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Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions. Even with advances in care, there remain many similarities in interventions for the improved treatment and screening of maternal syphilis over the past 30 years. There is a need for meaningful research that engages community members in study and intervention development and considers the social determinants of health in the context of maternal syphilis care. Examining interventions in relation to the socio-ecological model may help guide policymakers, researchers, and clinicians in intervention development. [ABSTRACT FROM AUTHOR]

Purpose: Systematic reviews on child homicide have proliferated recently, making it hard to keep up with their output. Using an umbrella review approach (i.e., a synthesis of systematic reviews), this study aimed to identify what aspects of child homicide have been examined in systematic reviews, synthesize systematic review findings, and discuss the implications for policy, practice, and future primary research. Method: The current study utilized an umbrella review approach to locate systematic reviews of studies on child homicide published in various disciplines. The final sample included fourteen systematic review articles published from 2010 to 2022. Results: The main research questions varied across systematic reviews, but they included risk factors, typology, statistics on incidence and prevalence, and punishment and disposition. Systematic reviewers highlighted the need for a database and monitoring system, multi-disciplinary Child Death Review Teams, parenting education, and women-friendly services and policies. Conclusions: More systematic reviews and meta-analyses need to be conducted, focusing on evidence-informed strategies, to inform child abuse policies and practices. It is also imperative that the child homicide research community establish knowledge dissemination strategies to build large-scale datasets and translate research results into effective risk management practices. [ABSTRACT FROM AUTHOR]

Background: Policy research aims to provide evidence to inform government policy decisions about health and social care. Engaging and involving the public and patients in this work is widely recognised as essential. Research funders prioritise equality, diversity and inclusion (EDI) in patient and public involvement and engagement (PPIE), but people who are most likely to experience poor outcomes are also those least likely to be involved in research. This paper describes our experience of setting out to understand how to overcome barriers to EDI in PPIE in the research carried out by the National Institute for Health and Care Research (NIHR) Policy Research Unit in Maternal and Neonatal Health and Care (PRU-MNHC), in a PPIE consultation project we called The Listening Series. Methods: We convened five video-recorded online discussion groups involving 20 individuals advocating for groups who are under-represented in our research. Those taking part included people working with Black and Asian women and families, young parents, those from socially deprived backgrounds, and women and families with physical and learning disabilities. Discussions focussed on practical solutions to addressing challenges to people being excluded, and how to improve EDI in our research. Learning and reflection: Five key themes were identified: 'build trust'; 'involve us from the beginning'; 'show us impact'; 'use clear, appropriate and inclusive communication'; and 'imagine life in our shoes'. We used the learning to create a guidance document for researchers and an accompanying 15-minute film. We also took practical steps to embed the learning strategically by expanding our Task Group for PPIE in the PRU-MNHC to include four Listening Series invitees with a remit to champion EDI in our research and ensure that it is embedded in our PPIE activities. We continue to reflect on and work to address the associated challenges. Conclusions: The Listening Series helped us rethink our processes for inclusion to go beyond traditional methods of involvement and engagement. The themes identified pose challenges that require time, resource and empathic engagement from researchers to be meaningfully resolved. This has implications for policy makers and research funders who need to consider this in their processes. Plain English Summary: What we know: It is important that health care researchers involve patients and the public from a wide range of social and ethnic backgrounds in research, but we know that this often does not happen. We are a group of researchers and patient/public representatives, working in research to improve care for pregnant women and babies. We wanted to find out how to involve people from more diverse backgrounds in our research. What we did: We organised five online discussion groups with 20 people working with Black and Asian families, young parents, those from socially deprived backgrounds and parents with physical or learning disabilities. We asked them what we should do to involve a wider range of people in our research. We called this The Listening Series. We summarised the most important things people said in a written guide for researchers and a short film. We then asked people who had been invited to take part in The Listening Series to join us to develop new ways of working together. What we learned: The five themes we identified were: 'build trust'; 'involve us from the beginning'; 'show us impact'; 'use clear, appropriate and inclusive communication'; and 'imagine life in our shoes'. In summary, researchers need to take the time to build trusting relationships with patients and the public; actively listening and learning from them. This can be challenging for researchers and patient representatives. Research funders need to allow time and money for this to happen in a meaningful way. [ABSTRACT FROM AUTHOR]

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10−8.03‰), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services. [ABSTRACT FROM AUTHOR]

