Search

Background: Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. Methods: This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. Results: Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions: Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area. [ABSTRACT FROM AUTHOR]

To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women., Author(s): Lori de Ravello[sup.1] , Arianne Folkema[sup.2] , Scott Tulloch[sup.3] , Melanie Taylor[sup.4] , Brigg Reilley[sup.5] , Karen Hoover[sup.3] , Robert Holman[sup.2] , Andreea Creanga[sup.1] Author Affiliations: (1) Division of [...]

Background: Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications. Methods: We used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15–49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section). Results: 16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0–100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p < 0.001), but lower supportive care scores, and about the same scores for dignity and respect and for the overall PCMC. 18 out of 31 experience of care indicators showed statistically significant differences by complications, but the magnitudes of the differences were generally small, and the direction of the associations were inconsistent. In general, women who delivered by c-section reported better experiences. Conclusions: There is insufficient evidence based on our analysis to suggest that women with obstetric complications report consistently better or worse experiences of care than women without. Women with complications appear to experience better care on some indicators and worse care on others. More studies are needed to understand the relationship between obstetric complications and women's experience of care and to explore why women who deliver by c-section may report better experience of care. Plain language summary: In several studies and reports, women have described mistreatment by health providers during childbirth in health facilities. Particularly in low- and middle-income countries, such mistreatment has negative effects on women's decisions to seek maternity care in health facilities. It is unclear if women with complications are more or less likely to experience some forms of mistreatment compared to women without complications. In this study, we examined 31 experience of care indicators in three domains: (1) Supportive Care; (2) Respect and Dignity; and (3) Communication and Autonomy from the validated Person-Centered Maternity Care (PCMC) questionnaire. We compare these experience of care indicators between women who report obstetric complications and those who don't report complications, by the reported severity of the complications, and by their mode of delivery. The study included data from three countries: Ghana, Kenya, and India. The results showed that the experience of care among women who reported obstetric complications was not consistently better or worse than that of those who did not have complications. Therefore, efforts should be made to improve the experience of care in health facilities for every birthing woman. Additionally, women who delivered via c-section had consistently better experiences than women who delivered vaginally. More studies are needed to understand the relationship between mode of delivery and women's experience of care. [ABSTRACT FROM AUTHOR]

Background The extent to which a favorable policy environment influences health care utilization and outcomes for pregnant and postpartum women is largely unknown. In this study, we aimed to describe the maternal health policy environment and examines its relationship with maternal health service utilization in low- and middle-income countries (LMICs). Methods We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) policy survey linked with key contextual variables from global databases, as well as UNICEF data on antenatal care (ANC), institutional delivery, and postnatal care (PNC) utilization in 113 LIMCs. We grouped maternal health policy indicators into four categories - national supportive structures and standards, service access, clinical guidelines, and reporting and review systems. For each category and overall, we calculated summative scores accounting for available policy indicators in each country. We explored variations of policy indicators by World Bank income group using c2 tests and fitted logistic regression models for ≥85% coverage for each of four or more antenatal care visits (ANC4+), institutional delivery, PNC for the mothers, and for all ANC4+, institutional delivery, and PNC for mothers, adjusting for policy scores and contextual variables. Results The average scores for the four policy categories were as follows: 3 for national supportive structures and standards (score range = 0-4), 5.5 for service access (score range = 0-7), 6. for clinical guidelines (score range = 0-10), and 5.7 for reporting and review systems (score range = 0-7), for an average total policy score of 21.1 (score range = 0-28) across LMICs. After adjusting for country context variables, for each unit increase in the maternal health policy score, the odds of ANC4+>85% increased by 37% (95% confidence interval (CI) = 1.13-1.64) and the odds of all ANC4+, institutional deliveries and PNC>85% by 31% (95% CI = 1.07-1.60). Conclusions Despite the availability of supportive structures and free maternity service access policies, there is a dire need for stronger policy support for clinical guidelines and practice regulations, as well as national reporting and review systems for maternal health. A more favorable policy environment for maternal health can improve adoption of evidence-based interventions and increase utilization of maternal health services in LMICs. [ABSTRACT FROM AUTHOR]

Background We aimed to describe the availability of newborn health policies across the continuum of care in low- and middle-income countries (LMICs) and to assess the relationship between the availability of newborn health policies and their achievement of global Sustainable Development Goal and Every Newborn Action Plan (ENAP) neonatal mortality and stillbirth rate targets in 2019. Methods We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) Policy Survey and extracted key newborn health service delivery and cross-cutting health systems policies that align with the WHO health system building blocks. We constructed composite measures to represent packages of newborn health policies for five components along the continuum of care: antenatal care (ANC), childbirth, postnatal care (PNC), essential newborn care (ENC), and management of small and sick newborns (SSNB). We used descriptive analyses to present the differences in the availability of newborn health service delivery policies by World Bank income group in 113 LMICs. We employed logistic regression analysis to assess the relationship between the availability of each composite newborn health policy package and achievement of global neonatal mortality and stillbirth rate targets by 2019. Results In 2018, most LMICs had existing policies regarding newborn health across the continuum of care. However, policy specifications varied widely. While the availability of the ANC, childbirth, PNC, and ENC policy packages was not associated with having achieved global NMR targets by 2019, LMICs with existing policy packages on the management of SSNB were 4.4 times more likely to have reached the global NMR target (adjusted odds ratio (aOR)=4.40; 95% confidence interval (CI)=1.09-17.79) after controlling for income group and supporting health systems policies. Conclusions Given the current trajectory of neonatal mortality in LMICs, there is a dire need for supportive health systems and policy environments for newborn health across the continuum of care. Adoption and implementation of evidence-informed newborn health policies will be a crucial step in putting LMICs on track to meet global newborn and stillbirth targets by 2030. [ABSTRACT FROM AUTHOR]

