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Objective: To develop a shortened, valid and reliable scale applicable across multiple settings for routine monitoring of person-centered maternity care (PCMC).Methods: Exploratory analysis was used to generate parsimonious versions of a 30-item PCMC scale in four datasets from cross-sectional surveys conducted between August 2016 and October 2017, involving women aged 15-49 years in Kenya, Ghana and India who had recently given birth. Analysis was informed by expert opinion via a separate online survey of global maternal and child health experts. Items retained in each dataset were compared, and those unique to a single setting removed. The remaining items were pooled and assessed for construct and criterion validity and reliability in each setting.Results: Thirteen items were retained for a potential multi-setting short PCMC scale, incorporating the domains of dignity and respect, communication and autonomy, and supportive care. Cronbach's alpha for the scale was >0.7 in each setting. Scores on the 13-item scale were correlated with the 30-item scale scores, and with global measures of care satisfaction in Kenya and India.Conclusion: Analysis yielded a 47% shorter PCMC scale, that showed promise for routine assessment of women's experience of care during childbirth across multiple settings. However, further validation is needed. [ABSTRACT FROM AUTHOR]

Objective: To assess postpartum contraceptive choices among women attending a well-baby clinic in Ghana.Methods: From April 1 to May 31, 2011, a descriptive cross-sectional survey was conducted among women who attended the well-baby clinic of Komfo Anokye Teaching Hospital, Kumasi, at 6-24 months after delivery. Participants were consecutively recruited and interviewed using semi-structured questionnaires. Data were collected on demographics, exposure to family planning counseling, message content, and postpartum contraceptive choices. Differences between the profiles of women who did or did not take up postpartum family planning were assessed.Results: Of the 200 women enrolled, 44 (22.0%) wanted no more children and the last pregnancy was unintended among 88 (44.0%). In all, 110 (55.0%) women took up postpartum contraception, with the calendar method (n=57; 51.8%) and injectable contraceptives (n=22; 20.0%) cited as popular choices. Family planning counseling was received at the prenatal clinic by 47 (23.5%) women, with 12 (6.0%) given written referrals on the postnatal ward. More previous contraceptive users than previous non-users chose long-acting or permanent postpartum methods (P<0.001).Conclusion: Inadequate postpartum family planning counseling and referrals during maternity care were recorded, suggesting that a comprehensive educational intervention is required to improve uptake. [ABSTRACT FROM AUTHOR]

Objective To investigate factors associated with self-reported pregnancy termination in Ghana and thereby appreciate the correlates of abortion-seeking in order to understand safe abortion care provision. Methods In a retrospective study, data from the Ghana 2008 Demographic and Health Survey were used to investigate factors associated with self-reported pregnancy termination. Variables on an individual and household level were examined by both bivariate analyses and multivariate logistic regression. A five-point autonomy scale was created to explore the role of female autonomy in reported abortion-seeking behavior. Results Among 4916 women included in the survey, 791 (16.1%) reported having an abortion. Factors associated with abortion-seeking included being older, having attended school, and living in an urban versus a rural area. When entered into a logistic regression model with demographic control variables, every step up the autonomy scale (i.e. increasing autonomy) was associated with a 14.0% increased likelihood of reporting the termination of a pregnancy (P < 0.05). Conclusion Although health system barriers might play a role in preventing women from seeking safe abortion services, autonomy on an individual level is also important and needs to be addressed if women are to be empowered to seek safe abortion services. [ABSTRACT FROM AUTHOR]

Objective: Factors contributing to the limited use of confidential inquiries into maternal deaths include the negative focus and demotivating effect of such inquiries, perceptions of unavailability of sufficient documentation of events, and lack of time and resources. To ascertain whether these problems can be overcome, variations to confidential inquiries into maternal deaths were introduced in Ghana and Indonesia.Methods: Clinical review panels were set up as part of the usual process of confidential inquiries, and modifications to the confidential inquiries were introduced. In Ghana, the traditional confidential inquiry process focusing on health facility care was modified to introduce the assessment of positive factors. In addition to the assessment of positive factors, adaptations in Indonesia consisted of including cases of obstetric complications, as well as deaths, and the use of interview testimonials as data sources. Information about resource and time needs for conducting confidential inquiries was collected.Results: The introduction of positive aspects to the process provided a balanced and more motivating setting for the inquiry. The data obtained from case notes in district hospitals and interview testimonials provided sufficient information to assess why maternal deaths and severe complications occurred. The costs of conducting the inquiries ranged from US $4000 to US $11000 (per study), and the estimated time required for a panel member to review each case was more than 3 hours.Conclusion: This study introduced practical ways to encourage the implementation of maternal death reviews, inquiries, and audits that are context specific and, therefore, acceptable to local practitioners. [ABSTRACT FROM AUTHOR]