This article explores the impact of the 'hostile environment' on racialised migrant women's experiences of pregnancy and childbirth in England, arguing that the 'hostile environment' functions as a technology of 'stratified reproduction.' First coined by Shellee Colen, the concept of stratified reproduction describes the dynamic by which some individuals and groups may be supported in their reproductive activities, while others are disempowered and discouraged. This paper locates the stratified reproduction produced by the 'hostile environment' as intertwined with wider gendered and racialised discourses around British citizenship which have been 'designed to fail' racialised residents of the UK. Drawing on interviews with racialised migrant mothers in the north of England, this paper analyses how the proliferation and intensification of immigration controls interacts with gender, race, class, and other social regimes to differentially allocate the resources necessary for a safe and healthy pregnancy and childbirth, and how this is experienced materially by pregnant migrants. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In 2019, the Australian government released a strategy for maternity care: Woman-centred care strategic directions for Australian maternity services (WCC Strategy), with mixed responses from providers and consumers. A public lecture and expert panel held in March 2021, titled "The Good, the Bad, and the Possible," facilitated critique and feedback on the WCC Strategy and the Australian maternity system. The aim of this article was to report the findings of a qualitative analysis of participants' views regarding the current perceptions of Australian maternity care. METHODS: A content analysis of responses to questions posed during the lecture and the commentary provided by participants was undertaken, utilizing a predetermined framework of "the Good, the Bad, and the Possible." RESULTS: Approximately 700 participants, mainly from Australia, attended the event. The majority were midwives. Under the guiding framework, the category "When it works well" captured "the Good" aspects of maternity care. Under "the Bad," major categories included "the system is broken," "roadblock to maternity service reform," and "not being seen or heard." Suggestions for improvement, and hope that these will be enacted, were encompassed in "the Possible" categories: "what is needed" and "we're in this together." CONCLUSION: Participants identified widespread maternity system issues resulting in women's needs not being met. Midwives indicated feeling invisible, as their repeated attempts at improvement were thwarted. Hierarchical power imbalances and medical privilege were suggested to be obstructions to respectful partnerships and expansion of midwifery models of care, preventing women from accessing safe birth options of their choice. [ABSTRACT FROM AUTHOR]

Objective: Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access. Methods: Qualitative interviews about newborn circumcision care were conducted from April–June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care. Results: The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5–38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision. Conclusions: Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions. Significance: What is already known on this subject? Access to desired newborn circumcision is inconsistent in the United States. Boys who are publicly insured, or Black/African American typically have less access, resulting in higher rates of riskier elective, operative circumcision procedures in these groups. What this study adds? Reasons for observed differences in access to desired newborn circumcision include hospital-level operational and logistical challenges, and an insurance reimbursement structure that often disincentivizes newborn circumcision. [ABSTRACT FROM AUTHOR]

Aims We examined relationships between pregnancy-specific alcohol policies and admissions to substance use disorder treatment for pregnant people in the USA. Methods We merged state-level policy and treatment admissions data for 1992–2019. We aggregated data by state-year to examine effects of nine pregnancy-specific alcohol policies on the number of admissions of pregnant women where alcohol was reported as the primary, secondary, or tertiary substance related to the treatment episode (N  = 1331). We fit Poisson models that included all policy variables, state-level controls, fixed effects for state and year, state-specific time trends, and an offset variable of the number of pregnancies in the state-year to account for differences in population size and fertility. Results When alcohol was reported as the primary substance, civil commitment [incidence rate ratio (IRR) 1.45, 95% CI: 1.10–1.89] and reporting requirements for assessment and treatment purposes [IRR 1.36, 95% CI: 1.04–1.77] were associated with greater treatment admissions. Findings for alcohol as primary, secondary, or tertiary substance were similar for civil commitment [IRR 1.31, 95% CI: 1.08–1.59] and reporting requirements for assessment and treatment purposes [IRR 1.21, 95% CI: 1.00–1.47], although mandatory warning signs [IRR 0.84, 95% CI: 0.72–0.98] and priority treatment for pregnant women [IRR 0.88, 95% CI: 0.78–0.99] were associated with fewer treatment admissions. Priority treatment findings were not robust in sensitivity analyses. No other policies were associated with treatment admissions. Conclusions Pregnancy-specific alcohol policies related to greater treatment admissions tend to mandate treatment rather than make voluntary treatment more accessible, raising questions of ethics and effectiveness. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. Materials and Methods: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. Results: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. Conclusions: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period. [ABSTRACT FROM AUTHOR]

This research explores how health care providers determine the mental health needs of immigrant women in the perinatal phase of childbirth. The contextual factors that affect the mental health of these women and influence their engagement with the British Columbian communities in which they reside are investigated. Using a critical ethnographic approach, eight health care providers were interviewed to gain insight into health care provider's health literacy and immigrant perinatal women's mental health. Each participant was interviewed for 45–60 min in the period from January to February 2021 to obtain relevant data. Three themes emerged from the data analysis: the health care provider's role and his/her health literacy, the health literacy of the participant, and the impact of the ongoing COVID-19 pandemic on the participant's situation. The findings indicate that a healthy working relationship between the health care provider and an immigrant woman in the perinatal phase of childbirth is essential to facilitate an effective interchange of health information. [ABSTRACT FROM AUTHOR]

Objectives: The study applies the principal-agent approach to explore providers' experiences before and after the introduction of performance-based financing (PBF) in Cameroon, challenges and facilitators in the implementation process, and mechanisms in place to ensure sustainability. Methods: The study was an in-depth qualitative study whose goal was to provide multiple descriptions of experiences and insights from a principal-agent analysis perspective. Purposive sampling was used to identify the key characteristics of the participants relevant to the study. A snowballing technique was used to further identify eligible participants. Only healthcare providers who were exposed to the previous system and could reflect on and provide meaningful data that captured the everyday experiences before and after the implementation of PBF were included. Data were collected from three districts in the Southwest region of Cameroon from May 2021 to August 2021. Data were transcribed and analyzed using MaxQDA. Results: A total of 17 interviews and 3 focus group discussions (24 participants) were conducted with healthcare providers and key stakeholders involved in PBF. The respondents described a range of changes that they had experienced since the introduction of PBF. Each of these changes was categorized as either positive or negative. Positive changes were framed into 14 dominant categories: motivation, negotiations, innovation, resource allocation, autonomy, decentralization, transparency, improved quality of care, separation of function, performance, equity considerations, opportunity to recruit, participation in decision-making, and improved access to and utilization of maternal health services. The main challenges (negative experiences) reported were framed into nine categories: management of change, retention issues, conflict of interest, poor understanding of the PBF concept, resistance to change, verification challenges, delays in payment of PBF incentives, data entry and documentation, and challenges in meeting the equity considerations of the poor and vulnerable. Despite the challenges, providers preferred the decentralized approach to the centralized system. Conclusion: PBF is a national strategy for achieving universal health coverage in Cameroon, and the experiences of providers provide a vital guide to refine national policy. The introduction of PBF has provided positive changes to providers' quality of care when compared to the previous system. Addressing the delays in PBF payments will help to overcome the challenges to implementation and provide opportunities for health facilities to be more efficient and improve their performance. Despite the limitations of delay in payment, PBF helps to align the incentives of the health workers (agent) with those of the Ministry of Health (principal). [ABSTRACT FROM AUTHOR]

