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Background: Anemia in pregnancy is considered a significant public health problem. It has an essential role in disabled life and death of pregnant women and their future children, mainly in developing countries. Pregnant women in Yemen in internally displaced camps remain at most exposed to anemia. The aim of this study is to determine the prevalence and associated factors related to anemia among pregnant women in Marib, Yemen. Methods: A cross-sectional study was conducted among 402 pregnant women attending General hospitals from October 2023 to January 2024. The data were collected through structured pretested questionnaire, and via an interview. Laboratory investigations were done. Data Analysis: the data were statistically analyzed through SPSS program (version 21) using descriptive statistics, Chi square test for investigating the association between anemia and the independent factors. Results: The overall prevalence of anemia among study participants was 56.7%. The moderate anemia were the most prevalence among pregnant women (65.8%). Risk factors associated with anemia among pregnant women were displacement, level education, low family income, gestational age, space interval of birth, lack of iron supplementation during pregnancy, and one /zero consumption of monthly meat, liver and vegetables during pregnancy, habits such as taking tea immediately after meal and chewing of khat during pregnancy. Conclusion: prevalence of anemia in this study was public health problem. Several factors were found to be associated with anemia during pregnancy. Measures have to be taken to solve the problem by mass iron supplementation, family planning and health education towards risk factors that were associated with anemia to avoid them. [ABSTRACT FROM AUTHOR]

Background: spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one of the highest rates of SVAW in the world, and its impact on reproductive health and fertility is not well understood. This study aims to investigate the extent to which SVAW influences the total fertility rate (TFR) of Afghan women. Methods: In this study, a regression model of discrete-time survival models was used to calculate the total fertility rate (TFR), parity progression ratio (PPRs), and average closed birth intervals (CBI) between two children. The method used in this study has its roots in the works of Griffin Finney (1983) and was further developed by Redford et al. (2010). The study population utilized the 2015 Afghanistan Demographic and Health Survey, and sample weights were used to ensure accurate estimates for the population of Afghanistan as a whole. Results: The study found that women in Afghanistan who have experienced SV are more likely to progress to the next parity, start childbearing faster, and continue to do so. Women who have not experienced SV tend to progress to higher parities at a slower pace during their initial reproductive years. The study also suggests that women with spousal violence (SV) experience may have slightly higher fertility rates and shorter birth intervals for certain birth orders, although the differences between the two groups are generally small. Specifically, the total fertility rate (TFR) for women who experienced SV was 6.9, while the TFR for women who did not experience SV was 6.2. Conclusions: These results provide valuable information for policymakers and public health professionals in developing effective policies and programs to address SVAW and improve maternal and child health outcomes in Afghanistan. [ABSTRACT FROM AUTHOR]

Background: Postpartum contraception is essential to sexual and reproductive health (SRH) care because it encourages healthy spacing between births, helps women avoid unwanted pregnancies, and lessens the risks of health problems for mothers and babies. Sub-Saharan African immigrant and refugee populations are rapidly increasing in the United States, and they come from a wide range of cultural, linguistic, religious, and social origins, which may pose challenges in timely access to culturally acceptable SRH care, for preventing mistimed or unwanted childbearing. The objective of this scoping review is to assess the extent of the available literature on postpartum contraception among sub-Saharan African immigrant and refugee women living in the United States. Methods: We developed preliminary search terms with the help of an expert librarian, consisting of keywords including birth intervals, birth spacing, contraception, postpartum contraception or family planning, and USA or America, and sub-Saharan African immigrants, or emigrants. The study will include the following electronic databases: PubMed/MEDLINE, PsycINFO, CINAHL, EMBASE, and the Global Health Database. The sources will include studies on postpartum care and contraceptive access and utilization among sub-Saharan African immigrants living in the US. Citations, abstracts, and full texts will be independently screened by two reviewers. We will use narrative synthesis to analyze the data using quantitative and qualitative methods. Factors associated with postpartum contraception will be organized using the domains and constructs of the PEN-3 Model as a guiding framework. Conclusion: This scoping review will map the research on postpartum contraception among sub-Saharan African immigrant and refugee women living in the US. We expect to identify knowledge gaps, and barriers and facilitators of postpartum contraception in this population. Based on the findings of the review, recommendations will be made for advocacy and program and policy development toward optimizing interpregnancy intervals in sub-Saharan African immigrants living in the US. Trial registration: Review registration Open Science Framework: https://osf.io/s385j. [ABSTRACT FROM AUTHOR]

Existing literature documents connections between short birth spacing (birth‐to‐conception interval of under 18 months) and the risk of child maltreatment, but explanations for this relation are understudied. We hypothesise that short birth spacing predicts child maltreatment, and it mediates the association between maternal history of childhood maltreatment and their child's risk of abuse and neglect. We use data for second and higher parity children from the Prospective Study of Infant Development (n = 335) and fit logistic regression models with relevant covariates to examine the association between maternal history of childhood maltreatment, her offspring's short birth spacing and her offspring's child maltreatment (CM) as measured by Child Protective Services (CPS) assessments. Findings demonstrate that children of mothers who reported experiencing any abuse or neglect during childhood have a higher likelihood of being born shortly spaced and a higher likelihood of CM. Additionally, short birth spacing is associated with increased likelihood of CM. No evidence for mediation from maternal history of maltreatment to CM operating through short birth spacing was detected. We conclude that maternal history of childhood maltreatment and short birth spacing are independent, additive factors for CM risk. Key Practitioner Messages: Maternal history of childhood maltreatment is a strong predictor of her children's birth spacing and her children's abuse and neglect risk.Maternal history of childhood maltreatment and birth spacing between her children serve as independent predictors of her children's abuse and neglect risk.Child maltreatment risk assessment models should incorporate historical information about parental childhood trauma, as well as prenatal indicators of wellbeing such as birth spacing.Child maltreatment prevention programmes should address parental childhood trauma as well as family planning to minimise risk. [ABSTRACT FROM AUTHOR]

Background: With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. Methods: A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017–18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. Results: We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35–39, women aged 40–45 (aOR = 0.53, 95% CI: 0.49–0.57) and 45–49 (aOR = 0.24, 0.22–0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74–0.94) and richest (aOR = 0.76, 95% CI: 0.66–0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07–1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19–1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32–1.55) in women with more than 2 children compared to those with ≤2 children. Conclusion: The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic. [ABSTRACT FROM AUTHOR]

Child malnutrition remains a significant concern in the Asia‐Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia‐Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia‐Pacific region between September 2000 and May 2023. Fixed‐effects or random‐effects meta‐analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta‐analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97–1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88–6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national‐level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia‐Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality. Key messages: Short interval pregnancies pose a persistent public health threat in the South Asian region.While a potential link with child malnutrition exists, reported associations often conflict.Our findings suggest that short interval births slightly increase the risk of child malnutrition.Addressing short interval pregnancies is crucial to mitigate the ongoing nutritional burden in South Asian countries. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. Methods: This prospective cohort study included women who had a first delivery and were in weeks 36–41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. Results: There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001). Conclusions: In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva. [ABSTRACT FROM AUTHOR]

