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Background: Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021)., Methods: The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest., Results: 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves., Conclusion: The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses., Trial Registration: Not Applicable., Jel Classification: D10, I12, J16., (© 2024. The Author(s).)

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: This paper aims to understand the maternal health vulnerabilities of migrant women in slums and explore their challenges during and after childbirth. Design/methodology/approach: The study used a qualitative approach, including in-depth interviews through purposive and snowball sampling techniques. Thematic analysis was used for analysing data. The consolidated criteria for reporting qualitative studies (COREQ)-32 items were followed for reporting this study. Findings: The study found that migrant women were highly susceptible to adverse birthing outcomes due to risks involved in birthing, lack of care and hygiene, lack of skilled care in dealing with complicated pregnancies and exposure to domestic and obstetric violence. Originality/value: The study intends to highlight the narratives of female migrants' birthing and maternal health challenges. The entire process of childbirth in slums with consequences can result in maternal and infant morbidities and mortalities. [ABSTRACT FROM AUTHOR]

Background: Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. Data and Methods: The study uses data from the fifth round of the National Family Health Survey conducted in 2019–2021 and analyzed 26,552 (15–49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Results: Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. Conclusion: There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality. Significance: What is already known about this subject? Existing literature in India mostly highlights a clear connection between women's autonomy and maternal healthcare services utilization. Women with higher autonomy, decision-making power, and mobility are more likely to use these services. However, in exploring the link between women's empowerment and maternal healthcare, some studies focus on education, employment, and media access among Indian mothers, sidelining broader empowerment dimensions. What this study adds? This study is likely the first to investigate the relationship between women's empowerment and the level of maternal healthcare service utilization in India. It covers key dimensions of women's empowerment, including Attitude to Violence, Social Independence, and Decision-making Power. Moreover, it is possibly the first Indian research paper to employ a survey-based women's empowerment index in this context. Notably, the assessment highlights Social Independence as a significant dimension. [ABSTRACT FROM AUTHOR]

Background: Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. Methods: We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. Results: Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. Conclusion: Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed. Plain language summary: Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions. [ABSTRACT FROM AUTHOR]

Introduction: The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. Methods: A household survey was conducted by using a multi-stage sample with 407 married women aged 18–45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. Results: Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. Conclusion: This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth. [ABSTRACT FROM AUTHOR]

Objectives: Community Health Workers (CHWs) are important healthcare professionals and key members of team. The purpose of this research is to identify the roles and responsibilities of CHWs in developed and developing countries who provide healthcare assistance to pregnant and lactating women. Methods: For this particular study, a comparison was conducted between CHWs role in seven developed countries, seven South Asian developing countries, and India, with special emphasis on improving maternal health status. Results: CHW programs are essential in communities, institutional health programs, and outreach delivery systems. Without active community involvement, CHWs cannot reach their full potential. Developed countries have frameworks for CHWs, such as the Swasthya Shebika Program, Village Health Worker Cadret, Lady Health Worker Programme, and Accredited Social Health Activist program. CHWs are well-paid in developed nations and work with marginalized groups to spread health messages. However, up to 60% of community health workers in low- and lower-middle-income countries do not receive remuneration. Conclusion: Health systems must support CHWs in choosing technical interventions and providing necessary training, supervision, and logistical support. [ABSTRACT FROM AUTHOR]

Aim: The aim was to examine the outcomes of pregnant women admitted to intensive care unit with coronavirus disease-2019 (COVID-19) infection during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in India. The primary outcome of the study was maternal mortality at day 30. The secondary outcomes were the intensive care unit (ICU) and hospital length of stay, fetal mortality and preterm delivery. Materials and methods: This was a retrospective multicentric cohort study. Ethical clearance was obtained. All pregnant women of the 15--45- year age admitted to ICUs with SARS-CoV-2 infection during 1st March 2020 to 31st October, 2021 were included. Results: Data were collected from nine centers and for 211 obstetric patients admitted to the ICU with a confirmed diagnosis of COVID-19. They were divided in to two groups as per their SpO2 (saturation of peripheral oxygen) level at admission on room air, that is, normal SpO2 group (SpO2 > 90%) and low SpO2 group (SpO2 < 90%). The mean age was (30.06 ± 4.25) years and the gestational age was 36 ± 8 weeks. The maternal mortality rate was10.53%. The rate of fetal death and preterm delivery was 7.17 and 28.22%, respectively. The average ICU and hospital length of stay (LOS) were 6.35 ± 8.56 and 6.78 ± 6.04 days, respectively. The maternal mortality (6.21 vs 43.48%, p < 0.001), preterm delivery (26.55 vs 52.17%, p = 0.011) and fetal death (5.08 vs 26.09%, p = 0.003) were significantly higher in the low SpO2 group. Conclusion: The overall maternal mortality among critically ill pregnant women affected with COVID-19 infection was 10.53%. The rate of preterm birth and fetal death were 28.22 and 7.17%, respectively. These adverse maternal and fetal outcomes were significantly higher in those admitted with low SpO2 (<90%) at admission compared with those with normal SpO2. [ABSTRACT FROM AUTHOR]

Introduction: The utilization of the maternal and newborn health services has increased, but mere increase in utilization of services does not ensure that quality services are being provided. The aim of the study was to assess the quality of maternal and newborn services and their impact on maternal and neonatal outcome at a primary health center of Western Rajasthan in India. Materials and Methods: An exploratory study was undertaken at a conveniently selected primary health center providing 24-hour delivery services. Information regarding the availability of services was collected from the available medical officer in charge using an Indian Public Health Standards (IPHS) Proforma. Assessment of quality of services was performed by using WHO standards of care based on assessment of quality of maternal and newborn services tool by the perspectives of the provider as well as the mothers utilizing the services. 36 mothers who delivered at the selected PHC were interviewed. Results: All basic obstetric care services were available at the selected primary health centers including the 24 × 7 delivery services. The assessment of quality by provider's perspective revealed that the system of referral could be improved. Quality of maternal and newborn services assessment revealed that the practice of skin to skin contact between the mother and newborn just after the delivery was not being followed and few (30%) mothers informed that they could not start breastfeeding within 1 hours of birth. 47% mothers reported that they were not given the freedom to ask questions during delivery. Maternal and newborn outcome revealed that all mothers (100%) had a normal vaginal delivery, and 22% mothers had an episiotomy. All (100%) newborns cried immediately after birth, and average birthweight was 2.89 kg. Conclusion: PHCs are the first point of contact of mothers and healthcare delivery system. Assessment of quality of services is an important tool for quality assurance. Inclusion of evidence-based practices like skin-to-skin contact and early initiation of breastfeeding is important to improve the maternal and newborn well-being. [ABSTRACT FROM AUTHOR]