Objective To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. Methods The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African-countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. Findings The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. Conclusion Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries. Objectif Etudier l'utilisation de la contraception dans 13 pays d'Afrique subsaharienne, evaluer les changements dans la satisfaction des besoins en matiere de contraception par rapport aux inegalites liees a la richesse, et decrire la relation existant entre l'utilisation des methodes contraceptives long terme eta court terme, ainsi que les intentions d'une femme en matiere de fecondite par rapport a la prosperite de son foyer. Methodes L'analyse a ete realisee a partir des donnees de I'enquete demographique et sanitaire menee dans 13 pays d'Afrique subsaharienne. Les inegalites liees a la richesse et ayant un effet sur le recours a la contraception ont ete calculees a partir des indices de richesse des menages et des indices de concentration. Des modeles de regression logistique ont ete adaptes pour relieter la probabilite d'utilisation d'une methode contraceptive a long terme, avec les ajustements suivants: le quintile d'indice de richesse, rintention de fecondite (espacer les naissances ou arreter toute procreation), le domicile (urbain/rural), l'education, le nombre d'enfants en vie, la situation familiale et l'annee de l'enquete. Resultats Le recours a la contraception a considerablement augmente entre les enquetes menees en Ethiopie, a Madagascar, au Mozambique, en Namibie et en Zambie, mais il a legerement diminue au Kenya, au Senegal et en Ouganda. Les inegalites liees a la richesse dans la satisfaction des besoins en matiere de contraception ont decru dans la plupart des pays, notamment au Mozambique, mais elles ont augmente au Kenya, en Ouganda et en Zambie en matiere d'espacement des naissances, et au Malawi, en Ouganda, en Republique-Unie de Tanzanie, au Senegal, et en Zambie en matiere de limitation du nombre de grossesses. Apres rajustement de l'intention de fecondite, les femmes appartenant au quintile le plus riche avaient une plus grande probabilite de pratiquer une contraception a long terme que celles appartenant au quintile le plus pauvre. Conclusion Les programmes de planification familiale en Afrique subsaharienne presentent differents degres de succes pour atteindre tousles segments de la societe, toutefois des inegalites persistent et ce, dans tousles pays. Objetivo Analizar el uso de anticonceptivos en 13 paises del Africa subsahariana, evaluar los cambios en las necesidades de anticoncepcion cubiertas en relacion con una distribucion desigual de la riqueza y describir la relacion existente entre el uso de metodos anticonceptivos (comparando el uso a largo y corto plazo) y las intenciones de embarazo de una mujer en funcion del nivel economico de la unidad domestica. Metodos El analisis se realizo empleando los datos de una encuesta sobre salud y datos demograficos procedentes de 13 paises del Africa subsahariana. Se calcularon las desigualdades en el uso de metodos anticonceptivos relacionadas con el nivel economico, empleando los indices de concentracion y de economia de la unidad familiar. Respecto a la probabilidad de emplear un metodo anticonceptivo a largo plazo, se adaptaron modelos logisticos de regresion con ajustes del quintil de ingresos, la intencion de embarazo (espaciar los nacimientos frente a dejar de tener hijos), la residencia (urbana/rural), la educacion, el numero de hijos vivos, el estado civil y el ano de la encuesta. Resultados El uso de metodos anticonceptivos ha aumentado considerablemente entre las encuestas de Etiopia, Madagascar, Mozambique, Namibia y Zambia, si bien ha registrado un ligero descenso en Kenya, Senegal y Uganda. Las desigualdades de tipo economico a la hora de cubrir la necesidad de utilizar metodos anticonceptivos han disminuido en la mayoria de los paises, especialmente en Mozambique, pero han aumentado en Kenya, Uganda y Zambia en relacion al espaciamiento de los embarazos, yen Malawi, Republica flnida de Tanzania, Senegal, Uganda y Zambia respecto a la reduccion de la maternidad. Tras realizar el ajuste de la intencion de embarazo, era mas probable que las mujeres que se encontraban en el quintil mas rico emplearan un metodo anticonceptivo a largo plazo que las mujeres que se situaron en el quintil mas pobre. Conclusion Los programas de planificacion familiar en el Africa subsahariana surten efecto de manera irregular en todos los segmentos de la sociedad, si bien las desigualdades persisten en todos los paises., Introduction Global health has improved considerably over the last four decades, but everywhere the health status of the poor compares unfavourably with that of the more affluent sectors of society. [...]

The article presents the discussion on overview of conditions and factors associated with obesity in pregnancy. Topics include clinicians caring for women of reproductive age since prevention of long-term complications associated with obesity in pregnancy requiring a life course approach; and taking into consideration the fat distribution pattern with visceral obesity posing greater metabolic risks than subcutaneous obesity.