Background: Skilled Birth Attendance (SBA) is important in achieving the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1. Ghana has made steady progress in SBA, yet, unsupervised deliveries still occur. The introduction of the Free Maternal Health Care Policy under the National Health Insurance Scheme (FMHCP under the NHIS) has improved the uptake of SBA but with some implementation challenges. This narrative review sought to explore the factors influencing the FMHCP under the NHIS provision for skilled delivery services in Ghana. Methods: Electronic searches were conducted of databases including PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 2003 and 2021 on factors influencing FMHCP/NHIS provision for skilled delivery services in Ghana. Keywords used in the literature search were in various combinations for the different databases. The articles were screened to determine the inclusion and exclusion criteria and quality was assessed using a published critical appraisal checklist. A total of 516 articles were retrieved for initial screening based on their titles, of which 61 of them, were further screened by reading their abstracts and full text. Of this number, 22 peer-reviewed and 4 grey articles were selected for the final review based on their relevance. Results: The study revealed that the FMHCP under the NHIS does not cover the full costs associated with skilled delivery and low socioeconomic status of households affects SBA. Also, funding and sustainability, hinders the quality-of-service delivery offered by the policy. Conclusion: For Ghana to achieve the SDGs above and further improve SBA, the cost associated with skilled delivery should be fully covered by the NHIS. Also, the government and the key stakeholders involved in the policy implementation, must put in place measures that will enhance the operation and the financial sustainability of the policy. [ABSTRACT FROM AUTHOR]

Claire Leader discusses the three-year delivery plan for maternal and neonatal services in England, focusing on the goal to grow the maternity workforce [ABSTRACT FROM AUTHOR]

The article presents the discussion on impact of migrant policies on the health of involuntary migrant women being integrated into nursing education curriculum. Topics include providing nurses with ongoing education and support related to the integration of trauma and violence-informed care within practice being recommended; and higher rates of mental health concerns and forms of abuse and violence.

The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic. What is known about the topic? The 'First 2000 Days' policy is publicly available, it represents an important effort to highlight the importance of the first 5 years of life for a child's development. This policy and others like it have been broadly adopted around Australia. What does this paper add? This paper is a constructive critique of the policy that suggests greater responsiveness, integration, sustainability and equity. What are the implications for practitioners? This paper helps us understand how best to shape early childhood health services so they can be most effective. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic is a unique global health challenge which disrupted essential health services (EHS). Most early data related to EHS during the COVID-19 pandemic came from country and regional "pulse" surveys conducted by the World Health Organization (WHO) and United Nations Children's Fund (UNICEEF), which relied on respondent perceptions and not necessarily routine health information system (RHIS) data. By conducting a scoping review, we aimed to describe the use of RHIS data for monitoring changes in EHS coverage for maternal, newborn, and child health (MNCH) during the COVID-19 pandemic. Methods We performed a scoping review using Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review (PRISMA-SCR) guidelines. We included descriptive or analytic reports on the availability and use of RHIS data published in peer-reviewed, pre-publication, or gray literature on MNCH essential health services coverage during the COVID-19 pandemic. The following databases were searched for studies published between January 2020 and May 2022: PubMed/MEDLINE, Google Scholar, Google, MedRXiv (pre-publication), Embase, CINAHL, Cochrane, Campbell, and Open-Grey. A single reviewer screened the titles, abstracts, and full texts of the retrieved publications, while a second reviewer screened 20% of the total sample. Publications were tabulated by WHO Region, World Bank income group, country, data sources, study topic, and period. We used content analysis to qualitatively describe the trends and use of data for policy or programming in the studies. Results We included 264 publications after the full-text review. The publications came from 81 countries, covering all WHO regions and World Bank income groups. The most common data sources were hospital information systems (27%) and primary health care management information systems (26%). Most studies examined data trends before COVID-19 compared to periods during COVID-19. Most publications reported a decrease in MNCH services (45%). Reports with follow-up beyond August 2020 (first six months of pandemic) were significantly more likely to report recovery of service coverage (8% vs 30%, P<0.001). Low- and middle-income countries reported significantly higher morbidity and/or mortality in COVID-19 periods than high-income countries (54% vs 30%, P<0.001). Less than 10% of reports described RHIS data quality specifically during the COVID-19 period and only 22% reported program mitigation strategies to address reductions noted from routine data. Conclusion Results suggest awareness and usefulness of RHIS to monitor MNCH service disruptions during the COVID-19 pandemic. However, with only 22% of reports including descriptions of policy or program adaptations, use of RHIS data to monitor MNCH service disruptions was not necessarily followed by data-informed policies or program adaptations. RHIS data on MNCH services should be strengthened to enable its use by program managers and policymakers to respond to direct and indirect effects of future public health emergencies. [ABSTRACT FROM AUTHOR]