While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Anemia in pregnancy is a pervasive health issue, particularly in developing countries. Aims and Objectives: This study aims to assess various socio-demographic factors, nutritional intake, and other risk factors contributing to anemia among pregnant women attending a tertiary care hospital in Prakasam District, Andhra Pradesh, India. Materials and Methods: A crosssectional study was conducted involving 160 pregnant women. Data were collected on sociodemographic factors (family type, religion, caste, residence, education, socio-economic status, age, occupation), anemia prevalence, antenatal care, birth spacing, nutritional intake (caloric, protein, and iron), and gravida status. Chi-square tests were used for statistical analysis to determine associations between anemia and various risk factors. Results: The study revealed a high prevalence of moderate anemia (74.4%) among the participants. Most women were from nuclear families (75%), lived in rural areas (89.4%), and were predominantly homemakers (83.1%) in the age group of 21–30 years. Nutritional analysis showed 74.6% of women had a calorie intake below 2000 K. Cal/day, 64.7% had a protein intake below 50 g/day, and 87.5% had an iron intake below 20 mg/day. A significant association was found between anemia and factors such as caloric intake (χ²=10.6654, P=0.001092), gravidity (χ²=7.0278, P=0.008025), and iron intake (χ²=27.277, P<0.00001), but not with protein intake (χ²=3.7547, P=0.052658). Conclusion: The study highlights a high prevalence of anemia among pregnant women in the Prakasam District, primarily associated with inadequate caloric and iron intake and increased gravidity. These findings emphasize the need for enhanced nutritional counseling and healthcare interventions focusing on diet and family planning for pregnant women in this region. [ABSTRACT FROM AUTHOR]

BACKGROUND: The fertility behavior of women is characterized by maternal age, birth spacing and order, and it impacts the health of women and children. Evidence on the factors associated with maternal high-risk fertility behavior is scant in Ethiopia. Thus, the aim of this study was to identify the factors associated with maternal high-risk fertility behavior in Hadiya Zone, Southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted. Three hundred women of reproductive age admissions to public hospitals in the Hadiya Zone who gave birth in the five years preceding this study were selected using systematic random sampling. Face-to-face interviews were held to gather data using interviewer-administered questionnaires. Descriptive statistics and binary logistic regression models were used to analyze data. Statistical significance was assessed using odds ratios and 95% confidence intervals and declared at a p-value of less than 0.05. RESULTS: The overall proportion of maternal high-risk fertility behavior was 60.3%. Mother, who lived in rural areas (AOR = 4.85; 95%CI: 2.56, 9.19), had early marriage (AOR = 3.39; 95%CI: 1.87, 6.14) and had unplanned last pregnancy (AOR = 2.62; 95%CI: 1.28, 5.39) were more likely engaged in high-risk fertility patterns. CONCLUSIONS: In the study area, there was a high overall proportion of married women engaging in high-risk fertility behavior. Mothers with early marriages, unplanned pregnancies, and rural residence were more likely engaged in high-risk fertility behaviors. Plans for interventions aimed at preventing maternal high-risk fertility behavior should center on expanding access to family planning services and ending the practice of early marriage by giving rural women extra care and attention. [ABSTRACT FROM AUTHOR]

Background: Child mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide. Methods: This study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality. Results: The study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders. Conclusion: Not only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy. [ABSTRACT FROM AUTHOR]

Background: Infant anemia has a significant impact on physical and cognitive development, not only in infancy but also throughout their life. Objective: The study aimed to estimate the prevalence, types, and risk factors of anemia in infancy. Patients and Methods: A cross-sectional study was conducted on 498 infants aged 6-23 months who attended five primary healthcare centers in Kafr-el Sheikh governorate, Egypt, for vaccination and follow-up. Results: The prevalence of anemia among the study infants was 44%, with the highest in those aged 6-12 months. Maternal anemia in pregnancy, low birth weight infant, and lack of adherence to iron supplementation were the significant risk factors for anemia. Conclusion: Infant anemia in Egypt resembles a complicated multifactorial severe health issue with a long-run burden. Health policy interventions such as early screening at 6 months old, more adherence to iron supplements for infants, maternal nutrition education, family planning, and birth spacing between siblings should be accessed to overcome and manage this health problem. [ABSTRACT FROM AUTHOR]

Early childhood care and education providers provide instruction to diverse learners, including children with developmental delays, but often lack training in the use of evidence-based instructional strategies to support children's meaningful learning engagement. This preliminary study examined effects of the Early Achievements for Child Care Providers professional development program with and without generalization training on center-based child care providers (N = 12). Outcomes assessed included providers' implementation fidelity, knowledge, and self-efficacy as well as children's (N = 43) social-communication skills and engagement in shared book reading. Results demonstrated that providers trained in a generalization context made larger gains in implementation fidelity in a generalization context; no other significant between-group differences were found for providers. Children in both groups made comparable, significant gains. Findings suggest that explicit generalization training is needed for providers to achieve fidelity when transferring newly learned evidence-based practices to additional classroom instructional contexts, but a brief interval of implementation likely is insufficient to differentially benefit child outcomes. Researchers should elicit providers' perceptions when designing professional development programs to maximize feasibility of investing additional time and resources for generalization training. [ABSTRACT FROM AUTHOR]

Anemia is more prevalent in low- and middle-income countries including India. Anemia in pregnancy is associated with increased risk of maternal health problems and adverse birth outcomes. This study estimates the prevalence and associated risk factors of anemia among pregnant women in India. This cross-sectional study is based on secondary data from the India National Family Health Survey-V (NFHS-5) conducted during 2019–2021. We extracted data of 27,317 currently pregnant women to estimate the prevalence and contributory factors associated with anemia using descriptive statistics and logistic regression analysis. The prevalence of anemia among pregnant women in India was 52.2%. Anemia was higher among adolescent women (61.5%), those with no education (59.2%), those belonging to poorest wealth index (61.9%), scheduled tribes (59.3%), and those from the eastern region of India (62.1%). Further, it was more prevalent among women with a habit of smoking, tobacco, or alcohol (63.0%), and women with shorter birth intervals (59.7%). Among Indian states, anemia prevalence was higher in the state of Bihar (63.1%) and the union territory of Ladakh (71.4%). Logistic regression models show that women with no education (aOR = 1.41, 95% CI = 1.27–1.57), belonging to a poorest wealth quintile (aOR = 1.69, 95% CI = 1.51–1.90), and those with a habit of smoking, tobacco, or alcohol (aOR = 1.39, 95% CI = 1.18–1.63) were more anemic than their counterparts. Additionally, women with no education showed a four-times higher risk of severe anemia (aOR = 4.79, 95% CI = 2.75–8.36) than their highly educated counterparts. Anemia affects half of all pregnant women in India. Anemia prevalence is higher among adolescents, illiterate, poor, and tribal communities. Social norm-based interventions and strengthening the community health facilitators should be implemented to reduce the high burden of anemia in India. Anemia in pregnancy increases the risk of maternal and new-born health problems that lead to unfavorable pregnancy outcomes. This study aimed to find the current proportion and factors influencing anemia among currently pregnant Indian women. This study analyzed the data of 27,317 currently pregnant women reported with hemoglobin levels to find the prevalence and contributing factors of anemia. The study revealed that about 52.2% of pregnant women suffer from anemia inclusive of 1.4% with severe anemia. The anemia proportion was higher in women living in the eastern region of India, the poorest households, teenage pregnant women, and women with no formal education. Severity was higher in women belonging to the poorest households, tribal groups, and those with a habit of smoking, tobacco, or alcohol. Further, women with no formal education were four-times more likely to have a risk of severe anemia during their pregnancy. Maternal anemia hampers the growth and development of the newborns. Thereby, anemia adds a huge burden to the nation's economy and health system. High rates of anemia among pregnant women could be a probable factor linked to the higher rate of maternal and child health illness and death in the eastern region, poorest strata, and other vulnerable populations in India. Special attention needs to be focused to ensure that these populations have easy access to healthy nutrition and the best public health systems. [ABSTRACT FROM AUTHOR]

