北京流动人口妇幼保健现况研究

目的 了解北京流动人口妇女儿童对医疗保健服务的利用，以及流八城市的相关部门对流动人口的管理和提供服务的现状．方法 采用定性和定量方法收集资料，应用SPSS统计软件对数据进行描述性统计和统计推断。结果 被调查的539名育龄妇女．平均年龄29．6岁，90．9％已婚，其孕期早检率为43．7％、5次及以上产前检查率为37．6％，选择回户籍地分娩的妇女住院分娩率（67．5％）高于留在北京分娩的妇女的住院分娩率（37．6％）。初中及以上文化水平妇女的住院分娩率（63．8％）高于初中以下者的住院分娩率（46．4％）。定性调查发现。流八地医疗保健机构、公安、街道等部门的人员和经费是按户籍人口进行配置的．因此这些部门在对流动人口进行管理和服务时，面临人员和经费严重不足的问题。提供妇幼保健的医疗单位的现有服务模式、收费标准等影响流动人口妇女孕期保健服务的利用。结论流动人口妇女孕产期医疗保健服务利用率低下。建议政府在为医疗保健部门人员经费配置时考虑流动人口数量；另外，提供妇幼保健服务的医疗保健机构需加强多部门合作，改变现有服务模式、提供适宜流动人口的医疗保健服务。     

Attitudes of professionals in providing maternity care in a primary health care system in Saudi Arabia

This study was done on a sample of the primary care centers in the Al-Baha region, Saudi Arabia to assess the opinions of the medical and paramedical staff regarding the capability and acceptability of providing antenatal and intrapartum care in the primary health care setting. The study showed that 96% of all the respondents supported the provision of antenatal care services in primary health care with 60% of them giving the reason that it is more convenient for pregnant women.90% of the respondents wanted the antenatal care to be delivered through special clinics and the majority of them wanted to give a greater role to the midwives in antenatal care. Questioned about the intranatal care provision in the centers, 98% of all the respondents agreed to the utilization of primary health care in such service. A similar percentage of them claimed to have the ability to do deliveries in the centers with existing facilities.To avoid duplication of care and to best use of available resources, low risk pregnancies should be seen antenatally and delivered in the primary health care centres provided the quality of such care is kept under control.Abdulaziz N. Al-Nasser is Assistant Professor of Primary Health Care; Mohammed A. Al-Sekait is Assistant Professor of Community Medicine; Elijah A. Bamgboye is Assistant Professor of Medical Statistics; all in the Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia.Wahid A. Khan is coordinator in the Primary Health Care Program, Al-Baha, Saudi Arabia.     

“My Body. My Choice”: A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice

Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women’s perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18–39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider’s advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.     

Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities

Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.     

Unintended pregnancies and the use of maternal health services in southwestern Ethiopia

Background

The benefits of maternal health care to maternal and neonatal health outcomes have been well documented. Antenatal care attendance, institutional delivery and skilled attendance at delivery all help to improve maternal and neonatal health. However, use of maternal health services is still very low in developing countries with high maternal mortality including Ethiopia. This study examines the association of unintended Pregnancy with the use of maternal health services in Southwestern Ethiopia.

Methods

Data for this study come from a survey conducted among 1370 women with a recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern Ethiopia. An interviewer administered questionnaire was used to gather data on maternal health care, pregnancy intention and other explanatory variables. Data were analyzed using STATA 11, and both bivariate and multivariate analyses were done. Multivariate logistic regression was used to assess the association of pregnancy intention with the use of antenatal and delivery care services. Unadjusted and adjusted odds ratio and their 95% confidence intervals are reported.

Results

More than one third ( 35%) of women reported that their most recent pregnancy was unintended. With regards to maternal health care, only 42% of women made at least one antenatal care visit during pregnancy, while 17% had four or more visits. Institutional delivery was only 12%. Unintended pregnancy was significantly (OR: 0.75, 95% CI, 0.58-0.97) associated with use of antenatal care services and receiving adequate antenatal care (OR: 0.67, 95% CI, 0.46-0.96), even after adjusting for other socio-demographic factors. However, for delivery care, the association with pregnancy intention was attenuated after adjustment. Other factors associated with antenatal care and delivery care include women’s education, urban residence, wealth and distance from health facility.

