Search results

The purpose of this paper is to examine the regional variations in maternal and child health all over India. The Maternal and Child Health Index (MCHI) is constructed to find the extent of variations in maternal and child health status for the States and Union Territories (UTs) of India.

The Wroclow taxonomic technique was used to construct the MCHI for the States and UTs of India. In all, 29 variables were selected for the construction of MCHI. All the variables were taken from National Family Health Survey-4 (NFHS, 2017) of India.

The findings suggest that there are wide variations in MCHI all over India. In India, Kerala topped in terms of MCHI followed by Jammu & Kashmir. Nagaland is on the bottom of the list followed by Bihar and Uttar Pradesh. High values of MCHI (> 0.4) are posing a serious concern for all States/UTs in India.

The existence of inequality in MCHI for India is truly posing a serious inquiry regarding the healthcare system in India. The outcome of the study demands that time has come to adopt a human rights approach to the right to health in India. The findings of the study could be used by the health policy makers in India.

This study shows the existence of wide variations in the quality of maternal and child health all over India. The quantification of the quality of maternal and child health is needed to improve the health of the population in India. Little research has been done on the issue of quality of maternal and child health in India. This study is an important contribution to the current knowledge of quality of maternal and child health in India.

The purpose of this paper is to investigate the effect of public and private health expenditures on selected maternal-child health outcomes in Sub-Saharan Africa (SSA).

The study utilizes panel data on 40 SSA countries spanning the period 2000-2010. The data are analyzed using the fixed effects estimation technique.

The results indicate that public health expenditure is inversely and significantly related to infant (IMRR) and under-five (U5MR) mortalities in SSA. Though public health expenditure has the a priori negative sign, it has no significant effect on maternal mortality (MMR) in SSA. Further, private health expenditure did not prove to be significant in improving maternal-child health outcomes (IMRR, U5MR and MMR) in SSA.

The implication of the findings is that a percentage point increase in public health expenditure (as a share of GDP) across the region will result in saving the lives of about 7,040 children every year. Hence, it is important for governments in SSA to increase their shares of health expenditure (public health expenditure) in order to achieve improved health outcomes.

Previous studies have not adequately explored the effect of various components of health expenditures – public and private – on health outcomes in the context of SSA. In addition to the focus on maternal-child health variables such as infant, under-five and maternal mortalities, the study accounts for the possibility of a non-linear and non-monotonic relationship between healthcare expenditures and health outcomes.

The purpose of this paper is to describe the major factors affecting health during pregnancy, birth and the postnatal period and outline the evidence for interventions to improve outcomes in women and their children.

Selective review of the literature. A number of electronic bibliographic databases were searched, including the Cochrane Database of Systematic Reviews, PubMed and PsycINFO, for relevant studies published since 1990. Papers were restricted to those published in English which presented data from studies conducted in high-income countries, with priority given to systematic reviews, randomised controlled trials and other quantitative studies which present a higher level of evidence.

Many factors may affect maternal and infant health during and after pregnancy. Potentially modifiable factors with an evidence base to support intervention include improving diet, and the avoidance of smoking, alcohol and illicit drugs. Good clinical management of underlying illness is also important, along with attempts to engage women in improving health prior to conception and postnatally rather than once pregnancy is established.

The evidence base for interventions on some potentially modifiable risk factors is incomplete. There is good evidence of benefit from some health behaviours such as smoking cessation and uptake of breastfeeding and accumulating evidence of the benefit of some models of maternity care.

Good maternal health during and after pregnancy plays a key role in giving the child a better start in life. Improved health behaviours are vital but often these are heavily dependent on social context and hence working to tackle social inequality and provide maternity care tailored to individual need is likely to be just as important as trying to directly alter behaviour.

Pregnancy and the postnatal period present an opportunity to improve maternal health and have a positive effect on future child health. Greater investment is required in this antenatal period of life.

Information communication technologies can serve as a crucial missing link toward tacking wicked problems of social welfare policy implementation through collaborative governance. Using a mixed methods approach, a pre- and postanalyses were used to investigate whether and how cell phones can increase awareness of pregnant women about different cash and service benefits of maternal health benefit policies of 82 pregnant women in a remote tribal community in Melghat forest of Maharashtra, India. Pregnant women received customized prerecorded bilingual audio calls on their mobile phones about maternal health benefit policies. The author then traced whether those audio messages increased the claiming of policy benefits and public engagement. The key contribution of this research is that contrary to the optimism about digital governance, findings suggest that cell phones are not a “silver bullet” for increasing receipt of maternal health benefits. This book chapter concludes with the prescription that the impact of mobile phones and other information technologies will be marginal as long as there are administrative deficiencies in policy implementation and a misalignment in state and federal policy designs.

Nurse home visiting programmes designed to reduce the likelihood of child maltreatment in families at risk have been widely implemented in Australia and overseas. The purpose of this paper is to examine the intensity and duration of maternal involvement in a nurse home visiting programme to prevent child maltreatment.

A retrospective, longitudinal design was employed. The clinical records of 40 mothers who had received nurse home visits following the birth of a new baby for at least six months, and had provided consent for their details to be accessed for research purposes, were selected for analysis. The influence of antenatal characteristics and well-being on maternal involvement in a nurse home visiting programme was examined using reliability of change indices.

