Explore the vast range of titles available.

Background Maternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 ( N  = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation ( N  = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level. Results Attendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5–1.8], 2.3 [2.1–2.6], and 3.1 [2.8–3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother’s country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy. Conclusion Social deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them.

The objective of the study is to identify racial disparities in prenatal care (PNC) utilization and to examine the relationship between PNC and preterm birth (PTB), low birth weight (LBW) and infant mortality in Mississippi. Retrospective cohort from 1996 to 2003 linked Mississippi birth and infant death files was used. Analysis was limited to live-born singleton infants born to non-Hispanic white and black women ( n  = 292,776). PNC was classified by Kotelchuck’s Adequacy of Prenatal Care Utilization Index. Factors associated with PTB, LBW and infant death were identified using multiple logistic regression after controlling for maternal age, education, marital status, place of residence, tobacco use and medical risk. About one in five Mississippi women had less than adequate PNC, and racial disparities in PNC utilization were observed. Black women delayed PNC, received too few visits, and were more likely to have either “inadequate PNC” ( P  < 0.0001) or “no care” ( P  < 0.0001) compared to white women. Furthermore, among women with medical conditions, black women were twice as likely to receive inadequate PNC compared to white women. Regardless of race, “no care” and “inadequate PNC” were strong risk factors for PTB, LBW and infant death. We provide empirical evidence to support the existence of racial disparities in PNC utilization and infant birth outcomes in Mississippi. Further study is needed to explain racial differences in PNC utilization. However, this study suggests that public health interventions designed to improve PNC utilization among women might reduce unfavorable birth outcomes especially infant mortality.

Background In Rwanda, a majority of pregnant women visit antenatal care (ANC) services, however not to the extent that is recommended. Association between socio-demographic or psychosocial factors and poor utilization of antenatal care services (≤2 visits during the course of pregnancy irrespective of the timing) among recently pregnant women in Rwanda were investigated. Methods This population-based, cross sectional study included 921 women who gave birth within the past 13 months. Data was obtained using an interviewer-administered questionnaire. For the analyses, bi-and multivariable logistic regression was used and odds ratios were presented with their 95% confidence intervals. Results About 54% of pregnant women did not make the recommended four visits to ANC during pregnancy. The risk of poor utilization of ANC services was higher among women aged 31 years or older (AO R , 1.78; 95% CI: 1.14, 2.78), among single women (AOR, 2.99; 95% CI: 1.83, 4.75) and women with poor social support (AOR, 1.71; 95% CI: 1.09, 2.67). No significant associations were found for school attendance or household assets (proxy for socio-economic status) with poor utilization of ANC services. Conclusion Older age, being single, divorced or widowed and poor social support were associated with poor utilization of ANC services. General awareness in communities should be raised on the importance of the number and timing of ANC visits. ANC clinics should further be easier to access, transport should be available, costs minimized and opening hours may be extended to facilitate visits for pregnant women.

Several different indices of prenatal care have been used in birth outcome models to analyze the relationship between the adequacy of prenatal care and low birthweight, preterm birth, and infant mortality. This investigation compared the performance of the Kessner index, the GINDEX, the adequacy of prenatal care utilization (APNCU) and certain variants of the APNCU in such outcome models. Data from National Center for Health Statistics' (NCHS) Linked Birth and Infant Death Cohort files were used in multivariate logistic regression models to estimate adjusted odds ratios comparing different prenatal care utilization categories for each index. When the indices were used in small-for-gestational-age outcome models, the conclusions suggested by the various indices were similar. In models for preterm birth and infant mortality, by contrast, the various indices gave widely differing results. Unlike the use of other indices, the use of the GINDEX paradoxically suggested that birth outcomes were better in the inadequate, intermediate, and intensive categories than in the adequate category. The conclusions drawn concerning the association between prenatal care utilization and small-for-gestational-age seem relatively robust in the sense of being consistent across indices. In analyzing associations between prenatal care and preterm birth or infant mortality, care must be taken in choosing indices, because results differ substantially across indices.

We examined disparities in prenatal care utilization (PNCU) among U.S. and foreign-born women with chronic conditions. We performed a cross-sectional analyses using data from 2011 to 2012 National Center for Health Statistics Natality Files (n = 6,644,577) to examine the association between maternal nativity (U.S. vs. foreignborn), presence of a chronic condition (diabetes or hypertensive disorder) and PNCU. After adjustment for selected maternal characteristics, overall and among those with chronic conditions, foreign-born women reported significantly lower odds of intensive and adequate PNCU and higher odds of intermediate and inadequate PNCU than U.S.-born women. Few differences in report of no care were found by maternal nativity. These findings suggest that foreign-born women may be receiving some form of prenatal care, but adequacy of care is likely to be lower compared to U.S.-born counterparts, even among those with chronic conditions.

The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant.

