Role of receipt of antenatal care in subsequent contraceptive use at primary health care centres serving slum areas of Cairo,Egypt

Abstract

Objectives: Information on family planning and use of antenatal care services is vital for understanding the main influences on fertility and evaluating the success of national family planning programmes. This study aimed to explore contraceptive use and its relation to use of antenatal care services in Egypt.

Methods: A cross-sectional survey was conducted among women attending three primary health care centres serving different slum areas of Cairo.

Results: Most of women who used antenatal care services obtained contraception from the state sector. Although the number of antenatal care visits was not significantly associated with contraceptive use, it was a significant determining factor for the type of method used. Reasons given for non-use of contraception were related to reproductive health concerns or disapproval of contraceptive use.

Conclusion: Contraceptive use is widespread in Egypt, regardless of age and level of education. Antenatal care is no longer viewed with suspicion. Antenatal care visits are an opportunity for health care providers (HCPs) to encourage the use of contraception. Repeated antenatal care visits help to engender a relationship of trust between women and HCPs. Incorporation of family planning programmes into antenatal care programmes would be an opportunity to promote modern contraceptive use.     

Anxiety in the perinatal period: antenatal and postnatal influences and women’s experience of care

Objective: To examine the characteristics of women with antenatal or postnatal anxiety and to investigate aspects of their care that may be associated with it. Background: Positive outcomes following childbirth are associated with good physical and mental health during pregnancy and following childbirth. Although a degree of anxiety is normal in pregnancy, for some women it can become a serious problem. Methods: This study used data on 5332 women from a 2010 national maternity survey which asked about antenatal and postnatal health and well-being three months after childbirth. Women self-identified as experiencing anxiety and other problems during pregnancy and the postnatal period. Results: Antenatal anxiety was reported by 14% of women and postnatal anxiety by 5% of women. Antenatal anxiety was associated with younger age, Black and Minority Ethnic status, single parenthood, living in a disadvantaged area, having an unwanted pregnancy and long-term health problems. Of these factors, only long-term mental health problems were associated with anxiety in the postnatal period. In the logistic regression models long-term mental health problems dominated the findings. Significant differences in the perceptions of the care experienced were evident in the responses from women with anxiety both antenatally and postnatally. Conclusions: This study shows that antenatal and postnatal anxiety are influenced by health and social factors. Asking women about their current physical and psychological health and past history during pregnancy and following up on their well-being in the postnatal period is an essential element in planning and providing care to meet their needs.     

Maternal health-related behaviours during pregnancy: a critical public health issue

Aim: The aim of the study was to investigate the health-related behaviours of pregnant women. Maternal health-related habits, use of psychoactive medicines, diet, prevention of neural tube defects, oral cavity hygiene, chronic diseases and physical activity were analysed in a group of pregnant women attending antenatal classes.

Methods: Hundred pregnant women recruited from various antenatal classes in Poznań, Poland, were investigated using a questionnaire based on the Pregnancy Risk Assessment Monitoring System.

Results: The results showed that 29% of pregnancies were unplanned. In women with higher education, 62% reported that they were taking folic acid supplements during pregnancy, in contrast with 35% women with a lower level of education (p?=?.012). The study showed that 24% of women were exposed to second-hand smoke during pregnancy, and this was more common among younger study participants (p?=?.038). Nine percentage of women admitted drinking alcohol during pregnancy. Pre-pregnancy alcohol consumption was more frequent among women with higher education (p?=?.011). Only 46.7% of women informed their dentist about their pregnancy, and these were more often older participants (p?=?.023).

Conclusion: The study found low maternal awareness regarding health-related behaviours, which presents a serious challenge to public health care in Poland. Pregnant women and those who wish to conceive need to be educated effectively about preventive measures in order to maintain optimal maternal and reproductive health, as well as normal fetal development.     

Why Do Women Seek Antenatal Care Late? Perspectives From Rural South Africa

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.     

Illicit drug users' experiences of pregnancy. An exploratory study

Abstract

This paper reports on qualitative data from a study of drug-abusing women during pregnancy. Semi-structured interviews were conducted with 30 drug-using women focusing on their attitudes to and feelings about pregnancy. The findings do not support stereotypes of pregnant drug users as selfish and irresponsible. The women's accounts are characterized by feelings of anxiety and guilt which are often exacerbated by comments from health professionals and others. Some implications for health care services for drug-using women and their babies are discussed.     

Safe motherhood perspectives and social support for primigravidae women in Lusaka, Zambia

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care.     

The experience of pregnancy, labour and birth of Thai women in Australia.

OBJECTIVE: To identify the perceptions and experience of pregnancy care, labour and birth of Thai women in Melbourne, Australia. DESIGN: An ethnographic interview and participant observation with women in relation to pregnancy, labour and birth. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Melbourne. FINDINGS: Thai women saw antenatal care as an important aspect of their pregnancy and sought care as soon as they suspected they were pregnant. They were more concerned about the well-being of their babies than their own health, therefore they attended all antenatal appointments. In general, these women were satisfied with care during labour, but some also had negative experiences with their caregivers and hospital routine. When asked to compare maternity services between Thailand and Australia, most of the women believed that services in Australia were better. However, women who had had good experiences of childbirth in Thailand, tended to have negative feelings about the Australian experience. There was also evidence in this study that most of these Thai women did not receive adequate information about care. IMPLICATIONS FOR PRACTICE: Women's perceptions and experiences of antenatal care, labour and birth deserve attention, if appropriate and sensitive care is to be provided to women in Australia and elsewhere. It is only when women's voices are heard in all aspects of health-care delivery that we may see better and appropriate health services for women in childbirth.     

