Search

Women of reproductive age are prone to face deaths and complications from maternal-related health issues if they do not utilize proper healthcare services. Certain challenges act as a disparity and hinder women of reproductive age from accessing maternal health care services leading to deaths and further complications. The study investigated the challenges in pregnancy and how they create disparities in the health of women through poor utilization of maternal healthcare services. The study adopted a phenomenological qualitative design and data was gathered through focus group discussions and in-depth interviews. The sample size for this study was 24 women of reproductive age from Okrika Local Government Area in Rivers State, Nigeria. Results of the study revealed that the majority of the women had a good knowledge of maternal healthcare services. Still, there was poor utilization of these care services due to challenges resulting from poverty, distance, religious beliefs, and inappropriate staff attitude which leads to poor care of the pregnant mother and the fetus resulting in preventable deaths and complications. The study concludes that these challenges that affect the utilization of maternal healthcare services must be addressed in order to help promote women's health and also improve the actualization of Sustainable Development Goals. Thus, there is a need for social service research that highlights the plights of women of reproductive age to ensure that their lives, health, and well-being are promoted. This study also recommends the continuous training of health workers to enable them to know how best to attend to these women. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. Materials and Methods: This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017–2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017–2019). Results: There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4–20.9%; P < 0.001), and examination at each visit (90.8–72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9–49.9%) and delivery by caesarean section (21.6–27.3%; P = 0.002). Conclusion: COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

Abstract Background Papua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG. Methods The study was conducted using the 2016–2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p

Background: The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. Materials and Methods: This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017–2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017–2019). Results: There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4–20.9%; P < 0.001), and examination at each visit (90.8–72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9–49.9%) and delivery by caesarean section (21.6–27.3%; P = 0.002). Conclusion: COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future. [ABSTRACT FROM AUTHOR]

Background: Papua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG. Methods: The study was conducted using the 2016–2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05. Results: The prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women's employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors. Conclusions: This study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women's education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS. [ABSTRACT FROM AUTHOR]

Disparities in health facilities between urban and rural areas significantly hamper health services in rural communities. Due to the high maternal and newborn mortality rates in East Nusa Tenggara Province, the Indonesian government revitalized health services through the Village Maternity Cottages Program. This study seeks to describe the index of community satisfaction with the quality of service at the Village Maternity Cottages. In addition, it provides strategic planning for the program in realizing long-term sustainable development of health services. This research uses a Mix Method approach. Data collection methods included observation, interview, and questionnaire distribution. Primary data were collected from 78 participants who accessed the Village Maternity Cottages health services in Suanae Village, East Nusa Tenggara Province. The results showed that the Village Maternity Cottages User Community Satisfaction Index obtained an average rating of good, to very good in fourteen categories of health services. Strategic planning can be done by the Regional Head must develop a Village Maternity Cottages Policy that sets out steps to achieve sustainable health service development goals. The government's ability to empower groups, build partnerships, develop strategic planning, funding stability, program evaluation, and environmental support as sustainable program development in the future. [ABSTRACT FROM AUTHOR]

Objective: To describe the initiation, integration, and costs of reduced-cost infertility services within the maternal health department of a public hospital in a low-income country. Design: Retrospective review of the clinical and laboratory components of patients undergoing in vitro fertilization (IVF) treatment in Rwanda from 2018 to 2020. Setting: Academic tertiary referral hospital in Rwanda. Patients: Patients seeking infertility services beyond the primary gynecological options. Interventions: The national government furnished facilities and personnel, and the Rwanda Infertility Initiative, an international nongovernmental organization, provided training, equipment, and materials. The incidence of retrieval, fertilization, embryo cleavage, transfer, and conception (observed until ultrasound verification of intrauterine pregnancy with fetal heartbeat) were analyzed. Cost calculations used the government-issued tariff specifying insurers' payments and patients' copayments with projected delivery rates using early literature. Main Outcome Measures: Assessment of functional clinical and laboratory infertility services and costs. Results: A total of 207 IVF cycles were initiated, 60 of which led to transfer of ≥1 high-grade embryo and 5 to ongoing pregnancies. The projected average cost per cycle was 1,521 USD. Using optimistic and conservative assumptions, the estimated costs per delivery for women

Background: It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. Material and Methods: In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Results: Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002]. Conclusion: Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future. [ABSTRACT FROM AUTHOR]

Background: It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. Material and Methods: In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Results: Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87–17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25–0.74); P = 0.002]. Conclusion: Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future.