Background: Since its first case of COVID-19 on March 13, 2020, Ethiopia has exerted efforts to curb the spread of SARS-CoV-2 (COVID-19) without imposing a nationwide lockdown. Globally, COVID-19 related disruptions and mitigation measures have impacted livelihoods and food systems, nutrition, as well as access and use of health services. Objective: To develop a comprehensive understanding of the impacts of the COVID-19 pandemic on food systems, health services, and maternal and child nutrition and to synthesize lessons from policy responses to the COVID-19 pandemic in Ethiopia. Methods: We conducted a review of literature and 8 key informant interviews across government agencies, donors, and non-governmental organizations (NGOs), to map the impacts of the COVID-19 pandemic on the food and health systems in Ethiopia. We summarized policy responses and identified recommendations for future actions related to the COVID-19 pandemic and other future emergencies. Results: The impacts of the COVID-19 pandemic were felt across the food system and include limited agriculture inputs due to travel restrictions and closed borders restricting trade, reduced in-person support by agriculture extension workers, income losses, increases in food prices, and the reduction in food security and dietary diversity. Maternal and child health services were disrupted due to fear of contacting COVID-19, diversion of resources, and lack of personal protective equipment. Disruptions eased over time due to the expansion of social protection through the Productive Safety Net Program, and the increased outreach and home service provision by the health extension workers. Conclusion: Ethiopia experienced disruptions to food systems and maternal and child nutrition services due to the COVID-19 pandemic. However, by expanding existing social protection programs and public health infrastructure and leveraging partnerships with non-state actors, the extent of the impact of the pandemic was largely minimized. Nevertheless, vulnerabilities and gaps remain and there is a need for a long-term strategy that considers the potential for future pandemics and other shocks. [ABSTRACT FROM AUTHOR]

Navigating a health system which differs considerably from one's own can be a challenging process. Navigating this in seeking maternal health care can be additionally daunting. This article explores how immigrant women from diverse countries and ethnic backgrounds experienced and navigated the Norwegian maternal health service during pregnancy and childbirth. Eleven semi-structured interviews collected between 2019 to 2020 and analysed thematically informed this analysis. Principles of universalism underpinning all social and health policy in Norway, expect equality of service provision and access. These principles result in less individual choice. The women in this study found these contrary to their expectations of care but responded differently, with some experiencing the health provision as liberating while others distrusted that they were receiving the best care. A focus of concern was the expectation of more medicalized services. While some of these women used their own resources to circumvent the Norwegian health provisions, the implications for the health system extend beyond these women's experiences. The analysis suggests a need to encourage those whose expectations of care differ to build trust in institutions providing care. This article contributes to knowledge on the implications of diversity on Norway's universal health system. [ABSTRACT FROM AUTHOR]

Racial inequities in birth outcomes persist in the United States. Doula care may help to decrease inequities and improve some perinatal health indicators, but access remains a challenge. Recent doula-related state legislative action seeks to improve access, but the prioritization of equity is unknown. We reviewed recent trends in doula-related legislation and evaluated the extent to which new legislation addresses racial health equity. We conducted a landscape analysis of the LegiScan database to systematically evaluate state legislation mentioning the word "doula" between 2015 and 2020. We identified and applied nine criteria to assess the equity focus of the identified doula-related legislative proposals. Our final sample consisted of 73 bills across 24 states. We observed a three-fold increase in doula-related state legislation introduced over the study period, with 15 bills proposed before 2019 and 58 proposed in 2019–2020. Proposed policies varied widely in content and scope, with 53.4% focusing on Medicaid reimbursement for doula care. In total, 12 bills in 7 states became law. Seven of these laws (58.3%) contained measures for Medicaid reimbursement for doula services, but none guaranteed a living wage based on the cost of living or through consultation with doulas. Only two states (28.6%; Virginia and Oregon) that passed Medicaid reimbursement for doulas also addressed other racial equity components. There has been an increase in proposed doula-related legislation between 2015 and 2020, but racial health equity is not a focus among the laws that passed. States should consider using racial equity assessments to evaluate proposed doula-related legislation. [ABSTRACT FROM AUTHOR]

Despite South Asia's promising social inclusion processes, staggering social and health inequalities leave indigenous populations largely excluded. Marginalization in the South Asian polity, unequal power relations, and poor policy responses deter Adivasi populations' rights and opportunities for health gains and dignity. The ongoing COVID-19 pandemic is likely to result in a disproportionate share of infections and deaths among the Adivasis, given poor social conditions and exclusions. Poor health of indigenous people, inequalities between indigenous and non-indigenous groups, and failures in enforcing constitutional and legal provisions to reclaim indigenous land and cultural identity herald deeper structural and political fractures. This article unravels health inequalities between the Adivasis and non-Adivasi populations in their social context based on a critical review of secondary sources. We call for intersectoral policies and integrated health care services to address systemic inequalities, discrimination, power asymmetries, and consequent poor health outcomes. The current COVID-19 pandemic should be viewed as a window to pursue real change. [ABSTRACT FROM AUTHOR]