Unauthorised pregnancies and use of maternity care in rural China

ABSTRACT

Objectives To describe the use of maternity care in rural China by the legal status of the pregnancy.

Methods Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors.

Results Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint.

Conclusions Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.     

Cashless childbirth,but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India

Aimthis study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities.Designqualitative in-depth interviews were conducted and analysed using the Grounded Theory approach.Participantsthirteen women who had given vaginal birth to a healthy newborn infant.Settingparticipants were interviewed in their homes in one district of Chhattisgarh, India.Data collectionthe interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth?Findings'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers.Conclusionsincreasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.     

Exploring health education with midwives,as perceived by pregnant women in primary care: A qualitative study in the Netherlands

Objectiveto explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives.Designqualitative semi-structured interview study, using thematic analysis and constant comparison.Setting and participantstwenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013.Findingswomen considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them.Key conclusions and implications for practicehealth education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits.     

Prevalence and factors associated with knowledge and access to delivery services at primary health care facilities amongst indigenous women in Khagrachhari district Bangladesh – A cross-sectional study

ObjectiveTo estimate the prevalence of facility delivery knowledge and access during childbirth amongst Indigenous women in the Chittagong Hill Tracts, Bangladesh and to identify factors associated with facility delivery service utilisation.DesignA cross-sectional study design using a structured self-report survey.SettingTwo Upazilas (subdistricts) of Kharachhari hill district of the Chittagong Hill Tracts.ParticipantsIndigenous women of reproductive age (15–49 years) within 36 months of delivery.Measurements and findingsA modified national survey about accessing maternal health services, including delivery services was administered to all Indigenous women that met eligibility, guided by community leaders. Data collected included socio-demographic characteristics and reproductive history. Main outcome variables were the proportion of women having prior knowledge about and access to facility delivery services for childbirth in the three years prior to the survey. Secondary outcomes were sources of information about facility delivery services, decision making about delivery place, and factors associated with knowledge and attendance at facility delivery services. Factors associated with knowledge and attendance were estimated using logistic regression with results reported as adjusted odds ratios and 95% confidence intervals. With an 89% response rate, a total of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) participated in the survey, and 75% were aged 16–29 years. Relatives played a vital role as a source of information about delivery services (59%). Nearly three-quarters (73%) were aware of facility delivery services, however, prevalence of accessing delivery services was 33% (n = 143; 95% CI 0.28–0.37). Relatives were the key decision-makers for accessing facility delivery services (60%). Independent factors associated with knowledge about facility delivery were higher household income (AOR 5.3, 95%CI 2.2–13); having knowledge of nearest health care facilities (AOR 5.8, 95%CI 3.0–11); and attending antenatal care visits during last pregnancy (four or more AOR 3.1, 95% CI 1.3–7.2 and one to three visits AOR 2.7, 95% CI 1.5–5.0). Independent factors associated with accessing facility delivery services at childbirth were attending antenatal care visit; having access to media; higher level of education of partners; and residing at Khagrachhari Sadar compared to Matiranga subdistrict.Key conclusions and implications for practiceIndigenous women in Chittagong Hill Tracts, Bangladesh have sub-optimal knowledge of, and attendance at, facility delivery services for childbirth. Maternal health related interventions should target Indigenous women in order to educate and motivate them to access facility delivery services at childbirth. Rigorous research is needed to explore Indigenous cultural practices related to childbirth that might influence their access to facility delivery services.     

The use of midwife-led primary antenatal care by obese women in The Netherlands: An explorative cohort study

Objectiveto study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care.Designan explorative cohort study.Setting11 Dutch midwife-led practices.Participantsa cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014.Findingsthe mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R²) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone.Key conclusionsBMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care.Implications for practiceTaking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women.     

Somali women's experiences of antenatal care: A qualitative interview study

ObjectiveTo explore Somali women's experiences of antenatal care in Norway.DesignA qualitative study based on individual semi-structured interviews conducted either face-to-face or over the phone.SettingNorway.ParticipantsEight Somali-born women living in Norway.Key findingsFour themes were generated from the analysis. From their experiences of antenatal care in Norway, the Somali women described: 1) when care was provided in a way that gained their trust, they made better use of the available health services, 2) the importance of continuity of care and of sharing commonalities with the caregiver, 3) a need for accessible information, specifically tailored to the needs of Somali women and 4) how culturally insensitive caregivers had a negative impact on the quality of care.Conclusion and implications for practiceThe Somali women in this study were grateful for the care provided, although the quality of antenatal care did not always meet their needs. This study should serve as a reminder of the importance of establishing trust between the pregnant woman and the caregiver, strengthening interpretation services and assuring tailored information is available to Somali women at an early stage. The findings further suggest that antenatal care for Somali women may be improved by offering continuity of care and improving clinical and cultural skills in clinicians. Suggestions for practice, and future research, include initiating group antenatal care especially tailored to Somali women.     