The purpose of this study was to assess the cultural beliefs influencing access to maternal healthcare in East Pokot Pastoral Communities, Baringo County, Kenya. The study was founded on the choicemaking model and the theory of access. The research methodology was directed by the descriptive survey design. The target population was 5720 women of reproductive age who are aged between 15 and 49 years and their partners, community leaders, government health facilities administrators, traditional birth attendants and community health workers from the pastoralist communities in East Pokot in Baringo County, Kenya. A stratified purposive sampling technique which included stratified and purposive sampling techniques were used to sample 146 participants. Data was collected using Focus Group Discussions and in-depth interviews. Using the Nvivo software, the data were coded and tracked and the findings were presented using narratives with quotations. The study found out that the cultural beliefs that were held by the community members, at times barred the women from accessing maternal healthcare services in the East Pokot sub-county. [ABSTRACT FROM AUTHOR]

Abstract Background The objectives of this study were to 1) measure the percentage of women who received SMS-based family planning communication, and 2) its association with modern contraception and maternal healthcare services among mothers. In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning and reproductive health. However, little is known regarding the role of SMS-based family planning communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. Methods Cross-sectional data on 94,675 mothers (15–49 years) were collected from the latest Demographic and Health Surveys in 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic maternal healthcare services (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. Results The coverage of SMS-based family planning communication for the pooled sample was 5.4% (95%CI = 3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI = 3.38, 8.70) compared with Asia (5.23, 95%CI = 1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI = 11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI = 1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI = 1.95, 2.83). The strength of the association was highest for Senegal (OR = 4.70, 95%CI = 1.14, 7.33) and lowest for Burundi (OR = 1.5; 95%CI = 1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. Conclusion Although positively associated with using facility delivery services, receiving SMS on family planning does not appear to affect modern contraceptive use and other components of maternal healthcare services such as timely and adequate utilisation of antenatal care.

Abstract Background Cambodia is a Southeast Asian country and has one the highest rates of maternal and child mortality with inadequate use of maternal healthcare services in the region. The present study aimed to analyse the progress made in terms of using maternal healthcare services since 2000. Methods Two rounds of Demographic and Health Surveys (DHS 2000 and DHS 2014) were used in the study. Sample population consisted 11,961 women aged between 15 and 49 years. The outcome measures were: Timing of first antenatal care (ANC) attendance, adequacy of ANC attendance, place of delivery and postnatal checkup. WHO guidelines were used to set the cut-off/define these measures. Data were analyzed in Stata version 14 using descriptive and multivariate regression analyses. Results Findings indicated that the overall prevalence of making the first ANC visit in the first trimester was 64.19% [95%CI = 62.22,66.11], and that of having at least four ANC visits was 43.80% [95%CI = 41.89,45.73]. Prevalence of health facility delivery was 48.76% [46.62,50.90] and that of postnatal checkup was 71.14% [95%CI = 69.21,73.01]. Between 2000 and 2014, the percentage of timely and adequate use of ANC increased by respectively 61.8 and 65.3%, while that of health facility delivery and postnatal care increased by respectively 74.5 and 43.9%. Important demographic, socioeconomic and geographic disparities were observed in the utilization of ANC, health facility delivery and postnatal care services. Urban residency, having better educational status, white collar job, access to electronic media showed positive association, whereas higher parity (having > 2 children) and unwanted pregnancy showed negative association with the use of maternal healthcare services. Having at least four ANC visits was associated with significantly increased higher odds of using health facility delivery and postnatal care. Conclusion There has a been a remarkable increase in the prevalence of women who are using the maternal healthcare services since 2000. The current findings provide important insights regarding the sociodemographic factors associated with the utilization of maternal health services in Cambodia that could contribute to evidence-based health policy making and designing intervention programs.

Background/Aims: In Nigeria, women's partners are often excluded from taking part in maternal healthcare, as a result of sociocultural norms. However, the involvement of male partners in maternal healthcare services has the potential to improve maternal health outcomes. This study examined factors associated with male involvement in maternal healthcare services in Ife Central, Osun State, Nigeria. Methods: A cross-sectional study was conducted, involving 265 men living in Ife Central who were married with at least one child, selected by multistage sampling. A structured questionnaire was used to assess men's knowledge of their expected roles in maternal healthcare, their perception of male involvement, and their current level of involvement in their spouse's healthcare. Descriptive and inferential statistical analyses were carried out to identify predictors of active male involvement in maternal healthcare, at a significance of P<0.05. Results: Approximately half (55.6%) of the respondents had good knowledge of the expected role of men in maternal healthcare services and 76.6% had a positive perception of this role. Overall, less than half (47.6%) of the participants were actively involved in maternal healthcare services. The participants most frequently reported that men's involvement was influenced by their degree of knowledge (92.4%), job schedule (92.0%), and clinic waiting time (86.4%), among others. Age (odds ratio=2.33, P=0.038), educational status (odds ratio=2.42, P=0.004) religion (odds ratio=2.34, P=0.012), occupation (odds ratio=2.81, P<0.001) and level of knowledge (odds ratio=2.34, P=0.001) were found to be significantly associated with men's level of involvement in maternal healthcare services. However, only good level of knowledge (adjusted odds ratio=2.32, P=0.004) emerged as an independent predictor of men's level of involvement in maternal healthcare services. Conclusions: The study concluded that men's involvement in maternal healthcare services was low, despite their positive perception towards it. Less than half of the participants had good knowledge regarding men's role in maternal healthcare, and this factor was identified as a significant predictor of level of involvement. Programmes and policies should aim to enhance men's knowledge of their role in maternal healthcare, and it may be necessary to restructure the healthcare delivery system to be more male friendly. [ABSTRACT FROM AUTHOR]