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We examined the association between women's justification of wife beating and their utilization of professional antenatal and delivery care in Bangladesh. We used data which describes a nationally representative sample of currently married women aged 15 to 49 years (n = 3,449). Services from medically trained providers were considered professional antenatal care (ANC) and delivery services. Women's attitudes toward wife beating in five circumstances (if a woman goes out without telling her husband, neglects children, argues with her husband, refuses to have sexual intercourse with her husband, and burns food) were used to describe the justification of wife beating. Chi-square tests and multilevel logistic regression analyses were performed; 74% of the women would not justify wife beating, 65% attended ≥1 ANC visits, 25% attended ≥4 ANC visits, and 44% utilized professional delivery care. Women who would not justify wife beating were more likely to utilize ≥1 ANC visits (adjusted odds ratio [AOR]: 1.89; 95% confidence interval [CI]: [1.26, 2.81]), ≥4 ANC visits (AOR: 1.14; 95% CI: [0.76, 1.71]), and professional delivery care (AOR: 1.93; 95% CI: [1.31, 2.85]). Older age, women's and husband's higher education, lower parity, urban residence (except for ≥1 ANC visits), and higher socioeconomic statuses including divisional differences were significant confounders for increased utilization of both professional ANC and delivery care. In addition, older age at marriage and current unemployment were also associated with increased utilization of delivery care services. This association between women's justification of wife beating and their utilization of professional antenatal and delivery care services has potential implications for maternal and child health policy in Bangladesh where intimate partner violence is commonplace, and societal norms teach women to obey their husbands and accept submissive roles. Public policy should aim to create awareness among women about the negative impact of justifying wife beating, and accepting intimate partner violence on their own and children's health. [ABSTRACT FROM AUTHOR]

In the United States, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers. Although awareness of and action on perinatal mental health is increasing, significant gaps remain. Screening and treatment are widely recommended but unevenly implemented, and policies and funding do not adequately support the mental health of childbearing people. As a result, treatable perinatal mental health conditions can have long-term, multigenerational negative consequences. This article provides an overview of the perinatal mental health landscape in the United States by identifying serious gaps in screening, education, and treatment; describing recent federal and state policy efforts; highlighting successful models of care; and offering recommendations for robust and integrated perinatal mental health care. [ABSTRACT FROM AUTHOR]

The article discusses the need for coordinated action to boost rural women's access to maternity services in Australia in 2022. Topics covered include such women's need of high quality care in the perinatal period, very remote communities' lesser likelihood of having birthing service, and the relocation and away-from-home birth options of expecting women in remote locations. Also noted is the lack of a consistent national strategy on the issue despite support by major stakeholders.

Racial and ethnic inequities in health are a national crisis requiring engagement across a range of factors, including the health care workforce. Racial inequities in maternal and infant health are an increasing focus of attention in the wake of rising rates of maternal morbidity and mortality in the United States. Efforts to achieve racial equity in childbirth should include attention to the nurses who provide care before and during pregnancy, at childbirth, and postpartum. [ABSTRACT FROM AUTHOR]

Background: COVID-19 exposes major gaps in the MCH safety net and illuminates the disproportionate consequences borne by people living in low resource communities where systemic racism, community disinvestment, and social marginalization creates a perfect storm of vulnerability. Methods: We draw eight lessons from the first 8 months of the pandemic, describing how COVID-19 has intensified pre-existing gaps in the MCH support network and created new problems. For each lesson identified, we present supporting evidence and a call for specific actions that can be taken by MCH practitioners, researchers and advocates. Results: LESSON #1: COVID-19 hits communities of color hardest, exposing and exacerbating health inequities caused by systemic racism. LESSON #2: Women experience the most devastating social, economic and mental health tolls during COVID-19. LESSON #3: Virulent pathogens find and exacerbate cracks in our public health and health care systems. LESSON #4: COVID-19 has become a pretext to limit access to sexual and reproductive health care. LESSON #5: COVID-19 has exposed and deepened fault lines in maternity care: over-medicalization, discrimination, lack of workforce diversity, underutilization of collaborative team approaches, and lack of post-delivery follow-up. LESSON #6: The pandemic adds impetus to much-needed Medicaid policy reforms that can have a lasting positive effect on maternal health. LESSON #7: Social and health policy changes, heretofore deemed infeasible, ARE possible under pandemic threat. LESSON #8: Finally, an overarching COVID-19 lesson: We are all inextricably connected. Conclusion: COVID-19 is a loud wake up call for renewed action by MCH epidemiologists, policy-makers, and advocates. [ABSTRACT FROM AUTHOR]

Several studies inform that early marriage is correlated with several situations, including socioeconomic status, cultural wisdom, religious values, education, and internet access. The study was aimed at analyzing the effect of education level on women's risk of early marriage in rural areas in Indonesia. The study used data from the 2017 Indonesian Demographic and Health Survey. There were 2,252 women aged 19-24 years in a rural area in Indonesia who was taken as a sample. The variables analyzed included early marriage, education level, wealth status, and employment status. The final stage was used as a binary logistic regression test to determine the risk factors. The result found that women who have secondary education have a risk of 0.396 times compared to women who have primary education to experience an early marriage (OR 0.396; 95% CI 0.309-0.506). Women who have a higher education have a risk of 0.091 times compared to women who have primary education to experience an early marriage (OR 0.091; 95% CI 0.059-0.140). This finding informs that the education level was a determinant of the incidence of early marriage among women in rural Indonesia. The lower the education of a woman in a rural area, the higher the risk of experiencing an early marriage. It could be concluded that a low level of education is a risk factor for women's early marriage in rural areas in Indonesia. [ABSTRACT FROM AUTHOR]

