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Annals of Internal Medicine Dec 2020Early prenatal care is vital for improving maternal health outcomes and health behaviors, but medically vulnerable and underserved populations are less likely to begin...
BACKGROUND
Early prenatal care is vital for improving maternal health outcomes and health behaviors, but medically vulnerable and underserved populations are less likely to begin prenatal care in the first trimester. In 2017, the Health Center Program provided safety-net care to more than 27 million persons, including 573 026 prenatal patients, at approximately 12 000 sites across the United States and U.S. jurisdictions. As part of a mandatory reporting requirement, health centers tracked whether patients initiated prenatal care in their first trimester of pregnancy.
OBJECTIVE
To identify health center characteristics associated with the initiation of prenatal care in the first trimester, as well as actionable steps policymakers, providers, and health centers can take to promote early initiation of prenatal care.
DESIGN
Secondary analysis of cross-sectional data from the 2017 Uniform Data System.
SETTING
The United States and 8 U.S. jurisdictions.
PARTICIPANTS
Health center grantees with prenatal patients ( = 1281).
MEASUREMENTS
Multinomial logistic regression (adjusted for state or jurisdiction clustering) was used to identify health center characteristics associated with achievement of the Healthy People 2020 baseline (77.1%) and target (84.8%) for women receiving prenatal care in the first trimester (Maternal, Infant, and Child Health Objective 10.1).
RESULTS
Overall, 57.4% of health centers met the Healthy People 2020 baseline (mean, 78%; median, 81%), and 37.9% met the Healthy People 2020 target. Several characteristics were positively associated with meeting the baseline (larger proportion of prenatal patients aged 20 to 24 years) and target (more total patients, prenatal care by referral only, a larger proportion of prenatal patients aged 25 to 44 or ≥45 years, and a larger proportion of White or privately insured patients). Other characteristics were negatively associated with the baseline (location outside New England, location in a rural area, and a large proportion of prenatal patients aged <15 years) and target (more prenatal patients, location outside New England, provision of prenatal care to women living with HIV, and more uninsured patients or patients eligible for both Medicare and Medicaid).
LIMITATION
The data set is at the health center grantee level and does not contain information on timing or quality of follow-up prenatal care.
CONCLUSION
Most health centers met the Healthy People 2020 baseline, but opportunities for improvement remain and the Healthy People 2020 target is still a challenge for many health centers. Policymakers, providers, and health centers can learn from high-achieving centers to promote early initiation of prenatal care among medically vulnerable and underserved populations.
PRIMARY FUNDING SOURCE
Health Resources and Services Administration.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Logistic Models; Pregnancy; Pregnancy Trimesters; Prenatal Care; Time Factors; United States; United States Health Resources and Services Administration; Young Adult
PubMed: 33253020
DOI: 10.7326/M19-3248 -
BMC Pregnancy and Childbirth Sep 2021Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal...
BACKGROUND
Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia.
METHODS
We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25.
RESULTS
Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces.
CONCLUSION
Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services.
Topics: Adolescent; Adult; Continuity of Patient Care; Cross-Sectional Studies; Educational Status; Female; Humans; Male; Maternal Health Services; Middle Aged; Patient Acceptance of Health Care; Pregnancy; Prenatal Care; Socioeconomic Factors; Surveys and Questionnaires; Young Adult; Zambia
PubMed: 34482830
DOI: 10.1186/s12884-021-04080-1 -
Revista Brasileira de Enfermagem 2024To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy. (Review)
Review
OBJECTIVE
To identify in the literature and summarize the elements and characteristics of fatherhood involved during pregnancy.
METHOD
Scoping review that used PRISMA-ScR guide to report this review. Searches were carried out in PubMed, CINAHL, PsycInfo, LILACS and Scopus. Google search engines and public health agency websites assisted in searches of gray literature and Rayyan in screening studies.
RESULTS
A total of 406 articles were identified, of which 16 made up the final sample. Five elements make up an involved fatherhood: feeling like a father, being a provider and protector, being a partner and participant in pregnancy, participating in prenatal appointments and feeling prepared to take care of a baby.
CONCLUSION
Fathers want to be involved in prenatal care, but feel excluded from this process. Public policies that encourage paternal involvement and healthcare professional training to better welcome and promote paternal involvement are of paramount importance.