Mothers with impaired family functioning reporting they experienced violence at home were more likely to leave the programme early and received fewer than the prescribed number of home visits compared to mothers who had been enroled into the programme for other complex psychosocial needs. At the same time, mothers enroled on the basis of impaired psychological functioning and who did not report violence in the home remained, and received more than the prescribed number of home visits over the course of their involvement.

Results showed that domestic violence increased the risk of poor engagement with a targeted nurse home visiting programme. At the same time, home visitors responded to complex individual and family needs by increasing the number of home visits accordingly. This theoretically based pilot research has helped to disentangle antecedents of maternal involvement and the subsequent impact on programme outcomes. Further investigation using a larger study sample is needed.

Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates.

Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates.

Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women’s literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad.

Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality.

All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of “tied aid”, thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative.

Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women’s health are valuable. Canada’s midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women’s lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/.

There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well.

The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.

Probit and ordered probit models are employed in this study.

The results generally indicate that most women in Ghana undertake the required visits for antenatal services and also take both doses of the tetanus toxoid vaccine as required by World Health Organization. However, the results show low levels of usage in terms of the other maternal health care services (i.e. prenatal care, delivery at a health facility, and postnatal care). There is clearly an urgent need to develop innovative strategies that will help upscale intervention especially for improvement in the use of these services by women in Ghana. The regression results reveal that utilization of maternal health services and intensity of use of antenatal services are influenced by age of mother, type of birth, education of mother, ethnicity, economic status, geographic location, residence, and religious affiliation. Obviously, this suggests that more than medical factors are responsible for the differences in the use of maternal health services by women in Ghana as well as the decision on the number of visits to undertake with respect to antenatal visits.

The findings of this study have important implications for health policy formulation targeted at improving maternal health care service utilization.

The purpose of the study is to investigate the factors responsible for the utilisation of safe motherhood practices under the Government of India (GOI)-run maternal health programme Janani Suraksha Yojana (JSY).

Data for the survey were collected from 435 expectant mothers registered under JSY from seven districts of western Uttar Pradesh, India. Based on the existing theories of behaviour change and the social marketing framework, a model of antecedents of adoption of safe motherhood practices was tested out empirically.

The results suggested that controlling for demographic variables such as age, education, number of children, intention to follow safe motherhood practices, maternal health self-efficacy, attitude towards safe motherhood, life satisfaction and facilitating conditions all contributed towards the adoption of safe motherhood practices. However, facilitating conditions moderated the relationship between intention to follow safe motherhood practices and adoption of safe motherhood practices.

The study focused only on maternal health, excluding child health under JSY.

The study findings suggest that social marketers should focus on the individual (micro)- as well as programme (macro)-level factors to bring about systemic behaviour change.

The adoption of safe motherhood practices will result in a reduction of the maternal mortality rate. This will improve the overall health of mother and child.

The JSY programme is targeted at promoting safe motherhood practices among poor women in the reproductive age group from India. The adoption of safe motherhood practices will result in less maternal mortality and contribute to the well-being of the family.

Home visiting is a strategy widely implemented to support families following the birth of a baby. There is a broad consensus that home visiting programmes are successful. But there is little understanding of factors moderating this success. The purpose of this paper is to examine the relationship between maternal involvement in a nurse home visiting programme, maternal depression, and adjustment to the parenting role.

A retrospective design was employed in which the medical records of 40 mothers who had been enroled in a nurse home visiting programme were examined. The number of nurse home visits from birth to six months, maternal depressive symptoms, Home Observation for Measurement of the Environment (HOME) and responsivity scores were examined. Mothers had been selected for the programme if they had a history of mental illness, were in a violent relationship, or reported drug or alcohol problems.

A significant, positive relationship was found between maternal involvement, positive HOME environment and maternal responsivity scores. Furthermore, the mothers with the highest scores for HOME environment and responsivity to their infant ' s cues at six months were mothers experiencing deteriorating symptoms of depression. These mothers had the highest levels of involvement with the programme. Despite their mothers’ deteriorating mental health, infants whose mothers received the greatest number of visits from a nurse received the greatest benefit ameliorating their risk for developing poor attachment and impaired behavioural, emotional and cognitive development.

This is the first study to examine the relationship between changes in maternal depression and programme outcomes in a home visiting programme. It is one of the first explorations of the relationship between maternal involvement and programme outcomes in a targeted nurse home visiting programme to prevent child maltreatment. The findings from this study are critical to future home visiting programme development and evaluation.

Depression is a prevalent, debilitating condition that will replace cancer as the second leading cause of morbidity within the next decade and, according to the Global Burden of Disease Study, ranks number one in disability-adjusted life years for females 5 years and older worldwide (Blehar & Oren, 1997; Murray & Lopez, 1996). Depression in the workplace has been linked to increased absenteeism and productivity loss, is equal to the costs of diabetes and hypertension, and these costs are almost equal to the direct costs of depression treatment (Kessler et al., 1999; Marlowe, 2002; Druss, Rosenheck, & Sledge, 2000; Elinson, Houck, Marcus, & Pincus, 2004). A national study of individuals 15–54 years documented a lifetime prevalence of 17.1% and found that depression was more common in females, young adults, and those with less education (Blazer, Kessler, McGonagle, & Swartz, 1994; Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993; Substance Abuse and Mental Health Services Administration, 2000; Kessler et al., 1994a, 1994b; Bebbington et al., 2003).