Improving reproductive health services: Is integration with primary healthcare better than vertical programmes?

At global development agenda, reduction of inequality in utilization of Reproductive and Child Health services across space has been accorded at top priority. In India, Reproductive and Child care is an essential component of its basic health care services. Using third round of District Level Household Survey(2007-08) data, this study examines variation in RCH services across different demographic, socio-economic groups and regions in Uttar Pradesh. The DLHS collected information on wide range of topics: fertility, family-planning, maternal and child health, living condition of household, health infrastructure and other variables. The study was carried out for six services namely Full antenatal care, Post natal care, Safe delivery, Contraceptive use, Unmet need of Family Planning and Child Immunization. For inter-district comparison a composite index of these services has been computed. The Bi-variate and multivariate analysis has been carried out for analysis. Preliminary results show that though utilization of reproductive and child health services has improved in state there is huge interstate and social group disparity in utilization of these services. The multivariate analysis on RCH services indicate that years of schooling and economic status are significant determinants of utilization of RCH services in Uttar Pradesh.

Background: The Vietnamese Government sets clear goals to increase universal access to sexual reproductive healthcare (SRH), particularly at the primary health level-commune health stations (CHSs). However, CHSs are under-utilized due to perceived poor service quality. To strengthen CHSs’ ability to deliver SRH services, Marie Stopes International Viet Nam and local partners implemented a partial social franchise model called “tinh chi em” (Sisterhood).

Objective: Social franchising is aimed at increasing service utilization, especially SRH services; enhancing clinical quality and improving users’ perceptions of services.

Results: “Tinh chi em” successfully franchised 220 CHSs in five provinces between 2007 and 2011. In the first year, service utilization at franchised CHSs increased by four-fold, and SRH consultations increased by five-fold. There was a positive correlation between franchised CHS membership with the improvement in community’s perception of service quality . Client satisfaction level increased significantly at franchised CHSs at first and second follow-up survey .

Conclusion: A partial franchise enables the utilization of existing public health system to increase SRH service delivery at the local level which can potentially reduce the burden on provincial/ central hospitals.

Antenatal care (ANC), which includes care during pregnancy, should begin from the early stages of pregnancy. This study was conducted to assess the factors that determine the use ANC service in a selected rural area of Bangladesh. A community-based cross-sectional study was conducted in Tangail district in Bangladesh. Postnatal mothers were randomly selected. The mean age of the respondents was 24 (SD=±4.4) years. Most (95.6%) women were housewives. Twenty-two percent of the respondents were from the poorest socioeconomic class. Mothers who had one living child had the highest percentage of adequate ANC use compared to those with other mothers who had two or more living children. Access to mass media (newspapers and TV) had a significant (p<0.001) and positive effect on ANC service use. The results of logistic regression showed that, after adjusting other factors, respondents who had primary-level education were nearly five times more likely to inadequate use of ANC compared to those who had higher level of education. The findings of the study supported that education of the mothers is an important determinant of ANC visits during pregnancy. Economic and educational improvements of poor mothers especially in health education through mass media should be strengthened to have a reinforcing effect on improved ANC service use.

It is reported that globally an estimate of 350000 to 500000 women die annually from preventable causes related to pregnancy and childbirth. Namibia as a member of the international community with its own challenges in the health system has also contributed to the mortality figures. MMR significantly increased from 271/100000 in 2000 to 449/100000 live births in 2006/07 and there is a growing concern whether Namibia will be able to achieve the target of reducing MMR by three quarters by 2015. Little is known about the specific factors contributing to maternal deaths in Namibia and a sample for the verbal autopsy consisting of respondents who were identified using the records of all reported maternal death cases in the institutions was drawn. The VA tool was employed to gather information through interviews in the community with family members, relatives, neighbours, or any person who witnessed the road to maternal death of the identified woman. A total of 97 deceased women of childbearing age were included for verbal autopsy. The most common illness suffered by the majority of deceased was HIV/AIDS. About 59% women died as a result of direct causes and the most common direct cause of death was reported to be post-partum hemorrhage.

Adolescent sexual and reproductive health is a critically important and problematic area in sub-Saharan Africa where an estimated one in ten young women experience a premarital birth by age 20. Given the situation, achieving the MDGs will include addressing the sexual and reproductive health needs of young people in the fight against reproductive problems. Using both quantitative and qualitative research approaches, the study examined the structures and main features of traditional teachings and practices and their relevance for adolescent sexuality and reproductive health in Ghana. Evidence from five (5) focus group discussions from a sample size of 30 women selected from adolescent mothers with three generations of women showed that there are traditional beliefs, teachings and practices, including health in general and adolescent sexuality and reproductive health in particular. These included preparation for motherhood, sexuality, sexual relations, pregnancy, post partum sexual abstinence, good hygiene and nutrition practices. The results have implications for health policy and planning regarding the incorporation of traditional health teachings and practices into the adolescent sexuality and reproductive health

Accessibility of contraceptives is a critical factor in determining the use of family planning. Regional differential in contraceptive access in India suggest for a better understanding and exploration of contraceptive method mix which might help program planners and increase use. Data from the District Level Household Survey Data 2007-08 on 4,73,768 currently married women belonging to 22,825 villages of India have been used to examine factors related to the accessibility of family planning services. The effects of individual- level and community-level factors were analyzed jointly.