Our aim was to investigate if structural and relational characteristics of sibling relationships moderated the association between known injury risk factors and child injuries. Prior to the pandemic, 80 Canadian parents of two school‐aged biological siblings completed standardized questionnaires concerning child risk‐taking behaviours and injury frequency; they also reported on sibling caregiving. Children reported on sibling warmth. Wider age spacing amplified injury risk for younger siblings who engaged in more risk‐taking, while warmer sibling relationships lessened injury risk for younger siblings cared for by older siblings. The importance of incorporating sibling characteristics into family‐centred injury prevention programs was discussed. [ABSTRACT FROM AUTHOR]

Sexual autonomy is an inalienable human right to protect and maintain an informed decision over one's body, sexuality, and sexual experience. With the increased attention to women's empowerment and gender equality all over the world, it is surprising that previous research has overlooked the relationship between women's sexual autonomy and short birth intervals. This study examined the association between women's sexual autonomy and short birth intervals in sub-Saharan Africa (SSA). Data were sourced from the Demographic and Health Surveys of 29 sub-Saharan African countries conducted from 2010 to 2019. A total of 222,940 women were included in this study. Multilevel logistic regression analysis was conducted to examine the association between sexual autonomy and short birth interval. The results were presented as adjusted odds ratios (aOR) and significance level was set at p <.05. The overall proportions of sexual autonomy and short birth interval among women in SSA were 75.1% and 13.3%, respectively. Women who reported having sexual autonomy had lower odds of short birth interval [aOR = 0.94; CI = 0.91, 0.96]. The likelihood of short birth interval among women increased with increasing maternal and partner's age but reduced with increasing level of education and wealth index. Given that short birth intervals could have negative maternal and child health outcomes, public health authorities in sub-Saharan African countries should endeavor to promote health interventions and social programs to empower women with low sexual autonomy. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa. Methods: Data for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15–49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI). Results: More than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46–0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87–0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55–0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07–1.28). Conclusion: HRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women's likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa. [ABSTRACT FROM AUTHOR]

Background: Adverse birth outcomes, such as preterm birth and low birth weight (LBW), are leading causes of neonatal morbidity and mortality. In this study, we aimed to estimate the association between inter‐pregnancy interval (IPI) and the risks of adverse birth outcomes in a subsequent pregnancy. Methods: We conducted a retrospective analysis involving 630 mothers who delivered a singleton live infant at a leading tertiary hospital in northern Jordan from March to August 2021. Outcome variables were preterm birth (<37 weeks of gestation) and LBW (<2.5 kg). Using multivariable logistic regression, the association between IPI and these two adverse birth outcomes was investigated. Results: The rates of preterm birth and LBW were 12.4% and 16.8%, respectively. Compared with an optimal IPI (24–36 months), a short IPI (<24 months) was positively associated with preterm birth (aOR: 4.09; 95% CI: 1.48–6.55) and LBW (aOR: 3.58; 95% CI: 1.57–5.15). Infants conceived after a long IPI (≥ 60 months) had increased odds of preterm birth (aOR: 3.78; 95% CI: 1.12–5.78) and LBW (aOR: 2.65; 95% CI: 1.67–4.03). Preterm delivery was also significantly associated with the mother's age (aOR: 1.10; 95% CI: 1.04–1.17), history of multiple cesarean births (aOR: 2.67; 95% CI: 1.14–4.29), prolonged rupture of membranes (aOR: 2.46; 95% CI: 1.10–5.52), and perinatal death (aOR: 3.42; 95% CI: 1.10–5.49). A mother's history of prior LBW (aOR: 4.39; 95% CI: 1.08–6.80), hypertensive disorders (aOR: 1.95; 95% CI: 1.03–3.89), and multiple cesarean births (aOR: 4.35; 95% CI: 2.10–6.99) was associated with LBW. Conclusions: Both short and long IPIs were related to preterm delivery and LBW. Optimal birth spacing is recommended to improve birth outcomes and must be considered when designing effective family planning programs. [ABSTRACT FROM AUTHOR]

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning. What is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning. What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning. What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement. [ABSTRACT FROM AUTHOR]

Introduction: The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing. Material and methods: We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random‐effects model, and the dose–response relationships were evaluated using generalized least squares trend estimation. Results: A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18–23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08–1.56; p < 0.05). The dose–response analyses further confirmed these J‐shaped relationships (pnon‐linear < 0.001–0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon‐linear < 0.005 and pnon‐linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon‐linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04–2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose–response analyses (pnon‐linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76–1.21; p > 0.05). Conclusions: Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18–23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months. [ABSTRACT FROM AUTHOR]

Background: Spacing of birth is an important parameter affecting maternal and foetal health. Optimal birth spacing provides multiple benefits for both mother and her child. Both short and long inter-delivery interval (IDI) is associated with multiple adverse perinatal outcomes. Therefore, inter-delivery interval is viewed as a potential modifiable risk factor for adverse foetal-maternal outcome. The objective of the study was to study the association of inter-delivery interval and pregnancy outcome in a tertiary care hospital, West Bengal, India. Methods: This Prospective hospital based study was done in Dept of Gynae and Obstetrics, Burdwan Medical College and Hospital, West Bengal, India for a period of 18 months from February 2021 to July 2022. All multigravida women with atleast three antenatal check-ups were included in the study. The data were statistically analysed using Microsoft Excel and SPSS software. Results: Most common age group of the mother was found 20-25 years 64 (64%), followed by 26-30 years 24 (24%). Maximum mothers were parity 3 i.e. 48 (48%), followed by parity 2, 40 (40%). Ectopic was present in 12 (12%) of mothers. Preterm <32 weeks was present in 12 (12%), preterm <36 weeks was present in 20 (20%), induction of labour (IOL) was present in 16 (16%) and cesarean delivery (CS) was observed in 24 (24%) of mothers. Normal birth weight babies delivered were 76 (76%%) and low birth babies delivered were 24 (24%). Maximum interval from last miscarriage was 6-12 months i.e. 32 (320%), followed by 19-24months 24 (24%) and 13-18 months 20 (20%). Miscarriage was observed in 20 (20%) mothers and still birth was 4 (4%). Anaemia was present in 34 (34%) mothers. Conclusions: Lack of contraceptive use significantly increases the risk of short IDI which increases the risk of preterm delivery, maternal anaemia PPH and scar rupture in post-CS pregnancy. [ABSTRACT FROM AUTHOR]