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Background

Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.

Methods

We used cross-sectional data from a representative sample of 4684 women with children aged 0–11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.

Results

About 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05).

Conclusion

We found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.

     

A safe motherhood education and counselling programme in Istanbul

Objective?Evaluation of an education/counselling programme intended for pregnant/puerperal women in a secondary health care facility.

Methods?The education/counselling programme was launched in September 2004, following the preparation of environmental and material components. Evaluation of the two-year project was achieved by means of satisfaction surveys of service receivers and service providers, an information survey of service receivers and focus group discussions (FGDs) for both groups.

Results?Forty percent of the pregnant women who attended antenatal visits and 90% of those who had recently delivered were given education/counselling in accordance with the project. The information survey showed that 92.5% of the pregnant women knew that they should take an iron supplement during pregnancy and the puerperium; 72% of the puerperal women knew of the danger signs postpartum and concerning the newborn, and 70% were aware of the methods of effective breastfeeding. The FGDs showed improved competence of the applicants in pre-delivery, pregnancy and puerperal care as well as in newborn nutrition. Feedback from service providers confirmed the patients' improved active participation in their self-care.

Conclusion?The safe motherhood education/counselling programme was successfully completed. The applicants and health care professionals benefited from the service.     

First-time mothers’ experiences of preparing for childbirth at advanced maternal age

ObjectiveTo explore the lived experiences of preparing for childbirth for nulliparous women aged 35–44 and determine how mature first-time mothers’ can be better supported regarding childbirth preparation.DesignThe research study comprised a cross-sectional qualitative design utilising Interpretative Phenomenological Analysis to provide a deep exploration into the experience of mature age women.SettingParticipants resided in South Australia and Victoria, Australia, in regional, suburban and inner-city locations.ParticipantsFourteen nulliparous women aged 35–44 were recruited in their third trimester of pregnancy using purposeful sampling.MethodData were collected by conducting in-depth semi-structured interviews during 28–36 weeks of pregnancy. Data were transcribed and analysed using Interpretative Phenomenological Analysis to identify themes of mature first-time mothers’ preparations for childbirth.FindingsThe super ordinate theme “Building confidence for childbirth” describes mature first-time mothers’ experience of preparing for childbirth. This process appears to influence women's information seeking behaviour, expectations of healthcare providers, and reflections on birth planning.ConclusionsParticipants sought various support and interactions with healthcare providers, both helpful and unhelpful, with nulliparous women of advanced maternal age undertaking various preparations with the intention of a positive childbirth experience. Participants were seeking support from friends, along with conducting their own independent research and activities.Implications for practiceIt is evident that more and more women in developed countries are delaying having children into their late thirties and over, and these women report various levels of support from health practitioners. Healthcare professionals have the potential to foster more trustful relationships and empowering interactions with women, provide various resources regarding childbirth preparation, and sensitive birth planning assistance that supports women's agency along with managing risk. Guidelines based on this and other research in managing the antenatal care of women of advanced maternal age would ensure consistency, particularly in terms of risk management and childbirth.     

Preliminary evaluation of the Well-being in Pregnancy (WiP) questionnaire

Background: The concept of well-being is multi-faceted by encompassing both positive and negative emotions and satisfaction with life. Measuring both positive and negative thoughts and emotions is highly relevant in maternity care that aims to optimise a woman’s experience of pregnancy and childbirth, focussing on positive aspects of health and well-being, not just the prevention of ill health. Yet our understanding of well-being in pregnancy and childbirth is limited as research to date has focussed on negative aspects such as stress, anxiety or depression. The primary aim of this study is to describe the psychometric properties of a newly developed Well-being in Pregnancy (WiP) questionnaire.

Methods: A cohort study of 318 women attending hospital antenatal clinics in Belfast completed a questionnaire including three general well-being measures (not pregnancy specific) and the newly developed WiP questionnaire. The psychometric properties of the questionnaire were analysed using correlations to explore the relationship between the WiP questionnaire with the generic well-being measures administered at the same time and exploratory factor analysis was conducted.

Results: The overall Cronbach’s alpha of the WiP was 0.73. Principal factor analysis was run on the WiP items and two factors were identified, one reflecting positive affect and satisfaction (Cronbach’s alpha?=?0.718) and the other concerns (Cronbach’s alpha?=?0.702). Both the overall WiP score and WiP sub-scale scores displayed significant correlations with the other well-being scales (r?=?0.235–0.527).

Conclusions: Measuring well-being in pregnancy is an important step in understanding the potential physical, psychological and social benefits of pregnancy and in understanding how well-being can be enhanced for women and their families at this important life stage. The initial psychometric data presented for the WiP questionnaire are encouraging. Most importantly, the measure provides an opportunity for women to express positive and negative emotions and thoughts about their pregnancy thus reflecting the whole spectrum of well-being.