Background Sao Tome & Principe (STP) has a high peri-neonatal mortality rate and access to high-quality care before childbirth has been described as one of the most effective means of reducing it. The country has a gap in the coverage-content of antenatal care (ANC) services that must be addressed to better allocate resources to ultimately improve maternal and neonatal health. Therefore, this study aimed to identify the determinants for adequate ANC utilization considering the number and timing of ANC contacts and screening completion. Methods A hospital based cross-sectional study was undertaken among women admitted for delivery at Hospital Dr. Ayres de Menezes (HAM). Data were abstracted from ANC pregnancy cards and from a structured face-to-face interviewer-administered questionnaire. ANC utilization was classified as partial vs adequate. Adequate ANC utilization was defined as having ANC 4 or more contacts, first trimester enrolment plus one or more hemoglobin tests, urine, and ultrasound. The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Multivariable logistic regression was used to identify determinants of adequate ANC utilization at P -value < 0.05. Results A total of 445 mothers were included with a mean age of 26.6 ± 7.1, an adequate ANC utilization was identified in 213 (47.9%; 95% CI: 43.3–52.5) and a partial ANC utilization in 232 (52.1%; 95% CI: 47.5–56.7). Age 20–34 [AOR 2.27 (95% CI: 1.28–4.04), p  = 0.005] and age above 35 [AOR 2.5 (95% CI: 1.21–5.20), p  = 0.013] when comparing with women aged 14–19 years, urban residence [AOR 1.98 (95% CI: 1.28–3.06), p  < 0.002], and planned pregnancy [AOR 2.67 (95% CI: 1.6–4.2), p  < 0.001] were the determinants of adequate ANC utilization. Conclusion Less than half of the pregnant women had adequate ANC utilization. Maternal age, residence and type of pregnancy planning were the determinants for adequate ANC utilization. Stakeholders should focus on raising awareness of the importance of ANC screening and engaging more vulnerable women in earlier utilization of family planning services and choosing a pregnancy plan, as a key strategy to improve neonatal health outcomes in STP.

Objectives. We sought to understand how local immigration enforcement policies affect the utilization of health services among immigrant Hispanics/Latinos in North Carolina. Methods. In 2012, we analyzed vital records data to determine whether local implementation of section 287(g) of the Immigration and Nationality Act and the Secure Communities program, which authorizes local law enforcement agencies to enforce federal immigration laws, affected the prenatal care utilization of Hispanics/Latinas. We also conducted 6 focus groups and 17 interviews with Hispanic/Latino persons across North Carolina to explore the impact of immigration policies on their utilization of health services. Results. We found no significant differences in utilization of prenatal care before and after implementation of section 287(g), but we did find that, in individual-level analysis, Hispanic/Latina mothers sought prenatal care later and had inadequate care when compared with non-Hispanic/Latina mothers. Participants reported profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members. Conclusions. Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos’ understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver’s licenses) to help undocumented persons access and utilize these services.

Background In Nigeria, over one third of pregnant women do not attend Antenatal Care (ANC) service during pregnancy. This study evaluated barriers to the use of ANC services in Nigeria from the perspective of non-users. Methods Records of the 2199 (34.9%) respondents who did not use ANC among the 6299 women of childbearing age who had at least one child within five years preceding the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus II), were used for this analysis. The barriers reported for not visiting any ANC provider were assessed vis-à-vis respondents’ social demographic characteristics, using multiple response data analysis techniques and Pearson chi-square test at 5% significance level. Results Of the mothers who did not use ANC during five years preceding the survey, rural dwellers were the majority (82.5%) and 57.3% had no formal education. Most non-users (96.5%) were employed while 93.0% were currently married. North East with 51.5% was the geographical zone with highest number of non-users compared with 14.3% from the South East. Some respondents with higher education (2.0%) and also in the wealthiest quintiles (4.2%) did not use ANC. The reasons for non-use of ANC varied significantly with respondents’ wealth status, educational attainment, residence, geographical locations, age and marital status. Over half (56.4%) of the non-users reported having a problem with getting money to use ANC services while 44.1% claimed they did not attend ANC due to unavailability of transport facilities. The three leading problems: “getting money to go”, “Farness of ANC service providers” and “unavailability of transport” constituted 44.3% of all barriers. Elimination of these three problems could increase ANC coverage in Nigeria by over 15%. Conclusion Non-use of ANC was commonest among the poor, rural, currently married, less educated respondents from Northern Nigeria especially the North East zone. Affordability, availability and accessibility of ANC providers are the hurdles to ANC utilization in Nigeria. Addressing financial and other barriers to ANC use, quality improvement of ANC services to increase women’s satisfaction and utilization and ensuring maximal contacts among women, society, and ANC providers are surest ways to increasing ANC coverage in Nigeria.