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points CenteringPregnancy is associated with a significant decrease in interpregnancy intervals ≤6 and ≤12 months. LARC uptake is significantly higher among patients participating in CenteringPregnancy. CenteringPregnancy participation enhances self-efficacy in making contraception decisions and promotes healthy pregnancy spacing. [ABSTRACT FROM AUTHOR]

In variable environments, habitats that are rich in resources often carry a higher risk of predation. As a result, natural selection should favour individuals that balance allocation of time to foraging versus avoiding predation through an optimal decision-making process that maximizes fitness. The behavioural trade-off between resource acquisition and risk avoidance is expected to be particularly acute during gestation and lactation, when the energetic demands of reproduction peak. Here, we investigated how reproductive female roe deer adjust their foraging activity and habitat use during the birth period to manage this trade-off compared with non-reproductive juveniles, and how parturition date constrains individual tactics of risk-resource management. Activity of reproductive females more than doubled immediately following parturition, when energy demand is highest. Furthermore, compared with non-reproductive juveniles, they increased their exposure to risk by using open habitat more during daytime and ranging closer to roads. However, these post-partum modifications in behaviour were particularly pronounced in late-parturient females who adopted a more risk-prone tactic, presumably to compensate for the growth handicap of their late-born offspring. In income breeders, individuals that give birth late may be constrained to trade risk avoidance for foraging during peak allocation to reproduction, with probable consequences for individual fitness. [ABSTRACT FROM AUTHOR]

Background and Objective: A basic factor in the reduction of fertility levels is delayed fertility. This research was carried out in Khorramabad, Lorestan Province, Iran. Methods: This descriptive-analytical study was conducted on 535 married women aged 15-49 years in Khorramabad. The data were collected face-to-face through a cross-sectional survey in 2020 using a researcher-made questionnaire between September and December 2019. This study used the Kaplan-Meier test to determine the childlessness survival time. A logistic parametric model with the gamma shared frailty distributions was employed to analyze its determinants. Results: The mean of childlessness survival time was 31.76 months, with a median of 24 months. Women in the age group of 15 to 30 years, women with university education, women who married at the age of less than 25 years, and women with a higher sense of socioeconomic insecurity had a longer childlessness survival time (P<0.05). Conclusion: Childlessness was evaluated as low in Khorramabad. Only 2% of the women remained childless after 10 years of marriage. [ABSTRACT FROM AUTHOR]

In many South Asian contexts, specific dates are auspicious and inauspicious for health-related behaviours and outcomes. This study analysed the effect of lunar date-related auspicious beliefs in Nepal on childbirths and neonatal health outcomes. Using the daily birth records from a tertiary maternity hospital, we empirically examined whether births occurred disproportionally around full moon days. We found an average of 10.7 extra births on and before full moon days, with an average of 7.5 extra Caesarean deliveries on full moon days. We demonstrated that births occurring on or before the full moon day have poor neonatal health outcomes. However, a subsample analysis suggested better health outcomes for low-risk mothers and worse health outcomes for high-risk mothers. These findings suggest that low-risk mothers may move their deliveries to auspicious dates with fewer complications than high-risk mothers. The results emphasise the need for additional research to distinguish health service demand from supply influences on birth timing in Nepal. [ABSTRACT FROM AUTHOR]

Studies show that body mass index during early adulthood ('early BMI') predicts the transition to first birth, but early childbearers tend to be omitted from such studies. This sample selection distorts the prevalence of childlessness, and particularly the racial/ethnic heterogeneity therein, because first birth timing differs by race/ethnicity. We imputed pre-parenthood early BMI for a larger sample, including early childbearers, for the same United States NLSY79 data used in a previous study and simulated differences in the probability of childlessness at age 40+ using posterior distributions based on the Bayesian framework. Obesity was consistently associated with higher childlessness across racial/ethnic groups in both sexes, but only among obese women were first births delayed until after early adulthood. The overall lower childlessness among the underweight women appeared largely driven by Black women. Our findings on the intersectionality of race/ethnicity and sex in the BMI–childlessness pathways encourage research on the underlying mechanisms and on more recent cohorts across different societies. [ABSTRACT FROM AUTHOR]

Background: Research has shown that short Interpregnancy Intervals (IPIs) are associated with adverse maternal and perinatal outcomes. The aims and objectives of this study was to determine the prevalence of short IPI's and further determine the demographic, sociocultural and health care related factors associated with short IPI's among women of reproductive age in Lusaka, Zambia. Methodology: A cross sectional study involving 218 women aged between 15 and 49 years attending antenatal clinics at selected Hospitals. Eligible participants were recruited using systematic random sampling method and a structured interviewer administered questionnaire was used to collect the data which was later processed using Epi-Data and exported to STATA for analysis. Results: The prevalence of short IPI's was 33.4%. Among the factors associated with short IPI's, it was noted that women aged 35 years or older were 61% (aOR=0.39; 95% CI: 0.21-0.98) less likely to have short IPI's compared to those aged less than 25 years. Furthermore, women from Matero Hospital had 4.89 (95% CI; 2.59-11.6) times higher odds of short IPI's than women from Chawama Hospital. In addition, women who reported having discussed the pregnancy with their partners were 59% (aOR=0.41; 95% CI; 0.31-0.96) less likely to have short IPI's compared to those who did not discuss. For those women who indicated that they did not receive information about recommended IPI's from health care workers, their odds of short IPI's were 4.47% (95% CI; 1.57-12.6) times higher than those who received the information. Conclusion: Raising awareness among women on the recommended birth intervals and encouraging partner participation on when to have the next child may help in efforts to avert the problem of short IPI's and its effect on maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background Utilization of adequate and quality prenatal healthcare services confers critical benefits to women and their unborn children. However, utilization rates remain low in many countries in Africa. Several studies have attempted to understand the primary drivers behind these low statistics. This article contributes to this discourse by examining the associations between birth interval and timing and number/frequency of antenatal care visits in Africa. Methods We pooled data from the publicly available Demographic and Health Surveys conducted in the last decade (2010–2020) for 32 African countries. Data were analysed using descriptive proportions and mixed effect binary logistic regression. Results The results illustrate moderate significant associations between spacing on the most recent birth by ≥36 months and early (first trimester) first antenatal care contact in both our bivariate (odds ratio [OR] 1.18, p<0.001) and multivariate (OR 1.106, p<0.001) analyses. The benefits on optimal antenatal contacts predicted on spacing are also noticed with birth intervals of 24–35 months (OR 1.08, p<0.001) and ≥36 months (OR 1.48, p<0.001). Conclusions Optimal birth spacing is beneficial for ANC utilization in terms of timing and total number of contacts. Post-partum family planning/contraceptive use can be an effective pathway to prolonging birth intervals. We argue that maternal and child health programmes strengthen prioritizing contraceptive use between births. [ABSTRACT FROM AUTHOR]