Objective: To identify in the scientific literature what points about obstetric violence and nursing care to prevent this occurrence. Method: This is an integrative review, guided by the question "What are the practices of obstetric violence and its implications on women's well- being, and what nursing care in the face of obstetric violence?" Data were collected in April 2019, in the Virtual Health Library (VHL) and at Capes Portal, from two crossings, using the descriptors in health sciences (DeCs): Violence; Childbirth; Humanized birth; Nursing care. Results: It was found the occurrence of humiliation at the time of delivery and the performance of unnecessary procedures. Nursing care stands out in reducing these invasive procedures through non-pharmacological methods, decent reception, active listening and physical and emotional support. Conclusion: Effective public policies and the provision of training for nursing professionals are needed for humanized care. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women's satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice. [ABSTRACT FROM AUTHOR]

Since its establishment in 1980, all biennial conferences of The International Marcé Society for Perinatal Mental Health had been convened in high-income nations. Relatively little consideration had been given to the experiences and needs of most women who live in the world's low- and middle-income countries (LMICs). The aim is to provide an account of the first conference convened in India, a middle-income country. The Global Experiences, Global Dialogues, Global Responses Biennial Conference of the International Marcé Society for Perinatal Health was convened at the National Institute for Mental Health and Neurosciences (NIMHANS) held in Bengaluru 26th–28th September 2018. The conference achieved all its aims of maximizing access for people living and working in LMICs through scaled registration fees, building capacity through a young professionals' program, promoting collaboration through symposia co-convened by South Asian and other international experts, and visits to NIMHANS' clinical services. It made an impact on the agendas of sister expert professional societies, and public policies in India and generated significant public interest. It was appraised as pivotal, transformative and presenting exceptionally high-quality science. It was financially successful in making the largest contribution to date from a biennial conference to the Society's resources. We commend this initiative to other international expert professional societies seeking to benefit from the opportunities for mutual learning that conferences convened in low- and middle-income countries can provide, and to reduce disparities in access to evidence to address health inequalities. [ABSTRACT FROM AUTHOR]

We conducted a randomized controlled experiment to test whether vouchers, cash transfers, and SMS messages were effective in boosting facility delivery rates among poor, pregnant women in rural Kenya. We find a strong effect of the full vouchers and the conditional cash transfers: 48% of women with access to both interventions delivered in a health facility, while only 36% of those with neither did. Amongst women who did not receive a cash transfer, we find that a small copayment dramatically reduced voucher effectiveness, suggesting a discontinuous impact of cost-sharing on the demand for health services. Both the unconditional cash transfer and the text messages had limited effect on the use of health services. Finally, we also find no evidence that a government policy to eliminate user fees increased demand for maternal health services. [ABSTRACT FROM AUTHOR]

The article shows transformative changes in Korea's family policies over the last two decades. It suggests that the reform has been mainly adopted in the form of childcare and maternity protection delivered as a result of state action in addressing a declining fertility rate. By using the concept of policy-layering with the process-tracing of historical methods, this article provides a case study that contributes to explaining the mechanisms of policy change and development in newly industrialized countries like Korea over welfare regime theories. It thereby shows the limit of typological thinking, while providing policy implications and lessons. [ABSTRACT FROM AUTHOR]

Immigrant women's mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women's perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women. [ABSTRACT FROM AUTHOR]

Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training. In this integrative review using a gender-oriented approach, we searched the Scielo database and the Ministry of Health’s (MofH) publications and edicts for institutional and research papers on SM initiatives addressing disrespect and abuse in the last 25 years (1993-2018) in Brazil, and their impact on public policies and training programmes. We analyse these groups of interrelated initiatives: (1) political actions of SM resulting in changes in public policies and legislation; (2) events organised by SM for diffusion of information to the public; (3) MofH policies to humanise childbirth with participation of SM; and (4) initiatives to change providers’ training, including legal actions based on obstetric violence reports. To promote real change in maternity care, the progression of policies and enabling environment of laws, regulations, and broad dissemination of information, need to go hand in hand with changes in all health providers’ training - including a solid base in ethics, gender and human rights. [ABSTRACT FROM AUTHOR]

The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action. [ABSTRACT FROM AUTHOR]

Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies. [ABSTRACT FROM AUTHOR]

This article is a comment on Vaswani, Karter, Cosgrove, Peters, and Brodt's (2018) article “Depression Screening During Pregnancy and the Postpartum Period: Enhancing Informed Consent Practices.” We review research on the types and magnitude of emotional distress that women commonly experience during pregnancy and postpartum, the prevalence of postpartum depression, and its predictors, including prior depression, stress, and lack of resources. We conclude that a more effective response by society than screening includes the development of public policies (e.g., paid maternal leave, subsidized child care) and the delivery of services that reduce stress and other risk factors for depression during pregnancy and postpartum in order to improve all mothers' experiences. [ABSTRACT FROM AUTHOR]

