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Around three million infants die within the first four weeks of life each year – nearly all (98%) of these deaths occur in developing countries. Approximately one million newborns die each year in India. Therefore, this study aims to determine the patterns of reported neonatal morbidity and care-seeking behavior and identify factors associated with it.

A cross-sectional study was conducted during November 2016. A systematic random sampling technique was used to select the sample. Statistical techniques like Binary Logistic regression and chi-square test were used.

The results of the study showed that around 31% mothers of neonates reported that their neonates suffered from some kind of morbidity. Fever, jaundice, cough and cold, the low birth-weight and difficulty in breathing were the most common dangers signs reported. Birth order and mother’s knowledge of neonatal danger signs were found to be significantly associated with reporting of neonatal morbidity. In all 95% of the mothers sought care for their newborns. Among those who had problems, 59% consulted private hospitals/clinics, 30% visited District Hospital/Taluka Hospital or higher facilities and another 9% to Primary Health Centers/Community Health Centers. Further, findings show that nearly half of the neonates taken to government facilities have got free treatment, whereas an average cost of 7,156 INR were recorded for treatment, 935 INR for outpatient department and 13,774 INR for inpatient department cases.

There is an urgent need to implement intervention modalities that focus on increasing the level of parental education and access to treatment, and advocating the message regarding newborn danger signs during pregnancy is pinpointed.

The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.

A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.

Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.

The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.

Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Huge gap exists between demand and supply of seeking health care leads to remain high maternal mortality in rural areas of Uttar Pradesh, India. The purpose of this paper is to make an effort in this direction.

This paper draws on Three Delays Model to understand the reasons behind poor maternal health outcomes among 964 currently married women aged 15–34, given birth in last two years preceding the survey including six case studies in poor settings of Northern India.

Receiving minimum four antenatal care and identifying the severity of obstetric complications during pregnancy was quite low (7 and 34 per cent, respectively). Major delay in seeking care in district was decision delay (average four days) followed by arranging transportation (average 4 hours) and start treatment within an hour after reaching health facility. Health services and trained human resources are mainly concentrated at towns and poor supply of drugs and equipment in labour room is always in demand at primary level in the district in area. Delays in decision making, travel and treatment compounded by ignorance of obstetric complications and poor healthcare infrastructure are the major contributing factors of maternal deaths in the district in area.

Interventions to improve timely seeking of medical care for obstetric complications may need to more effectively target husbands and family members rather than women. Strengthening of primary and secondary level facilities and timely referral to tertiary level care can play a crucial role in improving obstetric care in the district in rural areas.

Family planning is a vital component of reproductive health that enables individuals to make informed decisions about their fertility and plan for the timing and spacing of their pregnancies. However, marginalized communities, often face significant barriers to accessing family planning information and services, resulting in higher rates of unintended pregnancies and poor reproductive health outcomes. This chapter summarizes the current state of knowledge about knowledge related to family planning among marginalized communities, including the factors that shape knowledge, the implications for reproductive health outcomes, and the strategies for improving knowledge and access to family planning information and services. The review highlights the need for continued research, advocacy, and policy development to ensure equitable access to family planning information and services for all individuals, regardless of their demographic characteristics.

This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

This was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.

The results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.

This is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.

This research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.

Underutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

The purpose of this paper is to provide a situational overview of the facility-based maternal and perinatal morbidity and mortality audits (MPMMAs) in SSA, their current efficacy at reducing mortality and morbidity rates related to childbirth.

This is a scoping literature review based on the synthesis of secondary literature.

Not all countries in SSA conduct MPMMAs. Countries where MPMMAs are conducted have not instituted standard practice, MPMMAs are not done on a national scale, and there is no clear best practice for MPMMAs. In addition, auditing process of pediatrics and maternal deaths is flawed by human and organizational barriers. Thus, the aggregated data collected from MPMMAs are not adequate enough to identify and correct systemic flaws in SSA childbirth-related health care.

There are a few published literature on the topic in sub-Saharan Africa.

This review exposes serious gaps in literature and practice. It provides a platform upon which practitioners and policy makers must begin to discuss ways of embedding mortality audits in SSA in their health systems as well as health strategies.

The findings of this paper can inform policy in sub-Saharan Africa that could lead toward better outcomes in health and well-being.

The paper is original.

Gombe state in northeast Nigeria records a high prevalence of home deliveries with very low facility deliveries despite the efforts of government and international non-governmental organizations in supporting maternal health services. The purpose of this paper is to assess the factors influencing the decision to choose a birth center by pregnant women in Gombe, Nigeria.

The design was a cross-sectional study of women from a baseline survey conducted in August 2016 in Gombe state, Nigeria. Data on women groups’ utilization of maternal services with a focus on antenatal care, delivery and postnatal care were collected using a structured questionnaire used for household survey conducted in the state. Data for 157 pregnant women from the sample of 750 women (15–49 years) were selected for the purpose of this analysis. Descriptive statistics, bivariate and multivariate analyses were used to determine the factors associated with choice of birth center.

Religion (AOR=12.117, 95% CI 1.774–82.741), paid work (AOR=3.633, 95% CI 1.243–10.615) and identification and knowledge of pregnancy complications (AOR=4.281, 95% CI 1.054–17.387) were the factors found to be significantly associated with choice of birth center by pregnant women. Age, education, closeness to a facility and decision by husband or woman were not found to be statistically significant.

The significance of disseminating knowledge about pregnancy complications, role of religious leaders and encouraging savings from women earnings need attention of the government to improve facility-based delivery.

Twin to Twin Transfusion Syndrome (TTTS) is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000. There is no clustering of TTTS; instead the threat remains pathologically distinctive due to its pervasiveness. However, while incidence rates are random, survival rates are not. Despite compliant acceptance of “routine prenatal care,” sadly, there are many women who for currently unknown reasons are not receiving the advanced prenatal care needed to appropriately screen for, diagnosis and treat TTTS. And these women are paying the ultimate price for such obstetrical oversight.

This study hypothesizes that differential care being given by primary obstetricians of TTTS patients is resulting in experienced inequalities. Utilizing social reproduction theory, and through ethnographic and quantitative analyses of primary data, this study seeks to divulge the complex social processes taking place (or failing to take place) within the world of American obstetrics, and begin to understand how they are affecting TTTS mortality and morbidity rates.

Findings illuminate a profound imbalance of power and influence amongst the following entities: American Congress of Obstetricians and Gynecologists and Society of Maternal Fetal Medicine; obstetrical training and practice; and levels of patient awareness and advocacy.

This study argues that the current social relations being reproduced by these entities are perpetuating a climate that allows for disregard of proper TTTS management. Specifically, this study theoretically explores what social relations and subsequent (in)actions are being reproduced prior to TTTS diagnoses, and applies the effects of those observations.