Background: The neonatal period is the crucial and vulnerable period of the human life cycle. Various research has been conducted worldwide that provide the baseline data on clinical profiles and predictors of outcomes of babies admitted to sick newborn care units (SNCUs). Nonetheless, studies on tribal areas and community outreach areas are rare. In the present study, predictors and profiles of patients admitted to SNCU, in the Dantewada and Bijapur districts of Chhattisgarh, India, were evaluated which shall help prioritize patient care and preventive approaches. Methods: This retrospective study was undertaken from January 2019 to December 2020 in the SNCUs of Dantewada and Bijapur. Neonatal and maternal characteristics, course during labor, treatment given to the neonates, and outcome data were obtained and analysed. Results: In total, 1,531 neonates were enrolled in the study. Mothers had a mean age of 25.6 years (standard deviation [SD] ±4.9) with birth spacing less than 2 years (60.3%) and antenatal care (ANC) visits less than 4 (50.4%). Neonates were low birth weight (43.75%) and were home-delivered (15.8%). One hundred forty-nine neonates died. In the multivariate regression model, extremely low birth weight babies, less than 1 kg (odds ratio [OR]: 11.59 confidence interval [CI] 4.625-31.58), gestational age less than 34 weeks (OR: 2.13 CI 1.291-3.532), central cyanosis (OR: 10.40 CI: 3.269-32.35), duration of IV fluid > 3 days (OR: 2.16 CI 0.793-0.880), duration of antibiotic >3 days (OR 0.63 CI 0.408-0.979) were found to be independent predictors of mortality among neonates. Conclusion: The prevalence of newborns aged less than 12 h is higher among the study population. Birth asphyxia, prematurity, neonatal jaundice, and sepsis were fundamental and leading causes of morbidity. Preterm birth and low birth weight babies had significantly high mortality. The government needs to focus on marginalized communities with target-based interventions and policies. [ABSTRACT FROM AUTHOR]

Background/Aims: A short interpregnancy interval is associated with several maternal and neonatal complications. In Oman, the incidence of short interpregnancy interval is well documented in the annual health report, but evidence is lacking on its impact on adverse pregnancy outcomes. This study examined short interpregnancy interval, its risk factors and its association with the prevalence of adverse pregnancy outcomes among Omani pregnant women. Methods: A retrospective matched case–control design was adopted. Data were collected from medical records between January and December 2020. A total of 597 pregnant women from two tertiary care hospitals in Oman were included. Results: There was a significant relationship between interpregnancy interval and the prevalence of adverse maternal and perinatal outcomes, including postpartum haemorrhage, iron deficiency anemia, preterm birth and low birth weight. Significant risk factors for a short interpregnancy interval were advanced maternal age, young age at first birth, low parity and previous perinatal loss. Conclusions: Encouraging acceptance of birth spacing through the use of contraception would signify a notable change in cultural values that can act as a barrier to birth spacing. This would therefore improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: the ravaging COVID-19 pandemic has worsened the levels of unmet need (UMN) for family planning (FP). A pulse survey showed that FP services were interrupted during the lockdown in 68% of countries. There is a need to investigate the demand gap for FP among women in the postpartum period. This study aimed to determine the prevalence and predictors of UMN of FP among women in the extended postpartum period attending immunization clinics. Methods: this was a facility-based cross-sectional study among 485 women recruited from 5 health facilities using a random sampling technique and proportional to size allocation. Data was collected using an interviewer-structured questionnaire. Analysis was done using IBM SPSS version 26. Adjusted odds ratios with 95% confidence intervals were computed. The level of significance was 5%. Results: the total unmet need was 45.4% (95% CI: 40.2--50.7) with a higher need for child spacing (60.4%) compared to limiting pregnancies (39.6%). The mean age was 30.3 ± 6.1 years. The significant predictors included age [35-39 years (aOR=5.39, 95% CI: 1.61-18.06); ≥ 40 years (aOR= 32.48, 95% CI: 6.48-162.77)], lower education status (aOR= 5.21, 95% CI: 2.09-13.01), lower income (aOR =2.21, 95% CI: 1.10-4.46), rural residence (aOR= 4.27, 95% CI: 2.15-8.47), denomination [Pentecostal (aOR= 4.09, 95% CI: 1.77-9.43); Orthodox (aOR= 5.44, 95% CI: 2.03-14.58)] and poor knowledge of postpartum FP (PPFP) (aOR= 33.93, 95% CI: 13.21-87.12). The commonest reason for FP non-use was fear of side effects. Conclusion: close to half of the women in the extended postpartum period experienced UMN for PPFP. Policymakers should consider these factors when designing FP interventions. [ABSTRACT FROM AUTHOR]

Background: Short Birth Interval negatively affects the health of both mothers and children in developing countries. Studies conducted in Ethiopia on the spatial variation and determinants of individual and community-level factors about short birth intervals were limited. Thus, this study was intended to assess the spatial variation of the short birth interval and its determinants in Ethiopia. Methods: This study is a secondary analysis of the Ethiopian Demographic and Health Survey (mini EDHS 2019). A total of 1784 reproductive-age women were included in the analysis. The global spatial autocorrelation (Global Moran's I) and the Getis-Ord statistics tool were used to detect the presence of clustering and the high/low hotspot areas of SBI respectively. Ordinary kriging was used to interpolate short birth intervals, and spatial scan statistics were employed to identify spatial clusters with high and low SBI. A multilevel multivariable model was used to identify predictors of a short birth interval. Results: The prevalence of SBI was 62.89% (95%CI: 59.3, 69.7) in Ethiopia. High clustering of SBI was observed in all parts of Somali, in Afar (zones 1, 3, 4, &5), Oromia (Guje, Bale, & West Harerge), and northern Tigray. The most likely significant primary cluster was observed in the Somali region. Women who lived in the primary cluster were 24% more likely to have a short birth interval than those who lived outside the window. In the multilevel mixed-effect analysis age 25–34 [(AOR = 0.40, 95% CI: 0.35, 0.45)], 35–49 [(AOR = 0.44, 95% CI: 0.38, 0.51)], Muslim religion follower [(AOR = 3.5, 95% CI: 2.7, 4.69)], no formal education [(AOR = 0.5, 95% CI: 0.37, 0.70)], primary education[(AOR = 0.4, 95%CI: 0.28, 0.53)], and secondary education [(AOR = 0.3, 95% CI: 0.24, 0.48)], middle [(AOR: 1.3, 95% CI: 1.2, 1.52)], rich wealth status [(AOR: 1.4, 95% CI: 1.3, 1.68)], female sex children [(AOR: 1.2, 95% CI: 1.09, 1.42)], and two or fewer ideal number of children [(AOR = 0.2, 95% CI: 0.25, 0.32)] were found to be significant predictors of SBI. Conclusion: Overall, SBI was high and significantly clustered across the region of Ethiopia. Age, religion, education, wealth status, the sex of the indexed child, and the ideal number of children were found to be significantly associated with short birth intervals. Hence, the government should design a health promotion strategy and public health awareness in the identified hotspot areas of SBI and should scale up family planning and the wealth status of reproductive-age women. [ABSTRACT FROM AUTHOR]

