility-based delivery, providing iron supplementation, and uptake of balanced energy-protein diet among pregnant mothers. Besides, special attention should be given to the socio-economically disadvantaged women to address adverse pregnancy and birth outcomes including LBW.
... This finding is consistent with studies done in Ghana (36,37), India (38), Afghanistan (39),developing countries (17) and Cambodia (40). This might be due to education decreases teenage pregnancywhich can be ended up with LBW (37), teenage mothers have two folds risk of LBW (37)because of their demand for a double set of nutrition needed in completing her growth (41).Moreover, increased maternal education level improves ANC attendance (42,43),which combats the incidence of LBW (44). ...
... This finding is consistent with studies done in Ghana (36,37), India (38), Afghanistan (39),developing countries (17) and Cambodia (40). This might be due to education decreases teenage pregnancywhich can be ended up with LBW (37), teenage mothers have two folds risk of LBW (37)because of their demand for a double set of nutrition needed in completing her growth (41).Moreover, increased maternal education level improves ANC attendance (42,43),which combats the incidence of LBW (44). ...
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Objective To identify the medical causes of death and contribution of non-biological factors towards infant mortality by a retrospective analysis of routinely collected data using verbal and social autopsy tools. Setting The study site was Health and Demographic Surveillance System (HDSS), Ballabgarh, North India Participants All infant deaths during the years 2008–2012 were included for verbal autopsy and infant deaths from July 2012 to December 2012 were included for social autopsy. Outcome measures Cause of death ascertained by a validated verbal autopsy tool and level of delay based on a three-delay model using the INDEPTH social autopsy tool were the main outcome measures. The level of delay was defined as follows: level 1, delay in identification of danger signs and decision making to seek care; level 2, delay in reaching a health facility from home; level 3, delay in getting healthcare at the health facility. Results The infant mortality rate during the study period was 46.5/1000 live births. Neonatal deaths contributed to 54.3% of infant deaths and 39% occurred on the first day of life. Birth asphyxia (31.5%) followed by low birth weight (LBW)/prematurity (26.5%) were the most common causes of neonatal death, while infection (57.8%) was the most common cause of post-neonatal death. Care-seeking was delayed among 50% of neonatal deaths and 41.2% of post-neonatal deaths. Delay at level 1 was most common and occurred in 32.4% of neonatal deaths and 29.4% of post-neonatal deaths. Deaths due to LBW/prematurity were mostly followed by delay at level 1. Conclusion A high proportion of preventable infant mortality still exists in an area which is under continuous health and demographic surveillance. There is a need to enhance home-based preventive care to enable the mother to identify and respond to danger signs. Verbal autopsy and social autopsy could be routinely done to guide policy interventions aimed at reduction of infant mortality.
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Objectives: Low birth weight (LBW) is a major public health concern, especially in developing countries, and is frequently related to child morbidity and mortality. This study aimed to identify key determinants that influence the prevalence of LBW in selected developing countries. Methods: Secondary data analysis was conducted using 10 recent Demography and Health Surveys from developing countries based on the availability of the required information for the years 2010 to 2013. Associations of demographic, socioeconomic, community-based, and individual factors of the mother with LBW in infants were evaluated using multivariate logistic regression analysis. Results: The overall prevalence of LBW in the study countries was 15.9% (range, 9.0 to 35.1%). The following factors were shown to have a significant association with the risk of having an LBW infant in developing countries: maternal age of 35 to 49 years (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.2 to 3.1; p<0.01), inadequate antenatal care (ANC) (aOR, 1.7; 95% CI, 1.1 to 2.8; p<0.01), illiteracy (aOR, 1.5; 95% CI, 1.1 to 2.7; p<0.001), delayed conception (aOR, 1.8; 95% CI, 1.4 to 2.5; p<0.001), low body mass index (aOR, 1.6; 95% CI, 1.2 to 2.1; p<0.001) and being in the poorest socioeconomic stratum (aOR, 1.4; 95% CI, 1.1 to 1.8; p<0.001). Conclusions: This study demonstrated that delayed conception, advanced maternal age, and inadequate ANC visits had independent effects on the prevalence of LBW. Strategies should be implemented based on these findings with the goal of developing policy options for improving the overall maternal health status in developing countries.