While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage—Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facilitybased delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. Bien que la recherche ait évalué l’impact de l’assurance maladie sur l’utilisation des soins de santé, peu d’études se sont focalisées sur les effets de l’assurance maladie sur le recours aux soins de santé maternelle. Grâce à l’analyse des données nationales représentatives provenant d’Enquêtes sur la Démographie et la Santé (DHS) cette étude évalue l’impact du régime dl’assurance maladie sur l’utilisation des services de santé maternelle dans trois pays présentant un niveau relativement élevé de couverture d’assurance maladie – le Ghana, l’Indonésie et le Rwanda. L’analyse fait appel à l’appariement des cœfficients de propension pour tenir compte d’un choix manquant d’impartialité dansl’adoption de l’assurance maladie, et pour mesurer l’impact de l’assurance maladie sur quatre évaluations d’utilisation des soins de santé maternelle: effectuer au moins une visite prénatale; effectuer quatre (ou plus) visites prénatales; commencer les soins prénataux au cours du premier trimestre de la grossesse, et accoucher dans un établissement de santé. Bien que les régimes d’assurance maladie dans ces trois pays soient surtout conçus pour se concentrer sur les pauvres, la protection a été fortement orientée vers les riches, en particulier au Ghana et au Rwanda Dans le cas de l’Indonésie, on note moins de différences entre la protection et la situation économique. L’analyse a pu révéler les effets positifs considérables de l’assurance maladie sur au moins deux des quatre mesures d”utilisation des soins de santé maternelle dans chacun des trois pays. L’Indonésie est le pays où l’effet de l’assurance maladie sur l’ensemble des quatre mesures est le plus systématique. L’impact positif de l’assurance maladie semble plus important dans le le recours à l’accouchement en maternité, que dans le recours aux soins prénataux. L’analyse suggère qu’un’élargissement de l’assurance maladie visant à inclure des primes accordées aux faibles revenus ou des exonérations pour les populations pauvres, à faible revenu ou sans quote-part, peut renforcer le recours aux des soins de santé maternelle. 虽然有研究评估了医疗保险对医疗利用率的影响, 但很少有研 究探讨医保对孕产妇医疗使用的作用。 本研究分析国家人口 和卫生调查 （DHS） 中的国家代表性数据, 评估医疗保险在三 个医保覆盖率较高的国家 （加纳、印度尼西亚和卢旺达） 中 对孕产妇医疗服务使用的影响。 本研究采用倾向得分匹配校 正医保使用的选择偏倚, 评估医保对孕产妇医疗使用四个测量 值的影响：至少接受一次产前保健； 接受四次或四次以上产 前保健； 孕前期开始产前保健； 院内分娩。尽管这三个国家 的医保大多是为贫困人口设计, 保险覆盖率却极大地向富人倾 斜, 尤其是在加纳和卢旺达。印度尼西亚不同富裕程度之间的 医保覆盖率差异较小。 本研究发现, 在这三个国家, 医保覆盖 对至少两项孕产妇医疗服务使用测量值有积极作用。较为突 出的是印度尼西亚, 医保覆盖对所有四个测量值均有影响。 与 产前保健相比, 医保覆盖对院内分娩的积极影响更为一致。 本 研究提示, 扩大医疗保险, 根据收入调整保费或免除贫困人群 费用, 降低或取消共同支付费用, 可以增加孕产妇医疗的使 用。 Mientras la investigación ha evaluado el impacto del seguroa de salud sobre la utilización del cuidado de la salud, pocos estudios se han centrado sobre los efectos del seguro de salud sobre el uso del cuidado de la salud materna. Analizando los datos nacionales representativos de las Encuestas Demográficas y de Salud (EDS), este estudio estima el impacto del estatus de seguro de salud en el uso de servicios de salud materna en tres países con niveles relativamente altos de cobertura del seguro de salud — Ghana, Indonesia y Ruanda. El análisis usa el pareamiento por puntaje de propensión para ajustar el sesgo de selección en la absorción del seguro de salud y para evaluar el efecto del seguro de salud en cuatro mediciones de la utilización del cuidado de la salud materna: realización de al menos una visita de cuidado prenatal; realización de cuatro o más visitas de cuidado prenatal; iniciación del cuidado prenatal dentro del primer trimestre y parto en una instalación de salud. Aunque los planes de seguro de salud en estos tres países están diseñados principalmente para centrarse en los pobres, la cobertura ha sido altamente sesgada hacia los ricos, especialmente en Ghana y Ruanda. Indonesia muestra menos variación en la cobertura por la condición de riqueza. El análisis encontró efectos positivos significativos de la cobertura del seguro de salud sobre por lo menos dos de las cuatro medidas de utilización del cuidado de la salud materna en cada uno de los tres países. Indonesia se destaca por el efecto más sistemático del seguro de salud en las cuatro medidas. El impacto positivo sobre el seguro de salud aparece más consistentemente en el uso de instalaciones de salud durante el parto que en el uso del cuidado prenatal. El análisis sugiere que la ampliación del seguro de salud para incluir primas o exenciones sensibles a los ingresos para los pobres y copagos bajos o inexistentes puede aumentar el uso de la atención de la salud materna.