Interpregnancy interval and adverse pregnancy outcomes among pregnancies following miscarriages or induced abortions in Norway (2008-2016): a cohort study. Interpregnancy interval (IPI), or the time between the end of one pregnancy and the conception of the next pregnancy, has been associated with an increased risk of adverse pregnancy outcomes. The "ins" and "outs" of interpregnancy interval effects: Who contributes, and does it matter?. [Extracted from the article]

Preterm birth is a global public health crisis which results in significant neonatal and maternal mortality. Yet little is known regarding the molecular mechanisms of idiopathic spontaneous preterm birth, and we have few diagnostic markers for adequate assessment of placental development and function. Previous studies of placental pathology and our transcriptomics studies suggest a role for placental maturity in idiopathic spontaneous preterm birth. It is known that placental DNA methylation changes over gestation. We hypothesized that if placental hypermaturity is present in our samples, we would observe a unique idiopathic spontaneous preterm birth DNA methylation profile potentially driving the gene expression differences we previously identified in our placental samples. Our results indicate the idiopathic spontaneous preterm birth DNA methylation pattern mimics the term birth methylation pattern suggesting hypermaturity. Only seven significant differentially methylated regions fitting the idiopathic spontaneous preterm birth specific (relative to the controls) profile were identified, indicating unusually high similarity in DNA methylation between idiopathic spontaneous preterm birth and term birth samples. We identified an additional 1,718 significantly methylated regions in our gestational age matched controls where the idiopathic spontaneous preterm birth DNA methylation pattern mimics the term birth methylation pattern, again indicating a striking level of similarity between the idiopathic spontaneous preterm birth and term birth samples. Pathway analysis of these regions revealed differences in genes within the WNT and Cadherin signaling pathways, both of which are essential in placental development and maturation. Taken together, these data demonstrate that the idiopathic spontaneous preterm birth samples display a hypermature methylation signature than expected given their respective gestational age which likely impacts birth timing. [ABSTRACT FROM AUTHOR]

Background: Event histories such as marriage and birth have been used to study fertility behavior of women. Understanding the timing of these events provide insight to reproductive patterns of the population. Thus, the aim of this study was to assess the timing of marriage and durations of birth intervals and their associated factors, and and to examine their effects on the current fertility among women in Dabat health and demographic surveillance system site, Northwest Ethiopia. Methods: A community based cross-sectional survey was carried out in the beginning of 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. The parametric survival analysis was employed to estimate the relationships among socioeconomic and demographic variables with outcome variables, the timing of age at first marriage and duration of birth intervals. Results: This study confirmed that median age at first marriage was the lowest estimated at 15 years which was below the national and regional average. The result of the study also revealed that married women waited almost a median duration of three years for their first, second, third and fourth child which was increased to nearly four years for three years preceding the survey. The parametric survival analysis showed woman's education, occupation, and current age were the predictors of age at first marriage. divorce experience, women empowerment and marriage cohort were the determinant factors of first birth interval; women education, child death, and ideal number of children were the predictors of second and third birth intervals; and media exposure and child death experience of women were predictors of fourth birth interval. Conclusion: The study indicated that median age at first marriage was the lowest though the successive birth intervals were longer. The survival analysis identified women's education, occupation, child death and ideal number of children affected the timing of age at first marriage and duration of birth intervals. Hence, encouraging women for higher education and giving opportunity to women in employments may contribute for delaying age at first marriage and increasing the duration of birth intervals which in turn slowing down the fertility of women. [ABSTRACT FROM AUTHOR]

Issue addressed: To raise expectant fathers' awareness of risk factors for stillbirth. Methods: A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three‐point Likert scale and provided comments. Results: Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important‐good information," "not appropriate/anxiety provoking" and "not relevant‐obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." Conclusions: Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers‐to‐be. So what?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father‐focused text messaging service. [ABSTRACT FROM AUTHOR]

Background: Turkey hosts the highest number of refugees in the World including 65% of Syrian refugees who reside in Turkey. Mothers and children were the most negatively affected among the Syrian refugees who had to migrate from their countries as a result of the civil war in Syria. One of the most important issues in terms of child health is breastfeeding. Breastfeeding in migrants should be promoted worldwide to mitigate infant mortality and diseases. The aim of this study is to examine the association between breastfeeding status in Syrian refugee children under two years and socio-demographic characteristics of Syrian refugee mothers with further analysis of Turkey Demographic and Health Survey-Syrian Migrant-2018 (TDHS-SM-2018) data. Methods: The data source is the TDHS-SM-2018. Data for the last-born children with a gestational duration greater than 32 weeks from the mothers' singleton pregnancy, aged less than two years old and living with the mother were included (unweighted n = 744). The dependent variable was the breastfeeding status (breastfeeding in the last 24 h during the study period) in children under two years. Complex sample logistic regression evaluated the associations. Results: The percentage of breastfeeding in children under the age of two years was found to be 62.4%, and the total median breastfeeding duration was 14.6 months. Univariate analysis showed that the earlier mothers immigrated to Turkey, the higher the current breastfeeding rate. Breastfeeding rates were found to be higher among people living in the South and East regions (65.2% and 65.1% respectively). Multivariable binary complex sample logistic regression revealed that breastfeeding status at the study period was associated with long preceding birth interval; delivery in a public hospital; absence of prelacteal feeding; being non-pregnant; and the region and age of the child. No relationship for current breastfeeding was found with maternal activities, maternal life satisfaction, financial satisfaction, and educational status. Conclusion: Current breastfeeding in our sample was more likely among mothers with a longer birth interval who avoided prelacteal feeding. The Baby-Friendly approach and family planning services should be integrated into refugee health centers. [ABSTRACT FROM AUTHOR]

Objective: To examine cross-national differences in gestational age over time in the U.S. and across three wealthy countries in 2020 as well as examine patterns of birth timing by hour of the day in home and spontaneous vaginal hospital births in the three countries. Methods: We did a comparative cohort analysis with data on gestational age and the timing of birth from the United States, England and the Netherlands, comparing hospital and home births. For overall gestational age comparisons, we drew on national birth cohorts from the U.S. (1990, 2014 & 2020), the Netherlands (2014 & 2020) and England (2020). Birth timing data was drawn from national data from the U.S. (2014 & 2020), the Netherlands (2014) and from a large representative sample from England (2008–10). We compared timing of births by hour of the day in hospital and home births in all three countries. Results: The U.S. overall mean gestational age distribution, based on last menstrual period, decreased by more than half a week between 1990 (39.1 weeks) and 2020 (38.5 weeks). The 2020 U.S. gestational age distribution (76% births prior to 40 weeks) was distinct from England (60%) and the Netherlands (56%). The gestational age distribution and timing of home births was comparable in the three countries. Home births peaked in early morning between 2:00 am and 5:00 am. In England and the Netherlands, hospital spontaneous vaginal births showed a generally similar timing pattern to home births. In the U.S., the pattern was reversed with a prolonged peak of spontaneous vaginal hospital births between 8:00 am to 5:00 pm. Conclusions: The findings suggest organizational priorities can potentially disturb natural patterns of gestation and birth timing with a potential to improve U.S. perinatal outcomes with organizational models that more closely resemble those of England and the Netherlands. [ABSTRACT FROM AUTHOR]