The literature addressing attitudes about social policy and the welfare state has been telling us for decades that welfare interventions are supported by those individuals who benefit from a specific measure. The diffusion of ‘demanding’ active labour market policies (ALMPs), however, challenges this relationship. Using a novel dataset, I analyse which individual- and country-level factors explain public support for demanding ALMPs in five Western European countries. The results show that labour market risk and ideological orientation influence public attitudes towards these ALMPs. Thereby, unemployed individuals sympathising with the political right are more strongly opposed to demanding measures than employed individuals with the same political preferences. Moreover, aggregate support is found to be correlated with the country's ALMP legacy, varying from high levels in Germany and the UK to low levels in Denmark and France. The findings suggest that most ALMPs are in fact implemented despite the opposition of their beneficiaries. [ABSTRACT FROM PUBLISHER]

More than 300,000 women died due to pregnancy related causes in 2015, a global maternal mortality ratio (MMR) of 216 per 100,000 live births (Alkema et al., 2016). Millennium Development Goals have led to a 44% decline in global MMR, but significant variations still remain across geographical regions (United Nations [UN], 2015). India accounts for the second highest maternal deaths in the world (World Health Organization [WHO], 2015). In contrast, the U.S. is the only developed country with an increasing MMR in recent years ("Maternal Mortality," 2015). However, little attention has been given to maternal health in public policy research and practice in both countries. This paper compares and contrasts maternal health status and analyzes maternal health policies in India and the U.S. two health models. Based on comparative case analysis, the overall recommendation is to expand the scope of maternal health from a biomedical health model towards a biopsychosocial model and restructure the policy frameworks. This paper contributes to the maternal health discourse and hopes to garner attention of global and regional health policy scholars and policy makers. [ABSTRACT FROM AUTHOR]

Nepal introduced free delivery services for births in public facilities in 2005 in 25 districts with the intervention initially restricted to women with less than two living children and/or women with obstetric complications. After November 2007, eligibility conditions were relaxed to include all women, and the programme was later expanded to cover an additional 50 districts in December 2008. We exploit the phased expansion of the free birth delivery programme to identify its impact on place of delivery, the presence of skilled birth attendants (SBAs) and neonatal mortality using difference-in-difference methods, on data for 4457 live-births reported between 2001 and 2008 from Nepal Demographic and Health Surveys for 2006 and 2011. Programme impacts were estimated for: (1) initial implementation until the relaxation of eligibility criteria to include all women in November 2007 (early phase); and (2) initial implementation until the programme was expanded nationwide in December 2008 (longer phase). Early implementing districts were treatment districts, while late implementing hill districts were control districts. In the early phase, the likelihood of delivery by SBAs was 5.6 percentage points higher (95%CI 0.002, 0.111) and the likelihood of delivery in a public facility was 5.1 percentage points higher (95%CI -0.003, 0.106) in treatment districts compared with control districts. The programme lowered the likelihood of neonatal mortality by 4.0 (-0.072, -0.009) percentage points for women with less than two living children and by 6.9 percentage points (95%CI -0.104, -0.035) for women from lower castes and indigenous groups in treatment districts compared with women in control districts, during the early phase. Programme effects on use of public facilities for births and deliveries attended by SBAs were not sustained over a longer exposure period. The results on neonatal mortality persisted with longer programme exposure, although the effects were smaller in magnitude. [ABSTRACT FROM AUTHOR]

Performance-based financing (PBF) is a mechanism by which health providers are paid on the basis of outputs or results delivered. A PBF program was implemented on the provision of HIV, prevention of mother-to child HIV transmission (PMTCT), and maternal/child health (MCH) services in two provinces of Mozambique. A retrospective case-control study design was used in which PBF provinces were matched with control provinces to evaluate the impact of PBF on 18 indicators. Due to regional heterogeneity, we evaluated the intervention sites (North and South) separately. Beginning January 2011, 11 quarters (33 months or 2.75 years) of data from 134 facilities after matching (84 in the North and 50 in the South) were used. Our econometric framework employed a multi-period, multi-group difference-in-differences model on data that was matched using propensity scoring. The regression design employed a generalized linear mixed model with both fixed and random effects, fitted using the seemingly unrelated regression technique. PBF resulted in positive impacts on MCH, PMTCT and paediatric HIV program outcomes. The majority of the 18 indicators responded to PBF (77% in the North and 66% in the South), with at least half of the indicators demonstrating a statistically significant increase in average output of more than 50% relative to baseline. Excluding pregnant women, the majority of adult HIV treatment indicators did not respond to PBF. On average, it took 18 months (six quarters) of implementation for PBF to take effect, and impact was generally sustained thereafter. Indicators were not sensitive to price, but were inversely correlated to the level of effort associated with marginal output. No negative impacts on incentivized indicators nor spill-over effects on non-incentivized indicators were observed. The PBF program in Mozambique has produced large, sustained increases in the provision of PMTCT, paediatric HIV and MCH services. Our results demonstrate that PBF is an effective strategy for driving down the HIV epidemic and advancing MCH care service delivery as compared with input financing alone. [ABSTRACT FROM AUTHOR]

Background: To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women. Methods: Quantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire ( n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes. Results: The overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent ( n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent ( n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs. Conclusion: The NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women continued to make OOP payments, largely as a result of a delay in reimbursement by the NHIS. There is need to re-examine the reimbursement system in order to prevent shortage of funding to health facilities and thus encourage skilled attendance for the reduction of maternal deaths as well as the achievement of universal health coverage. [ABSTRACT FROM AUTHOR]

