Maternal and Child Health Commons^™

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Cesarean Section Deliveries In Egypt: Trends, Practices, Perceptions, And Cost, Nahla G. Abdel-Tawab, Doaa Oraby, Nevine Hassanein, Shatha El-Nakib

Reproductive Health

In Egypt, the past decade has witnessed a sharp increase in the prevalence of cesarean section (CS) with the most recent Egypt Demographic and Health Survey documenting a CS rate of 52 percent, suggesting that cesarean delivery might be overused or used for inappropriate indications. This study aimed to explore trends, practices, and costs associated with CS deliveries to women, their families, and the health system, as well as factors that may contribute to increased use of CS in Egypt. Participating physicians and key informants unanimously agreed that the CS mode of delivery was over-used in Egypt. Perceived reasons underlying …

Dynamics Of Interval Iud Use In India, The Evidence Project

Reproductive Health

The IUD is an important long-acting, reversible contraceptive method, and an alternative to permanent female sterilization that does not carry the risk of regret. In India, as the government aims to expand the basket of reversible method choice available to women, understanding the experiences of those who use the interval IUD is paramount. This brief describes a study by the Population Council, with support from USAID/India, which found that overall there is room to improve the quality of services clients receive. The report recommends disseminating messaging about potential side effects of the IUD, training frontline health workers on four domains …

Dynamics Of Oral Contraceptive Pill Use In India, The Evidence Project

Reproductive Health

The purpose of this brief is to provide evidence that can be used to strengthen the family planning program in India, particularly for community-based and facility-based distribution of oral contraceptive pills (OCPs), use of which remains low despite their availability. Understanding women’s interactions with frontline health workers while obtaining the method and during follow-up counseling can help the Government of India improve its National Family Planning Program. Based on its findings, the report recommends that all providers, especially frontline health workers, receive training focusing on four domains of quality of care: 1) respectful care, 2) counseling to enable appropriate method …

Dynamics Of Postpartum Iud Use In India, The Evidence Project

Reproductive Health

Evidence suggests that in India, compared to married women in general, postpartum married women have a much higher need for family planning that remains unmet. India’s postpartum IUD (PPIUD) program aims to help postpartum women space pregnancies and prevent mistimed or unwanted births. The majority of PPIUD users in this study were young, educated, and had one child. Most were involved in making the final decision about which family planning method to use after discussions with the provider, and most had spoken with a frontline health worker at least once about family planning methods in the three months preceding birth …

Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren

Reproductive Health

Pre-eclampsia and eclampsia (PE/E)—life-threatening high blood pressure and excess protein in the urine after 20 weeks gestation—is a leading cause of pregnancy-related deaths. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. The Population Council implemented a two-phase intervention involving training, mentoring, and supervising providers at secondary facilities on detection and management of PE/E patients (Phase 1), and training primary health care (PHC) providers to administer a modified loading dose of magnesium sulphate and refer women to secondary health facilities for monitoring (Phase 2). This brief describes the Population Council’s …

Engaging Community Women's Groups For Improved Uptake Of Antenatal Care Services In Cross River State, Nigeria: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

The Ending Eclampsia project seeks to understand the potential of underutilized and promising interventions that increase access to services, particularly improving community referral systems. This brief reports on a study in Nigeria’s Cross River state that aimed to test the feasibility of women’s group leaders delivering health information for pre-eclampsia and eclampsia (PE/E), referral, and other antenatal care (ANC) services to their peers, to increasing access to quality maternal and newborn health services. Women’s group findings suggest that community engagement is a critical model for information sharing and is an adaptable, acceptable model for increasing PE/E prevention and danger-sign recognition …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Cross River State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Cross River State on post-intervention landscape changes in: programmatic …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Ebonyi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Ebonyi State on post-intervention landscape changes in: programmatic and …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Kogi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Kogi state on post-intervention landscape changes in: programmatic and …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Ebonyi, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina …

Involving Men To Improve Maternal And Newborn Health: A Systematic Review Of The Effectiveness Of Interventions, Mariam Tokhi, Liz Comrie-Thomson, Jessica Davis, Anayda Portela, Matthew Chersich, Stanley Luchters

Population Health, East Africa

Background: Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes.

Objective: To determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships. …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

Food Allergy In Youth: A Primer For Allied Health Professionals, Philip Welch, Lauren Maziarz, Macy Mccartney, Chelsea Raker

Internet Journal of Allied Health Sciences and Practice

Purpose: Many youth struggle with the physical, mental, and social burdens of food allergy. The exact cause of food allergies is unknown, but several theories exist such as the “couch potato theory”, “hygiene hypothesis”, “microflora theory”, and “alarmins” theory. This non-systematic literature review summarizes the problem of youth food allergy and provides guidance to allied health professionals.

Method: A literature search of the relevant literature from years 2000 through 2017 was conducted using PubMed with the key words “food allergy”, “youth”, and “management”.