Conclusions

Women with unintended pregnancies were less likely to access or receive adequate antenatal care. Interventions are needed to reduce unintended pregnancy such as improving access to family planning information and services. Moreover, improving access to maternal health services and understanding women’s pregnancy intention at the time of first antenatal care visit is important to encourage women with unintended pregnancies to complete antenatal care.

     

河北省赵县孕产妇和儿童健康管理现状研究

目的：调查分析河北省赵县基本公共卫生服务项目中孕产妇和儿童健康管理实施现状,为改进服务质量提供研究资料和建议。方法根据国家基本公共卫生服务规范要求的服务内容设计调查问卷,主要包括体格检查、化验和咨询指导,现场观察乡镇卫生院妇幼保健人员的产前保健和儿童保健服务过程,并对保健人员进行访谈以了解其对自己的工作量、收入和提供喂养咨询指导的看法。结果调查共观察了88名孕妇的产前保健和194名儿童的保健服务。产前保健中有80％以上的孕妇进行了体格检查,但进行实验室化验者不足5％。保健人员很少提供咨询指导,没有孕妇得到母乳喂养方面的指导。儿童保健中98．5％的儿童测量了体重和身长,但分别只有6．2％和4．6％对照生长标准曲线进行了评价。只有21．6％的儿童家长接受了喂养指导。结论赵县基本公共卫生服务项目中产前保健和儿童保健的体格检查部分工作开展较好,但实验室化验和咨询指导方面的服务质量有待提高;保健人员反映工作量大、收入低,同时需要更多高质量的培训。     

Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of women’s experiences and expectations of participation

Objective  To describe the acceptability to women of being offered antenatal Sickle cell and Thalassaemia (SC&T) screening in primary and secondary care at the visit to confirm pregnancy; and to explore the implications of their views for participating in decisions about their health care. Methods Qualitative semi‐structured interviews were conducted with twenty‐one ethnically diverse women registered at twenty‐five general practices in two English inner‐city Primary Care Trusts. The material was analysed thematically, using the method of constant comparison. Results Women generally welcomed the opportunity of early diagnosis, although they expected screening to confirm they were carrying a healthy child. Women felt general practitioners did not present antenatal screening as a choice, but they did not necessarily see this as a problem. Doctors were believed to be acting out of concern for the women’s well being. Conclusions Women were generally positive about being offered screening in primary care at the first visit to confirm pregnancy. To this extent it was acceptable to them, although this was largely informed by assumptions associated with being a ‘good mother’ rather than a straightforward enactment of informed choice, assumed by health‐care policy. This represents the context in which women participate in decisions about their health care.     

Women’s Autonomy and Skilled Attendance During Pregnancy and Delivery in Nepal

Objectives This study aims to explore the association between women’s autonomy and skilled attendance during pregnancy and delivery in Nepal. Methods We adopt data from the Nepal Demographic and Health Survey (NDHS, 2011). We include only married women who gave birth in the 5 years preceding the survey (N = 4148). Women’s autonomy was assessed on the basis of four indicators of decision making: healthcare, visiting friends or relatives, household purchases and spending earned money. Each indicator was dichotomized (yes/no) and then summarized into a single variable to measure overall autonomy. Next, we measured health attendance (skilled vs. unskilled) during antenatal and delivery care. The association between women’s autonomy and skilled attendance was analysed using a logistic regression model. Results Most women had a medium (40 %) and high (35 %) level of overall autonomy. The proportion of women accessing skilled providers during antenatal and delivery care was 51 and 36 %. Women with autonomy in healthcare, visiting friends or relatives, making household purchases and spending money earned were associated with a higher likelihood of receiving care from skilled providers during antenatal care and delivery. An elevated probability of access to skilled attendance during antenatal (aOR 1.33; 95 % CI 1.10–1.59) and delivery care (aOR 1.38; 95 % CI 1.12–1.70) was reported among women with higher levels of overall autonomy. Conclusion Women’s autonomy was significantly associated with the maternal health care utilization by skilled attendants. This study will provide insights for policy makers to develop strategies in improving maternal health.     

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was ‘It is normal to experience nausea/vomiting in the first trimester of pregnancy’, the least accurately evaluated statement was ‘Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy’. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.     