The analysis measures access to health and family welfare services at village level, by a composite index. The results of the multivariate analysis indicate that not only access to public health facility have influence on utilization of family services after adjusting for the household-level and individual-level socioeconomic and demographic variables, there are some specific components of access e.g. presence of ANM (Auxiliary Nurse/Midwife), connectivity to all weather road, availability of pharmaceutical shops in village etc, have much higher effects on contraceptive use. Thus community resource and along with increased availability of contraceptive methods and information could increase use of family planning.

Use of maternal health services in Pakistan is characterized by vast inequities between the rich and poor. With 70% of services provided by the for-profit private sector, health care is becoming a commodity. To explore if maternal health care use was a symbol of high status, a 10-month village ethnography was conducted in Punjab, Pakistan. The Han et al.’s (2010) model of status consumption was used to understand how wealth level and need for status explained the observed patterns of usage that were sharply fragmented along social class lines. The highest class used the free public sector services, and did not loudly exhibit their use. Their social capital ensured they received acceptable quality care in a system traditionally understood as abusive and exclusionary. The better-off middle class used a private sector midwife and loudly constructed this as a symbol of wealth and status. The poorer middle classes felt social pressure to use the afore-mentioned midwife despite not having the financial means to do so. The poorest class used the public-sector services, and if they found it too abusive, avoided use altogether. In conclusion, when private health care is introduced in highly hierarchical societies, its uptake is susceptible to status consumption and creation of inequities.

The present paper is an attempt to study the utilization of maternal and child health care services in rural areas in the newly formed state of Uttarakhand in India. The data have been analysed from National Family Health Survey-III (NFHS-3). The findings reveal that the utilization of maternal and child care services is not uniform in the state of Uttarakhand. In rural areas of Uttarakhand only 10.5 percent of women received full antenatal care in compare to 33.3 percent of urban women. Only 26.4 percent of births were delivered in a health facility and 31.8 percent of births were assisted by a health professional. In rural areas of Uttarakhand only 28.7 percent of mothers received postnatal check-up. Thus the state has witnessed a higher proportion of high risk pregnancies. After controlling the demographic and socio-economic factors we find that the factors related with the women are the most important predictor in explaining the use of maternal health care services. Women’s age at birth, birth order and education level of the mother found to be the most important predictors for explaining the utilization of maternal and child health care services.

Background. An opportunity for personal contact with women to provide family planning referral message is when they go to health facility for the immunization of their children. Past studies have shown that such an approach can effectively increase the number of women who accept modern family planning (FP).

Methods. In 2011, a study was conducted in Misamis Occidental, Philippines where 42 immunization centers were randomly assigned to treatment (n=21) and control groups (n=21). In the treatment sites, mothers with unmet need for FP were provided referral messages that simply said that the health facility provides modern FP services, and would they like to visit to learn more about modern FP. If yes, a schedule was set for their visit. In the control sites no referral messages were given. After six months the same mothers were interviewed to determine their current family planning status.

Results. Analysis on 1,593 women who had complete information in both surveys showed a net difference in CPR between treatment and control sites of 8.2 percentage points (11.9 percentage increase in the treatment site minus 3.7 percentage point increase in the control sites). This net difference was statistically significant at the 1% level.

Birth-preparedness and complication readiness (BP/CR) is a comprehensive strategy aimed at promoting the timely utilization of skilled maternal and neonatal health care. The key elements include: knowledge of danger signs; plan for where to give birth, plan for a birth attendant, for transportation, for saving money, for potential blood donor and plan for a decision maker as well. This paper analyzes the individual, familial and contextual factors affecting the BP/CR in most populous state of India. Birth preparedness Index (BPI) and Social Composite Index (SCI) was computed to trace the study objective. Data and enough evidences from surveys reveal that government health facility was not the preferred choice for obstetric emergency by majority of mothers. Every eight families out of 10 saved money for delivery. Preparedness for transport was found low due to easy availability of local transport but again lack of maintained roads is a matter of concern for delays in study area. Only few families identified potential blood donor for emergency. BP Index increased from 33% to 54 percent. Increases in six of the seven components of the BPI were significantly associated. Women who have higher social Index (higher agency) have a better birth plan as compare to those women who have low social Index.