Results: Youth with food allergy may experience anxiety, social isolation, bullying, and depression, in addition to life-threatening …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

A Stakeholder Examination Of Gestational Weight Gain Guidelines, Melissa Kwitowski

Theses and Dissertations

Obesity is a significant health concern for women of childbearing age. More than 40% of women have a Body Mass Index (BMI) in the overweight or obese ranges at the time they conceive, posing significant health risks for both mother and child. Excessive weight gain during pregnancy is common and associated with numerous deleterious complications. The Institute of Medicine published gestational weight gain (GWG) guidelines based on prepregnancy BMI. However, more than 50% of women gain in excess of these recommendations. Further, many women report receiving minimal guidance from their healthcare providers regarding weight gain, nutrition, and physical activity during …

Do Adverse Pregnancy Outcomes Predict Under-Five Mortality In Nigeria?, Henry Chukwunonso Debem, Amany H. Refaat, Tolulope A. Osoba

Journal of Social, Behavioral, and Health Sciences

Nigerian children under 5 years of age are over 15 times more at risk of death than their counterparts in developed regions of the world; the prevalence of miscarriage, an adverse pregnancy outcome (APO), was estimated at 49%. In the present study, the relationship between APO and under-5 mortality (U5M) in Nigeria was examined to determine if APO could be used as a reliable early warning indicator for U5M. We used a cross-sectional secondary data analysis of datasets from three Nigeria demographic and health surveys: 2003, 2008, and 2013. The study population was women of reproductive age (15–49). Cochran–Mantel–Haenzel chi-square …

The Impact Of Mother–Father Relationship, Social Support And Neighborhood Context On Preterm Birth, Timothy O. Ihongbe

Theses and Dissertations

Background: Preterm birth is a major public health concern in the US. Previous studies have suggested that quality of the mother-father relationship, social support, and neighborhood violence may be associated with preterm birth; however, findings are equivocal.

Objectives: The main objectives of this dissertation were: 1) to determine the modifying effect of perceived residential environment on the association between quality of mother–father relationship and preterm birth in a sample of African-American women, 2) to examine whether the receipt of social support modifies the association between neighborhood violence exposure and preterm birth in a nationally representative sample of US women, and …

Factors Associated With Iron-Folic Acid Supplement Use Among Pregnant Women In Karu, Nasarawa State, Nigeria - A Cross Sectional Study Using Theory Of Planned Behavior, Toyin O. Akomolafe

College of Graduate Studies: Theses & Dissertations

Introduction: Iron-folic acid supplementation is one of the key interventions provided during antenatal care (ANC) services to reduce iron deficiency, maternal anemia, low birthweight and other pregnancy-related complications responsible for maternal and neonatal mortality. However, use of iron-folic acid supplements and adherence with recommended dosage in Nigeria is low. The purpose of this cross-sectional study was to examine factors associated with iron-folic acid supplements use among pregnant women in Karu local government area (LGA), Nasarawa, Nigeria. Methods: Questionnaires were administered in face-to-face interviews with 64 pregnant women (18 – 49 years old) and 19 healthcare providers in selected …

Cutting The Cords: Provider, Payer, Policy And Maternity Outcomes In Selected U. S. States, Courtney Gustin

College of Graduate Studies: Theses & Dissertations

Objective: The purpose of this study was to determine if there is variation in interventions and complications in the labors of women cared for by nurse midwives compared with physicians after controlling for medical risks and sociodemographic factors in pregnant women in Georgia, New Mexico, Illinois, Virginia, and Alaska.

Methods: The study was based on a secondary analysis of 2015 Birth Certificate Data from the National Center for Health Statistics. The outcome variables included VBAC, induction/augmentation of labor, third and fourth-degree laceration, and chorioamnionitis. The exposure of interest was provider type- nurse-midwife or physician. Multiple logistic regression was used to …

Insights And Evidence Gaps In Girl-Centered Programming: A Systematic Review, Nicole Haberland, Katharine Mccarthy, Martha Brady

Poverty, Gender, and Youth

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research …

Inequities In Antenatal Care, And Individual And Environmental Determinants Of Utilization At National And Sub-National Level In Pakistan: A Multilevel Analysis, Ambreen Sahito, Zafar Fatmi

Community Health Sciences

Background: Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies.
Methods: We analysed 7142 women with a recent birth, to assess the …

Root-Cause Analysis Of Persistently High Maternal Mortality In A Rural District Of Indonesia: Role Of Clinical Care Quality And Health Services Organizational Factors, Mohammad Afzal Mahmood, Ismi Mufidah, Steven Scroggs, Amna Rehana Siddiqui, Hafsa Raheel, Koentijo Wibdarminto, Bernardus Dirgantoro, Jorien Vercruyssen, Hayfaa A. Wahabi

Community Health Sciences

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.
Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.
Findings: The root causes were found in poor quality of care, which caused …