Factors related to the use of antenatal care services in Ethiopia: Application of the zero-inflated negative binomial model

The major causes for poor health in developing countries are inadequate access and under-use of modern health care services. The objective of this study was to identify and examine factors related to the use of antenatal care services using the 2011 Ethiopia Demographic and Health Survey data. The number of antenatal care visits during the last pregnancy by mothers aged 15 to 49 years (n = 7,737) was analyzed. More than 55% of the mothers did not use antenatal care (ANC) services, while more than 22% of the women used antenatal care services less than four times. More than half of the women (52%) who had access to health services had at least four antenatal care visits. The zero-inflated negative binomial model was found to be more appropriate for analyzing the data. Place of residence, age of mothers, woman’s educational level, employment status, mass media exposure, religion, and access to health services were significantly associated with the use of antenatal care services. Accordingly, there should be progress toward a health-education program that enables more women to utilize ANC services, with the program targeting women in rural areas, uneducated women, and mothers with higher birth orders through appropriate media.     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

What happens during antenatal visits? An ethnographic study of pregnant women’s experiences with midwives in Benin

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women’s experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives’ good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.     

Explaining Ethnic Differences in Late Antenatal Care Entry by Predisposing, Enabling and Need Factors in the Netherlands. The Generation R Study

Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57?C1.58), Cape Verdean (OR = 1.65. CI: 0.96?C2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07?C2.85; Dutch Antillean OR 1.80, CI: 1.04?C3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.     

Do Women Increase Their Use of Reproductive Health Care When It Becomes More Available? Evidence from Indonesia

Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health‐care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery—changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.     

From research to practice: the example of antenatal care in Thailand

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.     

Women’s autonomy and reproductive health-care-seeking behavior in Ethiopia

This paper investigated the potential importance of women’s autonomy in reproductive health-care-seeking behavior of women in Ethiopia. Data from the 2011 Ethiopian Demographic and Health survey (DHS), which involved a total of 16,515 women, were analyzed. A weighted sub-sample of married women and women who had a live birth were included in analyses on family planning and antenatal care. Women’s autonomy was measured by participation in decision making, attitudes toward wife beating, and whether getting permission to seek medical care was a big problem. Nearly 54% of women participated in all major household decisions, and 69% said getting permission to go for medical care was not a large problem. Women’s participation in domestic decision making was significantly positively associated with use of family planning (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.17–1.62), and antenatal care (aOR: 1.36, 95% CI: 1.13–1.64) after adjusting for the effects of socio-demographic variables. Moreover, greater women’s education, paid employment, exposure to media, and better household economic status were related to both use of family planning and antenatal care. Improving women’s autonomy will help to attain both gender equality and improved use of health services.     

Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.     

Kathy Pan,sticks and pummelling: Techniques used to induce abortion by Burmese women on the Thai border

Forced migrants face particular reproductive health problems. Migrant Burmese women in Thailand often need to work to support themselves and their families, and mistimed and unwanted pregnancies are a common problem. They have limited access to culturally appropriate reproductive health services and no access to safe elective abortion. They are at risk of deportation or at least harassment by Thai authorities if they travel. They use traditional methods such as herbal medicines, and employ lay midwives to provide pummelling and stick abortions to end their pregnancies. This ethnographic study used various methods to collect data over 10 months in Tak Province, Thailand. The authors describe the women's motives and means of ending their pregnancies and some of the difficulties in obtaining reliable modern methods of contraception. This study highlights the need for reproductive health care for displaced populations.     

Enabling Factors Associated with Receipt of Interconception Health Care

Maternal and Child Health Journal - Preventive health care between pregnancies may benefit future pregnancies and women’s long-term health, yet such care is frequently incomplete. We used...     

Antenatal care: a case of the inverse care law?

Abstract: As part of a review of maternity services this study assessed satisfaction with antenatal care among 1193 women who gave birth in Victoria during two weeks of 1989, except for those who had a stillbirth or whose infant died between the birth and the survey. The survey questionnaire was mailed to women eight to nine months after the birth. The response rate, excluding duplicates, women who gave birth outside the survey period and those whose questionnaires were returned because of a change of address was 71.5 per cent. Women attending public hospital clinics were the least satisfied with antenatal care and those attending private obstetricians were the most satisfied, with general practitioners intermediate. These differences by provider accounted for almost all the differences by sociodemographic factors (age, marital status, family income, being of non-English-speaking background and health insurance status). While the majority of women were happy with their antenatal care, an inverse care law still applied: women whose economic and social circumstances meant they were most likely to need ‘care’ from caregivers were more likely to be limited in their choice of caregiver and to be dissatisfied with the care they received.