Summary Public health emergencies like major epidemics in countries with already poor health infrastructure have the potential to set back efforts to reduce maternal deaths globally. The 2014 Ebola crisis in Liberia is claimed to have caused major disruptions to a health system not fully recovered after the country’s civil war, and is an important and relevant case for studying the resilience of health systems during crises. We use data on the utilization of maternal health care services from two representative surveys, one conducted before the outbreak of Ebola, the 2013 Liberian DHS, and another, smaller survey conducted in Monrovia in December 2014, during the height of the epidemic. We focus exclusively on data for women aged 18–49 residing in urban Monrovia, restricting our samples to 1,073 and 763 respondents from the two surveys respectively. We employ a mixed methods approach, combining a multinomial logit model with in-depth semi-structured interviews. Our regression analyses indicate that deliveries in public facilities declined whereas they increased for private facilities. Furthermore, overall facility delivery rates remained stable through the Ebola epidemic: the proportion of home births did not increase. Drawing on insights from extensive qualitative interviews with medical personnel and focus groups with community members conducted in Monrovia in August–September 2015 we attribute these survey findings to a supply side “substitution effect” whereby private clinics provided an important cushion to the shock leading to lower supply of government services. Furthermore, our interviews suggest that government health care workers continued to work in interventions facilities in their local communities when public facilities were closed. Our findings indicate that resources to shore up healthcare institutions should be directed toward interventions that support private facilities and health personnel working privately in communities during times of crisis so that these facilities are safe alternatives for women during crisis. [ABSTRACT FROM AUTHOR]

The article focuses on healthcare sector in Bangladesh. It list the healthcare network and regulatory bodies under the Ministry of Health and Family Welfare (MOHFW). Topics include community clinics, child and adolescent health care programmes, primary healthcare, child immunization and maternal health policies.

Background: In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat.Methods: This was a retrospective cohort study of multiparous eligible women (after excluding abortions and births at public facility). A structured questionnaire was administered by trained research assistant to those with recent delivery between Jan and Jul 2013. Outcome of interest was CY utilization in subsequent child birth (Jan-Jul 2013). Explanatory variables included socio-demographic characteristics (including category of eligibility), pregnancy related characteristics in previous child birth, before Jan 2013, (including CY utilization, out of pocket expenditure) and type of child birth in subsequent birth. A poisson regression model was used to assess the association of factors with CY utilization in subsequent child birth.Results: Of 997 multiparous eligible women, 289 (29%) utilized and 708 (71%) did not utilize CY in their previous child birth. Of those who utilized CY (n = 289), 182 (63%) subsequently utilized CY and 33 (11%) gave birth at home; whereas those who did not utilize CY (n = 708) had four times higher risk (40% vs. 11%) of subsequent child birth at home. In multivariable models, previous utilization of the scheme was significantly associated with subsequent utilization (adjusted Relative Risk (aRR): 2.7; 95% CI: 2.2-3.3), however previous out of pocket expenditure was not found to be associated with retention in the CY scheme.Conclusion: Women with previous CY utilization were largely retained; therefore, steps to increase uptake of CY are expected to increase retention of mothers within CY in their subsequent child birth. To understand the reasons for subsequent child birth at home despite previous CY utilization and previous zero/minimal out of pocket expenditure, future research in the form of systematic qualitative enquiry is recommended. [ABSTRACT FROM AUTHOR]

Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda setting, formulation and implementation processes in Ghana, a lower middle income country by exploring how and why less than three months into the implementation of a pilot prior to national scale up; primary care maternal services that were part of the basket of services in a primary care per capita national health insurance scheme provider payment system dropped off the agenda.Methods: We used a case study design to systematically reconstruct the decisions and actions surrounding the rise and fall of primary care maternal health services from the capitation policy. Data was collected from July 2012 and August 2014 through in-depth interviews, observations and document review. The data was analysed drawing on concepts of policy resistance, power and arenas of conflict.Results: During the agenda setting and policy formulation stages; predominantly technical policy actors within the bureaucratic arena used their expertise and authority for consensus building to get antenatal, normal delivery and postnatal services included in the primary care per capita payment system. Once policy implementation started, policy makers were faced with unanticipated resistance. Service providers, especially the private self-financing used their professional knowledge and skills, access to political and social power and street level bureaucrat power to contest and resist various aspects of the policy and its implementation arrangements - including the inclusion of primary care maternal health services. The context of intense public arena conflicts and controversy in an election year added to the high level political anxiety generated by the contestation. The President and Minister of Health responded and removed antenatal, normal delivery and postnatal care from the per capita package.Conclusion: The tensions and complicated relationships between technical considerations and politics and bureaucratic versus public arenas of conflict are important influences that can cause items to rise and fall on policy agendas. [ABSTRACT FROM AUTHOR]

India launched the Safe Motherhood Scheme (Janani Suraksha Yojana or JSY) in 2005 in response to persistently high maternal and child mortality rates. JSY provides a cash incentive to socioeconomically disadvantaged women for childbirth at health facilities. This study explores some unintended consequences of JSY. Using data from two large household surveys, we examine a policy variation that exploits the differential incentive structure under JSY across states and population subgroups. We find that JSY may have resulted in a 2.5-3.5 percentage point rise in the probability of childbirth or pregnancy over a 3-year period in states already experiencing high population growth. [ABSTRACT FROM AUTHOR]