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Distance to a maternity ward is correlated with adverse health effects for mothers and infants, motivating this study of maternity ward deserts in Wisconsin. Absolute distance from census tracts is used, as well as a multidimensional measure incorporating income/poverty and low rates of vehicle access, and each are compared to medically-underserved areas (MUAs). Absolute distance places deserts outside of urban areas relative to the multidimensional measure, with different patterns for race/ethnicity, and all are correlated with MUAs. Between 13% (multidimensional measure) and one-fifth (10 mile measure) of the population were in deserts as of 2017. Deserts defined by the 10 mile measure are positively correlated with rates of household vehicle access. A net reduction of 5 maternity wards between 2011 and 2017 resulted in a surprisingly reduced prevalence of maternity deserts (distance measure), although continued reductions in maternity wards may generate more adverse outcomes.

Background Due to the increasing number of vaccine-hesitant parents, new effective immunization promotion strategies need to be developed to improve the vaccine coverage (VC) of infants. This study aimed to assess the impact of an educational strategy of vaccination promotion based on motivational interviewing (MI) techniques targeting parents and delivered at the maternity ward, for the VC of infants at 3, 5, and 7 months of age. Methods An individual educational information session, administered using MI techniques, regarding immunization of infants aged 2, 4, and 6 months was (experimental group) or was not (control group) proposed to parents during the postpartum stay at the maternity ward. Immunization data were obtained through the Eastern Townships Public Health registry for infants at 3, 5, and 7 months of age. Absolute VC increases at 3, 5, and 7 months in the experimental group were calculated and the relative risks with the respective 95% confidence intervals were computed using univariate logistic regression with the generalized estimating equations (GEE) procedure. Multivariate regression using GEE was used to adjust for confounding variables. Results In the experimental and control groups, 1140 and 1249 newborns were included, respectively. A significant increase in VC of 3.2, 4.9, and 7.3% was observed at 3, 5, and 7 months of age ( P < 0.05), respectively. The adjusted relative risk of the intervention’s impact on vaccination status at 7 months of age was 1.08 (95% confidence interval: 1.03–1.14) ( P = 0.002). Conclusions An educational strategy using MI techniques delivered at the maternity ward may be effective in increasing VC of infants at ages 3, 5, and 7 months. MI could be an effective tool to overcome vaccine hesitancy.

Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings. Des données de plus en plus nombreuses issues de documents en provenance d’un certain nombre de pays d’Asie et d’Afrique font état d’importants changements dans les accouchements médicalisés au cours de la dernière décennie. Ces améliorations n’ont pas permis d’obtenir de meilleurs résultats en matière de santé tel que l’avaient prévu autrefois des chercheurs en politiques de la santé. À la lumière de ces données inattendues, nous avons évalué des renseignements provenant de multiples sources, notamment des données représentatives à l’échelle nationale collectées dans 43 pays d’Asie et d’Afrique, afin de comprendre l’importance et l’étendue de changements relatifs au lieu de l’accouchement en Asie et en Afrique. Nous avons passé en revue les politiques, les programmes et les expériences de financement dans plusieurs pays afin de comprendre les facteurs qui influencent les pratiques changeantes et les conséquences pour la santé maternelle et néonatale et les systèmes de santé destinés aux femmes et aux nouveau-nés. Finalement, à mesure que nous progressons vers la prochaine étape de l’action mondiale nous avons examiné les implications des changements relatifs au lieu d’accouchement sur les stratégies de soins maternels et néonatals. À la suite de notre analyse, nous formulons quatre grandes recommandations stratégiques. 1) L’expansion des investissements en faveur des installations de niveau intermédiaire pour les accouchements médicalisés et l’abandon des installations à faible volume pour les accouchements en zones rurales. 2) L’accès assuré pour les femmes rurales grâce au financement des infrastructures de transport, des bons de transport, des subventions ciblées en guise d’appui pour les services et l’hébergement avant et après l’accouchement. 3) La spécialisation accrue des maternités et des services consacrés aux accouchements au sein des grandes formations sanitaires. Et 4) un accent plus marqué en faveur de l’amélioration de la qualité à tous les niveaux des services de soins obstétriques, aussi bien dans les secteurs publics que privés. 亚洲和非洲一些国家有越来越多的证据显示, 过去几十年院内 分娩迅速增长。与卫生政策研究者过去预测的不同, 这些增长 并未带来健康结果的改善。有鉴于此, 我们评估了多种来源的 数据, 包括43个亚洲和非洲国家的全国代表性数据, 以便了解 亚洲和非洲地区分娩场所改变的规模和范围。我们回顾了多 个国家的政策、项目和筹资情况, 从而了解分娩实践变化的驱 动因素, 对孕产妇和新生儿健康以及服务妇女和新生儿的卫生 体系的影响。最后, 我们研究了在向全球行动的下一阶段迈进 时, 分娩场所的变化对孕产妇和新生儿护理策略会带来什么影 响。根据分析结果, 我们提出四项主要的政策建议： （1） 扩 大对中级机构分娩服务的投入, 减少农村地区低服务量分娩机 构的使用； （2） 通过投资交通基础设施、交通补贴、服务定 向补贴、分娩前后入户支持等方式, 确保院内分娩对农村女性 的可及性； （3） 提高妇产机构的专业化, 大型机构设置专门 的妇产病房；（4）所有层级的公立和私立分娩机构重新关注 改善服务质量。 La creciente evidencia de un número de países en Asia y Á frica documenta un incremento en la última década en la partos en las instalaciones de salud. Estos aumentos no han conducido a mejoras en los resultados en la salud que predijeron los investigadores de políticas de salud en el pasado. En el contexto de esta evidencia inesperada, evaluamos los datos de múltiples fuentes, incluyendo datos representativos a nivel nacional de 43 países en Asia y África, para comprender el tamaño y el rango de la localización cambiante de los partos en Asia y África. Revisamos las políticas, los programas y las experiencias financieras en varios países para entender los factores que impulsan las prácticas cambiantes y las consecuencias para la salud materna y neonatal y los sistemas de salud que atienden a mujeres y recién nacidos. Y finalmente, consideramos las implicaciones que los cambios en la localización del parto tendrán para las estrategias de atención materna y neonatal a medida que avanzamos hacia la siguiente etapa de acción global. Como resultado de nuestro análisis, hacemos cuatro recomendaciones principales de políticas. (1) Una expansión de la inversión en instalaciones de nivel medio para servicios de partos y un alejamiento de las instalaciones rurales de parto de bajo volumen. (2) Acceso asegurado para mujeres rurales a través de fondos para infraestructura de transporte, vales de viaje, subsidios específicos para servicios y apoyo de residencia antes y después del parto. (3) Especialización aumentada de las instalaciones de maternidad y salas de maternidad dedicadas dentro de instituciones más grandes. Y (4) un enfoque renovado en mejoras de calidad en todos los niveles de las instalaciones de parto, tanto en entornos privados como públicos.

Introduction Denmark is one of the safest places for childbirth, yet some women report dissatisfaction with their maternity care. However, some negative birth experiences may remain unreported due to thresholds for complaining. The study aimed to identify patterns of unreported negative birth experiences and to quantify the extent of these dark figures. Material and Methods A survey was distributed to 3081 women who gave birth at a Danish hospital in 2022, resulting in 1022 responses (response rate = 33.2%). The women reported their birth experiences in categories based on the Healthcare Complaints Analysis Tool (HCAT), specifying problems, harm caused, and whether they had filed a complaint or intended to. Dark figure ratios regarding problems and harm levels were calculated by comparing unreported negative experiences to formally filed complaints based on the survey responses, covering each problem type and harm level. Results Of the 1022 respondents, 336 (32.9%) women reported negative birth experiences, yet only 26 women had filed complaints. The remaining 310 unreported cases comprised 787 problems across HCAT categories. The most frequent problems were about communication and quality. The highest dark figure ratios were found within the management domain comprising institutional processes (13.0) and environment (9.9). The dark figure ratios showed an inverse relationship with harm severity, being highest for minimal (19.5) and minor (21.2) harm levels and decreasing for moderate (5.5), major (4.8) and catastrophic (0.3) harm levels. Conclusions This study demonstrates a substantial underestimation of negative birth experiences when relying solely on formal complaints, with dark figure ratios ranging from 4.8 to 13, depending on the issue. The inverse relationship between harm severity and dark figure ratios suggests a threshold for filing a complaint, as the likelihood of reporting increases with greater harm. These findings provide novel insights into unreported maternity care experiences, highlighting the need to integrate patient experiences into healthcare improvements. Patient complaints represent only a fraction of problems experienced during childbirth. Among 336 women with negative birth experiences, only 26 filed complaints, revealing a dark figure with up to 13 times more unreported issues. Integrating complaint data with dark figure estimates enables a more accurate assessment of the true scope and nature of patient‐perceived problems.

Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse. In this paper, we report results from a mixed methods study in two hospitals in the Tanga region of Tanzania, comparing the prevalence of disrespect and abuse during childbirth as measured through observation by trained nurses stationed in maternity wards to prevalence as measured by the self-report upon discharge of the same women who had been observed. The huge disparity between these two measures (baseline: 69.83% observation vs. 9.91% self-report; endline: 32.91% observation vs. 7.59% self-report) suggests that disrespect and abuse is both internalised and normalised by users and providers alike. Building on qualitative research conducted in the study sites, we explore the mechanisms by which hidden and invisible power enforces internalisation and normalisation, and describe the implications for the development of HRBAs in maternal health.

The growing congestion in delivery rooms in Israeli hospitals is the underlying issue of the current study. Aim: The study sought to examine various alternatives for public policy aimed at reducing congestion. The choice of Israel as a case study derives from its conspicuous imbalance between supply and demand in the maternity, resulting from the high demand for prenatal and birthing services on one hand and the low supply, both in absolute terms and relative to OECD countries, of medical resources such as physicians, nurses, and hospital beds. The research combines quantitative research that includes analysis of data related to human resources and hospital beds in Israel compared to other countries on one hand and data on productivity and childbirth in Israel on the other, and qualitative research that includes examination of the different alternatives to hospital-based birth. The research findings present fertility and birth data for Israel in the last decade, which are leading to increased congestion and crowding in delivery rooms and maternity wards at local hospitals. Discussion: Two possible alternatives are proposed for designing and implementing public policy capable of contributing to the regulation of this congestion. One is the home birth, and the second is private birthing centers. The research conclusions indicate that policymakers in Israel must anticipate the increasing congestion in hospital delivery rooms and maternity wards and expedite efforts at designing alternative solutions before the emergence of a crisis situation that will make it essential to identify immediate solutions.

Introduction: Nursing students frequently report experiencing both excitement and anxiety during clinical placements, particularly in high‐stakes environments such as maternity wards and pediatric units. Numerous studies have identified challenges such as insufficient supervision, inconsistent mentorship, unclear role expectations, and unsupportive clinical environments as barriers to effective clinical learning. These issues may adversely impact students’ learning outcomes, confidence, and overall satisfaction with the nursing profession. Aim: This study aimed to explore the clinical lived experience of nursing students in the mother and child center. Methods: This study employed interpretive phenomenological analysis (IPA) as its research design. Purposive sampling was used to recruit 14 Kazakhstani nursing students from December 16, 2023, to February 17, 2024. Data were collected through semistructured interviews. The researchers ensured the ethical conduct of the study and addressed rigor by establishing credibility, transferability, dependability, and confirmability. Result: The study reveals four major themes: “transformative learning: from observation to aspiration,” “joy and emotional satisfaction,” “compassion toward mother and newborn,” and “challenges of student nurses.” Conclusion: This study reveals the learning experiences of nursing students and the challenges they encountered at the Mother and Child Center in Kazakhstan. The results can contribute to advancing the clinical education and practice of nursing students in Kazakhstan.