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Due to the high number of maternal deaths, provision of antenatal care services (ANC) in Indonesia is one of the key aims of the post-Millennium Development Goals agenda. This study aimed to assess the key factors determining use of ANC by adolescent girls and young women in Indonesia. Data from the Indonesia Demographic and Health Survey 2012 were used, with a focus on married adolescent girls (aged 15–19 years, n = 543) and young women (20–24 years, n = 2,916) who were mothers. Bivariate and multiple logistic regression analyses were performed to determine the factors associated with ANC use. The findings indicated that adolescents were less likely to make ANC visits than young women. Richer women were more likely to make four ANC visits in both groups compared to the poorer women. Living in urban areas, higher educational attainment, and lower birth order were also all associated with higher levels of receiving ANC among young women. The results showed that socio-economic factors were related to the use of ANC among adolescent girls and young women. Ongoing health-care interventions should thus put a priority on adolescent mothers coming from poor socio-economic backgrounds.
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Objective: In an effort to improve utilization of maternal health care services, age at marriage of girls has gain very little attention by the policy maker and programmer. Studies have indicated that child marriage has serious negative consequences on maternal health. Moreover, there is a paucity of research on explaining the links between child marriage and maternal health care utilization. In this study, we aimed to examine the association between child marriage and utilization of maternal health care services using nationally representative sample survey of India. Design: Cross-sectional observational study. Setting: India. Participants: A total number of 190,898 ever-married women who had at least one live birth during the last five years preceding the survey from the 2015 to 2016 National Family Health Survey (NFHS) were utilized. Measurements: Outcome measures: At least four antenatal visits (ANC), ANC visit within first trimester, institutional delivery, delivery by skilled health personnel, and postnatal care (PNC) within 42 days of delivery. Predictor variable: Child marriage. Control variables: Socio-economic and demographic characteristics of women. Bivariate and multivariate analyses were performed for the analyses of the study data. Results: The results of our study revealed that women who married at < 18 years were significantly less likely to use maternal health care services than those married at ≥18 years even after accounting for socio-economic and demographic characteristics of women. Furthermore, nuanced analysis revealed that the odds of maternity care services is much lower for those women who married at ≤14 years compared with later married groups. Conclusions: The findings of our study suggest that effort s should be made to increase age at marriage of girls which could have positive impact on utilization of maternal health care services. Moreover, targeted intervention is needed to improve the utilization of maternity care especially among socio-economically vulnerable women.
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Introduction: India along with Nigeria is estimated to account for over 1/3rd of all maternal deaths worldwide in the year 2015. However, among all the maternal deaths, most of the deaths can be prevented. But for that all women need access to antenatal care (ANC) during pregnancy. Objective: The present study aims to highlight the current status of ANC coverage in India. Further this study examines the extent of expenditure incurred for seeking ANC. Materials and methods: Data for the analyses are drawn from the 71st round of the National Sample Survey Office conducted between January to June 2014. Bivariate and logistic regression analyses have been used to fulfil the objectives of this paper. Results: Despite having a vast public health infrastructure and several safe motherhood programmes, overall 9.2% pregnant women did not consume IFA supplements, 6.6% did not receive TT dose and 10.3% pregnant women could not receive any ANC during pregnancy in India. Among the states, Uttar Pradesh accounted for a large number (16.7%) of pregnant women who neither did consume IFA tablets nor received any ANC (22.4%) during pregnancy. However, a woman had to spend a large amount of money to seek ANC from both public and private health care facilities. Conclusion: After a tremendous emphasis given to delivery of free ANC services throughout the country, India is still very far from achieving universal coverage of ANC.
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Despite India's impressive economic performance after the introduction of economic reforms in the 1990s, progress in advancing the health status of Indians has been slow and uneven. Large inequities in health and access to health services continue to persist and have even widened across states, between rural and urban areas, and within communities. Three forms of inequities have dominated India's health sector. Historical inequities that have their roots in the policies and practices of British colonial India, many of which continued to be pursued well after independence; socio-economic inequities manifest in caste, class and. gender'differentials; and inequities in the availability, utilisation and affordability of health services. Of these, critical to ensuring health for all in the immediate future will be the effectiveness with which India addresses inequities in provisioning of health services and assurance of quality care.
