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Background Mobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited. Methods A pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care. Results Two thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05–2.4, p  = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07–2.75, p  = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38–2.33, p  = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49–4.35, p  = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54–0.88, p  = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23–0.91, p  = 0.027). Both groups’ knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards. Conclusions This study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings. Trial registration The mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111 ).

Background Quality maternal care is crucial to improve outcomes for both mothers and newborns. Many initiatives to improve maternal care concentrate on improving clinical practice. However, women’s experiences of care are also important determinants of health outcomes. Establishing strong interpersonal relationships between health workers and women is essential for delivering high-quality person-centered care, with health workers who empathize with women, respect their needs and concerns, and communicate effectively. Aligned with the World Health Organization standards of care framework, this study aimed to explore women’s experiences of care during labour and childbirth, focusing on communication, respectful, and supportive care. Methods A qualitative exploratory study was conducted with postpartum women in rural district hospitals in KwaZulu-Natal. Purposive sampling was used to recruit women from communities within the hospitals’ catchment areas. Data were collected through focus group discussions (FGDs) conducted in the local language of participants. Five FGDs were conducted between January and April 2023. Inductive thematic analysis using NVivo v12 was employed to analyze the data. Findings A few women described positive experiences of care, but most women reported suboptimal care characterized by poor communication, lack of privacy, and disrespectful treatment. Participants described experiences of verbal and physical abuse, being called demeaning names, facing invasive procedures without providing consent, and inadequate emotional support, such as their concerns being systematically ignored and birth companions being denied entry to labour wards. Some women responded to these challenges through various coping mechanisms including staying quiet to avoid confrontation, following instructions rigidly, seeking advice from other women in the labour ward, and in some cases standing up for themselves. Some women described persistent anger and distress as a result of their experiences. Conclusion The findings of the study highlight persistent gaps in effective communication and supportive care for women during labour and childbirth. Possible interventions could be aimed at improving communication skills of health workers as well as fostering a culture of empathy and respect for women in their care. In addition, empowering women through antenatal education and implementing birth companion policies could further improve women’s experiences during labour and childbirth.

Background In July 2008, Ghana introduced a ‘free’ maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the ‘free’ policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception. Methods The study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008–2014) and constructed exposure variable of the FMHCP using mothers’ national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the ‘free’ maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models. Results Antenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06–0.10]; p  < 0.001 and 0.13; CI: 95% [0.11–0.15], p  < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61–2.4]; p  < 0.001 and aOR = 1.87; CI: 95% [1.57–2.23]; p  < 0.001, respectively. Conclusions Antenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.

\"Focussing ethnographically on private sector maternity care in South Africa, Privileges of Birth attends to the ways healthcare and childbirth are shaped by South Africa's racialised history. Birth is one of the most medicalised aspects of the life-cycle across all sectors of society and is also deeply divided between what the privileged can afford compared with the rest of the population. Examining the ethics of care in midwife-attended birth, the author situates the argument in the context of a growing literature on care in anthropological and feminist scholarship, offering a unique account of birthing care in the context of elite care services\"-- Provided by publisher.

Background Maternal mental health conditions are prevalent across the world. For women, the perinatal period is associated with increased rates of depression and anxiety. At the same time, there is widespread documentation of disrespectful care for women by maternity health staff. Improving the empathic engagement skills of maternity healthcare workers may enable them to respond to the mental health needs of their clients more effectively. In South Africa, a participatory empathic training method, the “Secret History” has been used as part of a national Department of Health training program with maternity staff and has showed promising results. For this paper, we aimed to describe an adaptation of the Secret History empathic training method from the South African to the German setting and to evaluate the adapted training. Methods The pilot study occurred in an academic medical center in Germany. A focus group ( n  = 8) was used to adapt the training by describing the local context and changing the materials to be relevant to Germany. After adapting the materials, the pilot training was conducted with a mixed group of professionals ( n  = 15), many of whom were trainers themselves. A pre-post survey assessed the participants’ empathy levels and attitudes towards the training method. Results In adapting the materials, the focus group discussion generated several experiences that were considered to be typical interpersonal and structural challenges facing healthcare workers in maternal care in Germany. These experiences were crafted into case scenarios that then formed the basis of the activities used in the Secret History empathic training pilot. Evaluation of the pilot training showed that although the participants had high levels of empathy in the pre-phase (100% estimated their empathic ability as high or very high), 69% became more aware of their own emotional experiences with patients and the need for self-care after the training. A majority, or 85%, indicated that the training was relevant to their work as clinicians and trainers, that it reflected the German situation, and that it may be useful ultimately to address emotional distress in mothers in the perinatal phase. Conclusions Our study suggests that it is possible to adapt an empathic training method developed in a South African setting and apply it to a German setting, and that it is well received by participants who may be involved in healthcare worker training. More research is needed to assess adaptations with other groups of healthcare workers in different settings and to assess empathic skill outcomes for participants and women in the perinatal period.