Background: Cambodia is a Southeast Asian country and has one the highest rates of maternal and child mortality with inadequate use of maternal healthcare services in the region. The present study aimed to analyse the progress made in terms of using maternal healthcare services since 2000.Methods: Two rounds of Demographic and Health Surveys (DHS 2000 and DHS 2014) were used in the study. Sample population consisted 11,961 women aged between 15 and 49 years. The outcome measures were: Timing of first antenatal care (ANC) attendance, adequacy of ANC attendance, place of delivery and postnatal checkup. WHO guidelines were used to set the cut-off/define these measures. Data were analyzed in Stata version 14 using descriptive and multivariate regression analyses.Results: Findings indicated that the overall prevalence of making the first ANC visit in the first trimester was 64.19% [95%CI = 62.22,66.11], and that of having at least four ANC visits was 43.80% [95%CI = 41.89,45.73]. Prevalence of health facility delivery was 48.76% [46.62,50.90] and that of postnatal checkup was 71.14% [95%CI = 69.21,73.01]. Between 2000 and 2014, the percentage of timely and adequate use of ANC increased by respectively 61.8 and 65.3%, while that of health facility delivery and postnatal care increased by respectively 74.5 and 43.9%. Important demographic, socioeconomic and geographic disparities were observed in the utilization of ANC, health facility delivery and postnatal care services. Urban residency, having better educational status, white collar job, access to electronic media showed positive association, whereas higher parity (having > 2 children) and unwanted pregnancy showed negative association with the use of maternal healthcare services. Having at least four ANC visits was associated with significantly increased higher odds of using health facility delivery and postnatal care.Conclusion: There has a been a remarkable increase in the prevalence of women who are using the maternal healthcare services since 2000. The current findings provide important insights regarding the sociodemographic factors associated with the utilization of maternal health services in Cambodia that could contribute to evidence-based health policy making and designing intervention programs. [ABSTRACT FROM AUTHOR]

Introduction: Food insecurity at the individual level has been shown to be associated with the adoption of risky behavior and poor healthcare-seeking behavior. However, the impact of household food insecurity (HFI) on the utilization of maternal healthcare services (MHS) remains unexplored. In this study, we aimed to investigate whether or not household food insecurity was associated with non/inadequate utilization of MHS. Methods: Participants consisted of 3562 mothers aged between 15 and 49 years and with at least one child. The outcome variable was the utilization of MHS, e.g., institutional delivery, attendance ante-, and pre-natal visits. The explanatory variables included various sociodemographic factors (e.g., age, residence, education, wealth) apart from HFI. HFI was measured using the Household Food Insecurity Access Scale (HFIAS). Result: The prevalence of non- and under-utilization of MHS was 5.3 and 36.5, respectively. In the multivariate analysis, HFI, wealth index, and educational level were independently associated with MHS status. The odds of non- and under-utilization of MHS were 3.467 (CI = 1.058–11.354) and 4.104 (CI = 1.794–9.388) times higher, respectively, among women from households reporting severe food insecurity. Conclusion: Severe HFI was significantly associated with both under- and non-utilization of MHS. Interventions programs that address HFI and the empowerment of women can potentially contribute to an increased utilization of MHS.

Access to maternal healthcare services is a challenge in most low- and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions in place to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access these services. The aim of this study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. The objectives of this study were to describe the experiences of women with disabilities in accessing maternal healthcare services during pregnancy, childbirth and post-partum care; explore the inhibitors of access to maternal healthcare services for women with disabilities; and explore the facilitators of access to maternal healthcare services for women with disabilities. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al., 2008. Our study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. Women with hearing impairments faced communication difficulties due to the lack of sign language interpreters in most facilities. Moreover, healthcare professionals displayed unfavourable attitudes toward women with hearing impairments, and these women were often overlooked when seeking help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment that is not adjustable, such as beds and scales.