Article
The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Maternal malnutrition is a key contributor to poor fetal growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality. This review summarised the evidence on association of maternal nutrition with birth outcomes along with review of effects of balanced protein-energy supplementation during pregnancy. A literature search was conducted on PubMed, WHOLIS, PAHO and Cochrane library. Only intervention studies were considered for inclusion and data were combined by meta-analyses if available from more than one study. Sixteen intervention studies were included in the review. Pooled analysis showed a positive impact of balanced protein-energy supplementation on birthweight compared with control [mean difference 73 (g) [95% confidence interval (CI) 30, 117]]. This effect was more pronounced in undernourished women compared with adequately nourished women. Combined data from five studies showed a reduction of 32% in the risk of LBW in the intervention group compared with control [relative risk (RR) 0.68 [95% CI 0.51, 0.92]]. There was a reduction of 34% in the risk of small-for-gestational-age babies in the intervention compared with the control group [RR 0.66 [95% CI 0.49, 0.89]]. The risk of stillbirth was also reduced by 38% in the intervention group compared with control [RR 0.62 [95% CI 0.40, 0.98]]. In conclusion, balanced protein-energy supplementation is an effective intervention to reduce the prevalence of LBW and small-for-gestational-age births, especially in undernourished women.
Article
An ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services-married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery. Data from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15-19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective. It was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care. Findings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas.
Article
In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.
Article
A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28-2.36), greater wealth (OR 2.31; 95% CI 1.73-3.1), urban residence (OR 1.42; 95% CI 1.12-1.82) and parity of 3-4 (OR 0.79; 95% CI 0.62-0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42-3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49-2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11-2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country's development in maternal health.
Article
Studies in low-income countries have shown that women's autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether women's autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate women's autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of women's autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported women's autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in women's autonomy and these village factors may improve healthier child bearing in rural India.
Article
It is generally recognized that low birth weight can be caused by many factors. Because many questions remain, however, about which factors exert independent causal effects, as well as magnitude of these effects, a critical assessment and meta-analysis of the English and French language medical literature published from 1970 to 1984 were carried out. The assessment was restricted to singleton pregnacies of women who lived at sea level and who had no chronic illnesses. Extremely rare factors were also excluded, as were complications of pregnancy. In this way, 43 potential determinants were identified. A set of a priori methodological standards were established for each potential determinant. Studies that satisfactorily met (SM) or partially met (PM) these standards were used to assess the existence and magnitude of an independent causal effect on birth weight, gestational age, prematurity, and intrauterine growth retardation (IUGR). A total of 921 relevant publications were identified, of whihc 895 were successfully located and reviewed. Factors with well-established direct causal impacts on intrauterine growth include infant sex, racial/ethnic origin, maternal height, pre-pregnancy weight, paternal weight and height, maternal birth weight, parity, history or prior low-birth-weight infants, gestational weight gain and caloric intake, general morbidity and episodic illness, malaria, cigarette smoking, alcohol consumption, and tobacco chewing. In developing countries, the major determinants of IUGR are Black or Indian racial origin, poor gestational nutrition, low pre-pregnancy weight, short maternal stature, and malaria. In developed countries, the most important single factor, by far, is cigarette smoking, followed by poor gestational nutrition and low pre-pregnancy weight. For gestational duration, only pre-pregnancy weight, prior history of premature or spontaneous abortion, in utero exposure to diethylstilbestrol, and cigarette smoking have well-established causal effects, and the majority of prematurity occurring in both developing and developed country settings remains unexplained. Modifiable factors with large effects on intrauterine growth or gestational duration should be targeted for public health intervention in the two settings, with an emphasis on IUGR in developing countries and prematurity in developed countries. Future research should focus on factors of potential quantitative importance for which data are either unavailable or inconclusive. In developing countries, the most important of these for intrauterine growth are caloric expenditure (maternal work), antenatal care, and certain vitamins and trace elements. For prematurity, especially in developed countries, factors deserving further study include genital tract infection, antenatal care, maternal employment and physical activity, and stress and anxiety.
Article
Over ninety low-weight infants were born per thousand live births in South Carolina, based on 96,000 birth records from 1975 and 1979. Higher incidence of low birth weight for black infants cannot be explained away as a result of black/white differences in age or education of mothers, prenatal care, parity or length of birth intervals. Though all these factors are important predictors of birth weight, an increasing propensity to have low-weight babies persists among black mothers even after all these factors are controlled.