Objective The study aimed to determine if single year birth certificate data can be used to identify regional and hospital variation in rates of short interpregnancy interval (IPI < 6 months). Study Design IPI was estimated for multiparous women ages 15 to 44 years with singleton live births between 2015 and 2016. Perinatal outcomes, place of birth, maternal race, and data for IPI calculations were obtained by using birth certificates. IPI frequencies are presented as observed rates. Results The cohort included 562,039 multiparous women. Short IPI rates were similar to those obtained with analyses by using linked longitudinal data and confirmed the association with preterm birth. Short IPI rates varied by race and Hispanic nativity. There was substantial hospital (0.8–9%) and regional (2.9–6.2%) variation in short IPI rates. Conclusion IPI rates can be reliably obtained from current year birth certificate data. This can be a useful tool for quality improvement projects targeting interventions and rapidly assessing their progress to promote optimal birth spacing. Key Points Near-real time regional and hospital IPI rates can be reliably obtained from current year birth certificate data. Substantial variations in rates of short IPI exist between hospital and perinatal regions. IPI rates from individual birth certificates can be a tool to target and assess interventions. [ABSTRACT FROM AUTHOR]

Malnutrition and morbidity are substantial problems in Ethiopia and are still pervasive and persistent. Despite this, there has been scant research on the coexistence of malnutrition and morbidity indicators. Moreover, previous studies were based on all data records of measurements from manifest data. Thus, this study aims to identify the correlates and coexistence of child malnutrition and morbidity within this country. Cross-sectional data which is collected by Ethiopia Demographic and Health Survey were used. The generalized structural equation models were used to examine the association between child malnutrition, morbidity, and potential risk factors. The generalized structural equation models help to provide latent effects of child malnutrition and morbidity within a combined modeling framework. In addition, the generalized structural equation models make it possible to analyze malnutrition as a mediator of the association between selected risk factors and latent variable morbidity. The data analysis was done using SPSS AMOS and R software. The analysis indicated that children born to nourished mothers (AOR = 0.71, 95% CI 0.68–0.75), born to enough birth space between 24 and 47 months and (AOR = 0.93, 95% CI 0.88–0.99), 48 months and above (AOR = 0.71, 95% CI 0.65–0.76), being from middle-income households (AOR = 0.85, 95% CI 0.78–0.91), high-income households (AOR = 0.66, 95% CI 0.61–0.72), from mother with primary or secondary (AOR = 0.79, 95% CI 0.75–0.85) and higher education level (AOR = 0.57, 95% CI 0.41–0.78) were less affected by malnutrition. It also revealed that a child born second to third (AOR = 0.87, 95% CI 0.77–0.99), fourth and higher (AOR = 0.88, 95% CI 0.79–0.99) and children from a husband-educated higher level (AOR = 0.76, 95% CI 0.64–0.89) were less likely to be ill. Children who breastfeed (AOR = 0.98, 95% CI 0.80–0.99), from nourished mothers (AOR = 0.96, 95% CI 0.94–0.097), from middle income (AOR = 0.97, 95% CI 0.96–0.99), high-income households (AOR = 0.94, 95% CI 0.93–0.96), birth spacing 24–47 months (AOR = 0.99, 95% CI 0.98–1.00) and 48 months and above (AOR = 0.96, 95% CI 0.94–0.97) were indirectly affected by morbidity via malnutrition. This investigation has revealed that childhood malnutrition and morbidity remain major child health challenges in Ethiopia with demographic, socioeconomic, maternal, child, and geographic variables playing significant roles. Efforts to resolve these issues need to take these factors into account. Therefore, malnutrition and morbidity prevention should include encouraging birth spacing, mother education programs, and breastfeeding practices. [ABSTRACT FROM AUTHOR]

Introduction: Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India. Methods: We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12–17 months, 18–23 months (ref), 24–35 months, and 36–59 months] and five child health outcomes – neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations. Results: 3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05–1.18), stunting (OR: 1.13; 95% CI: 1.08–1.18) and underweight (OR: 1.06; 95% CI: 1.01–1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12–17 months and 36–59 months had higher odds of stunting, and IPI of 12–17 months was also associated with higher odds of underweight. Discussion: Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12–17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India. [ABSTRACT FROM AUTHOR]

Issue addressed: To raise expectant fathers' awareness of risk factors for stillbirth. Methods: A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three‐point Likert scale and provided comments. Results: Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important‐good information," "not appropriate/anxiety provoking" and "not relevant‐obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." Conclusions: Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers‐to‐be. So what?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father‐focused text messaging service. [ABSTRACT FROM AUTHOR]

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning. What is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning. What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning. What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Age at marriage is one of the proximate determinants of fertility. Women with early age at marriage experiences early motherhood, associated with high fertility, low education, and rural residence accompanied with poverty. In the present study, an attempt has been made to evaluate age at marriage and factors affecting it and its effect on first birth interval (FBI) using systematic review and meta-analysis. METHODOLOGY: Inclusion criteria were availability of full- and free-text articles, published in English language, and current married age of mother being 13 years and above. PubMed and Google search was used for systematic review for the study. Meta-analysis was carried out using Microsoft Excel 2013. RESULTS: Pooled-weighted average age at marriage was 19.96 years (with 4.26 standard error). The age at marriage in China was highest (21.56 years). Literacy and occupation of women had significant effect on age at marriage. Urbanization could not affect significantly on age at marriage. Furthermore, FBI has been modified by age at marriage. [ABSTRACT FROM AUTHOR]

As first births are increasingly postponed across Europe, a strong twochild family norm persists. Past research has examined educational differentials in progressions to second birth, testing various hypotheses but overlooking normative aspects. Comparing fertility surveys from France and Spain, we explore whether late first-time mothers, who have fewer reproductive biological years left to conceive, accelerate the transition to a subsequent child (time squeeze effect). We also consider a normative dimension, i.e., whether women have their first child earlier or later than others in their educational and cohort groups. In both countries, among first-time mothers between 25 and 34 years of age, highly-educated women transitioned to second birth more frequently than less-educated women did. Within the same age group, highly-educated women in Spain had a second child more quickly after the firstborn than their less educated counterparts did, while there is no such difference in France. These results hold after controlling for cohort effects, but are only partly explained by a time squeeze effect. Different normative ages at first birth by education and birth cohort explain the educational gap in the likelihood of transitioning to second birth, but not the birth intervals in Spain. In sum, our analysis demonstrates a persistent educational gap in second births in this country that cannot be reduced to biological or normative effects. This suggests that a broad range of economic constraints play a role, such as unfavourable individual economic conditions and lower levels of institutional support for parenthood. [ABSTRACT FROM AUTHOR]