The assessment of acute non‐procedural pain in term neonates in maternity wards is challenging due to the difficulty in selecting an appropriate scale and the time‐consuming nature of the process. This can lead to inadequate neonatal pain management. To validate the EValuation ENfant DOuLeur (EVENDOL) pain scale for acute non‐procedural pain in term neonates in maternity units by comparing it with the Echelle Douleur et Inconfort du Nouveau‐né (EDIN) used as a reference. We hypothesized that EVENDOL would be equivalent to EDIN in assessing acute non‐procedural neonatal pain, with better appearance. Prospective multicentric non‐interventional open study. Term neonates over 37 weeks' gestation in the delivery room and postnatal care units, with or without acute non‐procedural pain, before and after analgesia. Cronbach's α coefficient, intraclass correlation (ICC), and correlation between EVENDOL and EDIN scores, documented by the researchers and the caregivers at rest and mobilization, before and after oral paracetamol, were measured. Ninety‐one neonates were included: 48 (51%) had pain and 43 (47%) had no pain. Before analgesia, the Cronbach coefficient was above 0.80, the ICC (25th–75th interquartile ranges [IQ]) were 0.84 (0.77–0.89) and 0.90 (0.85–0.93) at rest and mobilization, respectively. Seventeen patients received oral acetaminophen and were re‐assessed. Psychometric values remained good after analgesia (Cronbach coefficient above 0.80, ICC [IQ]: 0.65 [0.26–0.85] and 0.76 [0.45–0.91]) at rest and mobilization, respectively. The feasibility and ease of use were better for EVENDOL for researchers and caregivers. EVENDOL is suitable for the assessment of acute non‐procedural neonatal pain for term neonates in the maternity wards. Trial Registration: ClinicalTrials.gov identifier: NCT02819076, registered in June 2016 as EVENDOL scale validation for at term newborn

Background Communication and information are part of the Sexual and Reproductive Health and Rights (SRHR). Various studies show that successful communication between birthing person and health care professionals (HCP) has a positive impact on birth and lowers risk of traumatic birth experience for women. Since information and communication is a major challenge for both forced migrant women (FMW) and health workers during birth, we investigated experiences of both sides in qualitative study. Methods Qualitative interviews were conducted with 7 maternal HCPs (midwifes, physicians, social workers) and with 7 FMW 1-9 months after the birth of their child in 3 regions in Germany. The refugee sample included new mothers from 6 countries of origins, 14 languages, and an average of three years living in Germany. The interviews were analyzed via framework analysis. Results The majority of the interviewed FMW had no or little knowledge about SRHR. Good communication is one of the main factors allowing a safe and trustful environment with the birthing women. If verbal communication is not possible nonverbal communication helps to create and maintain a care relationship with the women is given. However, due to lack of staff, time and interpreters FMW with little German language proficiencies receive hardly any relevant information and had a poorer accompaniment during birth. Conclusions To provide for equity and SRHRs in maternal health and care there is an urgent need for reliable professional interpretation and easily accessible information in relevant languages material about giving birth, medical possibilities, procedures and interventions. Additionally, further training on heterogeneous needs and life contexts is necessary, to improve professional care during birth in maternity wards. HCPs 1:1 support is strongly recommended. Key messages • Information on SRHR and communication are a fundamental part of birth work and should be made possible for all women including FMW to prevent discrimination and traumatic birth experiences. • If given, 1:1 support by HCPs during birth can comensate missing communication.

Background Mistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran. Methods A formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18. Results Mistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth). Conclusions Our study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions. Plain language summary Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. A qualitative approach to explore manifestations of mistreatment during labour and childbirth while learning about the factors that influence them was used for this study. It obtained this information thanks to semi-structured interviews with women, maternity healthcare providers, and managers between October 2021 and May 2022. Our findings showed that women experienced various forms of mistreatment during labour and childbirth. At individual level, e.g., providers’ perception about women’s limited knowledge on childbirth process was an influencing factor for mistreatment. At healthcare provider level, a highlighted factor was provider stress and stressful working conditions. At hospital level, e.g., staff shortages played a main role; and at national health system level, participants believed that lack of access to pain management during labour and childbirth was an influencing factor for mistreatment. These findings can provide a good platform for designing and implementing intervention programs to reduce disrespectful maternity care. It can also be used as a guide for managers and policymakers to improve the quality of services provided to women.