Article
Domestic violence is increasingly recognized as a potentially modifiable risk factor for adverse pregnancy outcomes. This study was conducted to evaluate the relationship between abuse during pregnancy or within the last year and low birth weight and preterm birth. From 1997 to 2001, 3149 low income, relatively low-risk pregnant women (82% African-American) participated in this prospective study. The Abuse Assessment Screen, a validated screening tool, which assesses emotional, physical or sexual abuse, injuries due to physical abuse and physical abuse in the index pregnancy, was filled out by 3103 women. Of the women screened, 26.6% reported emotional abuse, 18.7% reported physical abuse in the past year and 10.3% women reported being beaten, bruised, threatened with a weapon or being permanently injured. Abuse during pregnancy was reported by 5.9% of the women. Low birth weight and preterm birth occurred in 10.9% and 10.2% of the pregnant women, respectively. Logistic regression analyzes indicated that injury due to physical abuse within the past year was significantly associated with both preterm birth [adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) after adjusting for other covariates. The mean birth weight of infants born to women who were injured due to physical abuse was significantly lower (-75.2 g, p = 0.04) than the mean birth weight of infants of women who were not injured. These results indicate that in our population, injuries resulting from physical abuse are associated with both low birth weight and preterm birth.
Article
The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998-1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n = 11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access.
Article
The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century.
Article
The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an effective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative configurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fifth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal.
Article
Previous studies have found that inadequate prenatal care was associated with increased neonatal mortality in the general pregnant women. To examine the association between adequacy of prenatal care and neonatal mortality in the presence and absence of antenatal high-risk conditions. We conducted a retrospective cohort study of infants based on 1995-2000 vital statistics data in the USA. The relative risk for neonatal death associated with adequacy of prenatal care was estimated by multivariate logistic regressions with adjustment of confounding factors. Inadequate prenatal care was associated with increased neonatal mortality when pregnancies were complicated by anaemia, cardiac disease, lung disease, chronic hypertension, diabetes, renal disease, pregnancy-induced hypertension, and previous preterm/small-for-gestational-age birth. The observed association also existed in the absence of these antenatal high-risk conditions. Overutilisation of prenatal care was associated with increased risk of neonatal deaths in both the presence and the absence of antenatal high-risk conditions. When gestational age at delivery and birthweight were further adjusted, the observed association between inadequate prenatal care and neonatal mortality was not significant in pregnancies with various high-risk conditions. Inadequate prenatal care is associated with increased neonatal death in both the presence and the absence of antenatal high-risk conditions. The observed association between inadequate prenatal care and neonatal mortality may be mediated by increased risk of preterm delivery and low birthweight in these pregnancies. Overutilisation of prenatal care is associated with potential risks for fetal and neonatal development, leading to increased neonatal mortality.
Article
This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.
How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatric and Perinatal Epidemiology
  • G Carroli
  • C Rooney
  • J Villar
Carroli, G., Rooney, C., & Villar, J. (2001). How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatric and Perinatal Epidemiology, 15(s1), 1-42. https://doi.org/10.1046/j.1365-3016.2001. 0150s1001.x.
United Nations Children's Fund
  • Unigme
UNIGME (2018). Levels & Trends in Child Mortality: Report 2018. New York: United Nations Children's Fund. Retrived from https://data.unicef.org/wp-content/uploads/ 2018/09/UN-IGME-Child-Mortality-Report-2018.pdf.
The Sustainable Development Goals
United Nations (2018). The Sustainable Development Goals Report 2018. United Nations, New York Retrived from https://unstats.un.org/sdgs/files/report/2018/ TheSustainableDevelopmentGoalsReport2018-EN.pdf.
WHA global nutrition targets 2025: Low birth weight policy brief. Geneva: World Health Organization
WHO (2014). WHA global nutrition targets 2025: Low birth weight policy brief. Geneva: World Health Organization. Retrived from https://www.who.int/nutrition/topics/ globaltargets_lowbirthweight_policybrief.pdf.
WHO recommendations on antenatal care for a positive pregnancy experience
WHO (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO. Retrived from http://apps.who.int/iris/bitstream/handle/10665/ 250796/9789241549912-eng.pdf;jsessionid= 71D6206810481E8B3F700C62FA392663?sequence=1.
  • P Paul
P. Paul, et al. Children and Youth Services Review 106 (2019) 104459
How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence
  • Carroli