The route from family planning intentions to practices is not linear, it is contingent on different social factors including the preferences of individuals and couples, their gendered positions and bargaining power, the wider political, economic and social context, and also physical and bodily circumstances. We used qualitative data collected in rural Burundi between 2013 and 2016 to explore how these diverse factors influence reproductive navigation in a context framed by uncertainty and changing social norms. We describe representations of bodily (pre)dispositions for fertility and reproduction, such as the 'natural' capacity for birth spacing or the bodily capacity to use 'natural' (having a regular cycle) and 'modern' methods (not having negative side effects) that contribute collectively to an understanding of 'the body is difficult'. We found that despite these bodily constraints, women enact embodied agency to ensure livelihoods and social status, thus framing their reproductive intentions and practices. In the context of Burundi where corporeality is key to gendered social belonging, family planning programmes fail to respond to the needs and concerns of women and their embodied reproductive experiences. [ABSTRACT FROM AUTHOR]

Children's welfare in the health aspect can be seen in the level of growth and development of children. Socio-demographics and family food security are important because they affect the nutritional status of the community. If food security and sociodemographics are lacking, nutritional status will also be lacking and cause a decline in health status. This condition can lead to malnutrition or stunting in the community. This study aims to analyze the influence of socio-demographics and food security on the incidence of stunting in Medan City. This type of research is quantitative observational with a survey research study design using a cross-sectional study design that examines at a certain point in time the entire sample population or predetermined subset. The sample in this study was 266 toddlers from Medan Tuntungan, Medan Maimun, Medan Sunggal, Medan Helvetia and Medan Denai sub-districts. The analytical method used is bivariate analysis using the chi square test and multivariate analysis using logistic regression. The results showed that there was a positive and significant effect of the variables of mother's education, birth spacing and family income on the incidence of stunting in toddlers in Medan City with a p value <0.05. Furthermore, it was found that there was no significant effect of the variable number of children, mother's occupation and family food security on the incidence of stunting in toddlers in Medan City. Mothers should be able to find additional sources of income that can increase family income without neglecting the provision of good parenting for toddlers. This is done to increase the understanding of mothers in providing adequate nutritional intake to children under five. [ABSTRACT FROM AUTHOR]

Iron-deficiency anemia is defined as anemia, a condition in which there less than the normal hemoglobin (Hb) accompanied by an indication of iron deficiency. Nearly half of all pregnant women worldwide suffer from anemia, and iron deficiency accounts for about half the world's anemia burden. Most of the studies conducted on iron-deficiency anemia during pregnancy were conducted at the institution level and associated factors are not well studied and documented. Hence, the aim of this study is to determine the prevalence of iron-deficiency anemia and associated factors among pregnant women in Bolosso Bomibe District, Southern Ethiopia, 2019. Community-based cross-sectional quantitative study was conducted from April to June 2019. Multistage sampling was used to include 270 study participants in 6 kebeles. The structured and pretested questionnaire, middle upper arm circumference (MUAC), Hb, serum ferritin, and C-reactive protein were used as a tool to collect data. The data was compiled and entered to EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 23.00 packages for analysis. Univariate, bivariate, and multivariable logistic regression with odds ratio along with the 95% confidence intervals (CI) was computed and interpreted. p value < 0.05 was declared as statistically significant. The prevalence of iron-deficiency anemia was 11.3% (95% CI: 8.9-15.7). Factors associated with iron-deficiency anemia were ANC follow-up for the recent pregnancy (adjusted odds ratio [AOR] = 3, 95% CI: 1.15-8.9, and years b/n successive pregnancy (AOR = 4,95% CI: 1.2-12.4). Prevalence of iron-deficiency anemia was low, which is a mild public health concern among pregnant women in Bolosso Bombe District. The factors associated with iron-deficiency anemia in this study population were MUAC, ANC follow-up, birth spacing among successive pregnancy, and duration of menstrual bleeding. Thus, there should be the integration of concerned stakeholders for implementation of different interventions to solve these problems. Subjects: Medicine; General Medicine; Hematology; Primary Health Care & Family Practice [ABSTRACT FROM AUTHOR]

Introduction: sub-optimal birth spacing is higher in sub-Saharan countries including Ethiopia. It can affect the economic, political and social aspects of a given country. Therefore, this study aimed to assess magnitude of sub-optimal child spacing practice and associated factors among childbearing women in Southern Ethiopia. Methods: a community based cross-sectional study was conducted from July to September 2020. A random sampling technique applied to select kebeles, and systematic sampling was employed to recruit study participants. Data were collected by pretested and interviewer administered questionnaire through face-to-face interviews. Data cleaned and checked for completeness, and analyzed by SPSS version 23. A p-value of < 0.05 was considered as cutoff point to declare the strength of statistical association with 95% of CI. Results: magnitude of sub-optimal child spacing practice was 61.7% (CI: 57.7: 66.2). Not attending formal education (AOR= 2.1 (95% CI: 1.3, 3.3), family planning utilization for less than 3 years (AOR= 4.0 (95% CI: 2.4,6.5), being poor (AOR= 2.0 (95% CI: 1.1, 4.0), breastfeeding of less than 24 months (AOR= 3.4 (95% CI: 1.6,6.0); having more than 6 children (AOR= 3.1 (95% CI: 1.4,6.7); and waiting time =30 minutes (AOR= 1.8 (95% CI: 1.2,5.9) were predictors of sub-optimal birth spacing practices. Conclusion: sub-optimal child spacing was relatively high among the women of Wolaita Sodo Zuria District. Improving utilization of family planning, expanding all inclusive adult education, delivering community based continuous education on optimum breast-feeding practice, involving women in income generating activities, and facilitated maternal services were recommended to fill the identified gap. [ABSTRACT FROM AUTHOR]

Background Sociocultural factors remain an important determinant for women's involvement with decision making and getting husbands' support for their reproductive healthcare. Therefore this study was conducted to examine sociodemographic factors associated with women's involvement in decision making and getting husbands' support for their reproductive healthcare. Methods An institutional-based cross-sectional study was conducted in Lalitpur, Nepal. A total of 600 respondents were selected from 15 immunization clinics. Participants were women ≥18 y of age who came to the child's immunization clinic. The association between sociodemographic variables and women's involvement in decision making and getting husbands' support for their reproductive healthcare was analysed through multivariate logistic regression models. Results While women's involvement in decision making was greater for childcare, it was less in the area related to financial matters. In contrast, husbands supported more in the area related to finances than for childcare and accompanying to health facilities. The significant determinants for women's involvement in decision making and getting husbands' support were the woman's caste, education level, employment status, household income, age group and number of children. Madhesi/Muslim/other women were less likely (adjusted odds ratio [AOR] 0.31 [95% confidence interval {CI} 0.12 to 0.73]) to decide the number of babies and birth spacing. These women were also less likely (AOR 0.18 [95% CI 0.02 to 0.86]) to be accompanied by their husbands to the family planning (FP) clinic. Janajati, Dalit and Madhesi/Muslim/other women were less likely to receive their husbands' support for birth preparedness. Women who were <20 y of age and had a single child were less likely to get involved in decision making and getting their husbands' support for FP services. Conclusions The findings call for reproductive health programs that encourage women's involvement in decision making and receiving husbands' support in women's reproductive healthcare. When designing such a program in the FP area, the woman's caste, age and parity should be given special consideration. Also, caste should be considered when designing such a program related to birth preparedness. [ABSTRACT FROM AUTHOR]