Studies have focused on both individual and community factors affecting the use of maternal healthcare services. However, studies in Nigeria have rarely examined whether the influence of individual and community factors in explaining the use of maternal healthcare has changed in the context of the Boko Haram insurgency in North-East Nigeria. This study investigates factors associated with the use of maternal healthcare services during the Boko Haram insurgency in North-East Nigeria. The study analysed data from the 2013 Nigeria Demographic and Health Survey. Results showed that some individual characteristics are no longer associated with the use of maternal healthcare services, compared to community characteristics which are. Humanitarian assistance to the region should take this into account when considering interventions to encourage better uptake of maternal healthcare services. [ABSTRACT FROM AUTHOR]

Introduction The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on health services around the world. Many hospitals and clinics were overwhelmed by the influx of patients, leading to delays and disruptions in care. The fear of contracting the virus also led to a decrease in the number of people seeking medical care, even for urgent or life-threatening conditions. Various studies have reported a decrease in overall utilization of maternal health services. However, it remains vital to find the reasons for reduced utilization along with the experiences of the women as well as healthcare workers during the pandemic. Objective The objective of this study was to identify the facilitators and barriers to maternal healthcare services utilization during the COVID-19 pandemic. Methods It was a qualitative study conducted in a rural area of Haryana, India. Twelve in-depth interviews (IDIs) were conducted with health workers and four focused group discussions (FGDs) were conducted with pregnant women. Textual analysis was done for both IDIs as well as FGDs. Qualitative analysis was done manually. Results The identified themes were complete cessation of services, no outpatient department (OPD) services for many months, no antenatal care (ANC) services for two months, disruption of supply of medicines, unavailability of drugs, fear of getting COVID-19 infection, mandatory COVID-19 negative report for admission in hospital, and increased referral from government health facilities during the pandemic and lockdown. Conclusion Maternal healthcare services suffered during COVID-19 for various reasons including the closure of health facilities, limited supply of stocks, or fear of the disease among pregnant women. This evidence can be used to prepare as well as manage healthcare services in future., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Singh et al.)

Objective: To describe the initiation, integration, and costs of reduced-cost infertility services within the maternal health department of a public hospital in a low-income country., Design: Retrospective review of the clinical and laboratory components of patients undergoing in vitro fertilization (IVF) treatment in Rwanda from 2018 to 2020., Setting: Academic tertiary referral hospital in Rwanda., Patients: Patients seeking infertility services beyond the primary gynecological options., Interventions: The national government furnished facilities and personnel, and the Rwanda Infertility Initiative, an international nongovernmental organization, provided training, equipment, and materials. The incidence of retrieval, fertilization, embryo cleavage, transfer, and conception (observed until ultrasound verification of intrauterine pregnancy with fetal heartbeat) were analyzed. Cost calculations used the government-issued tariff specifying insurers' payments and patients' copayments with projected delivery rates using early literature., Main Outcome Measures: Assessment of functional clinical and laboratory infertility services and costs., Results: A total of 207 IVF cycles were initiated, 60 of which led to transfer of ≥1 high-grade embryo and 5 to ongoing pregnancies. The projected average cost per cycle was 1,521 USD. Using optimistic and conservative assumptions, the estimated costs per delivery for women <35 years were 4,540 and 5,156 USD, respectively., Conclusions: Reduced-cost infertility services were initiated and integrated within a maternal health department of a public hospital in a low-income country. This integration required commitment, collaboration, leadership, and a universal health financing system. Low-income countries, such as Rwanda, might consider infertility treatment and IVF for younger patients as part of an equitable and affordable health care benefit., (© 2023 The Authors.)

Please cite this paper as: Both J, van Roosmalen J. The impact of Prevention of Mother to Child Transmission (PMTCT) programmes on maternal health care in resource-poor settings: looking beyond the PMTCT programme-a systematic review. BJOG 2010;117:1444-1450. Background There is increasing debate about the impact of scaled-up HIV/AIDS programmes on fragile healthcare systems in low-income countries. Objectives To contribute to the understanding of the relation between HIV/AIDS programmes and healthcare systems, this systematic review focuses on the impact of Prevention of Mother to Child Transmission (PMTCT) programmes on maternal health care. Search strategy Publications describing the effect of PMTCT programmes on maternal healthcare services were sought through computerised searches in five electronic databases. Selection criteria Abstracts of publications were evaluated for appropriateness for inclusion based on whether they met the inclusion criteria. Data collection and analysis Copies of all selected publications were obtained. A classification system was developed to group the relevant publications. Main results The findings show that empirical evidence of the effect of PMTCT programmes on maternal health care is scarce and further research is badly needed. Twenty-one studies that were included in the systematic review showed that PMTCT programmes are often semi-integrated in maternal health care with positive as well as negative effects on various aspects of maternal health care. Authors' conclusions It appears that PMTCT programmes miss the opportunity to have an overall positive effect on maternal health care because of their verticality. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the association between women's decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women., Settings: This is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully., Participants: Cross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child's healthcare and visiting to family or relatives were included in the analysis., Results: Prevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner., Conclusion: Neither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)