Topics: Humans; Fathers; Pregnancy; Female; Male; Prenatal Care
PubMed: 38716905
DOI: 10.1590/0034-7167-2023-0029 -
Revista Colombiana de Obstetricia Y... Sep 2021To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals.
OBJECTIVE
To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals.
MATERIALS AND METHODS
Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified.
RESULTS
The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years.
CONCLUSIONS
It is advisable to develop education strategies, strengthen group care and involve the teenager’s support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.
Topics: Adolescent; Brazil; Delivery of Health Care; Female; Humans; Pregnancy; Pregnancy in Adolescence; Pregnant Women; Prenatal Care
PubMed: 34851568
DOI: 10.18597/rcog.3695 -
Ethiopian Journal of Health Sciences Mar 2020
Topics: Developing Countries; Female; Health Services Accessibility; Healthcare Disparities; Humans; Maternal Health Services; Prenatal Care; Socioeconomic Factors
PubMed: 32165803
DOI: 10.4314/ejhs.v30i2.1 -
JAMA Network Open Dec 2021Policy makers are considering insurance expansions to improve maternal health. The tradeoffs between expanding Medicaid or subsidized private insurance for maternal...
IMPORTANCE
Policy makers are considering insurance expansions to improve maternal health. The tradeoffs between expanding Medicaid or subsidized private insurance for maternal coverage and care are unknown.
OBJECTIVE
To compare maternal coverage and care by Medicaid vs marketplace eligibility.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective cohort study using a difference-in-difference research design was conducted from March 14, 2020, to April 22, 2021. Maternal coverage and care use were compared among women with family incomes 100% to 138% of the federal poverty level (FPL) residing in 10 Medicaid expansion sites (exposure group) who gained Medicaid eligibility under the Affordable Care Act and in 5 nonexpansion sites (comparison group) who gained marketplace eligibility before (2011-2013) and after (2015-2018) insurance expansion implementation. Participants included women aged 18 years or older from the 2011-2018 Pregnancy Risk Assessment Monitoring System survey.
EXPOSURES
Eligibility for Medicaid or marketplace coverage under the Affordable Care Act.
MAIN OUTCOMES AND MEASURES
Outcomes included coverage in the preconception and postpartum periods, early and adequate prenatal care, and postpartum checkups and effective contraceptive use.
RESULTS
The study population included 11 432 women age 18 years and older (32% age 18-24 years, 33% age 25-29 years, 35% age ≥30 years) with incomes 100% to 138% FPL: 7586 in a Medicaid state (exposure group) and 3846 in a nonexpansion marketplace state (comparison group). Women in marketplace states were younger, had higher educational level and marriage rates, and had less racial and ethnic diversity. Medicaid relative to marketplace eligibility was associated with increased Medicaid coverage (20.3 percentage points; 95% CI, 12.8 to 30.0 percentage points), decreased private insurance coverage (-10.8 percentage points; 95% CI, -13.3 to -7.5 percentage points), and decreased uninsurance (-8.7 percentage points; 95% CI, -20.1 to -0.1 percentage points) in the preconception period, increased postpartum Medicaid (17.4 percentage points; 95% CI, 1.7 to 34.3 percentage points) and increased adequate prenatal care (4.4 percentage points; 95% CI, 0.1 to 11.0 percentage points) in difference-in-difference models. No evidence of significant differences in early prenatal care, postpartum check-ups, or postpartum contraception was identified.
CONCLUSIONS AND RELEVANCE
In this cohort study, eligibility for Medicaid was associated with increased Medicaid, lower preconception uninsurance, and increased adequate prenatal care use. The lower rates of preconception uninsurance among Medicaid-eligible women suggest that women with low incomes were facing barriers to marketplace enrollment, underscoring the potential importance of reducing financial barriers for the population with low incomes.
Topics: Adult; Cohort Studies; Eligibility Determination; Female; Health Services Accessibility; Humans; Insurance Coverage; Insurance, Health; Medicaid; Patient Protection and Affordable Care Act; Postnatal Care; Poverty; Pregnancy; Prenatal Care; Retrospective Studies; United States; Young Adult
PubMed: 34870677
DOI: 10.1001/jamanetworkopen.2021.37383 -
Sexual & Reproductive Healthcare :... Jun 2022Neglect is a form of child abuse in which the child's basic needs are not met. Early identification of the risk factors and protective factors is key to intervention...
BACKGROUND
Neglect is a form of child abuse in which the child's basic needs are not met. Early identification of the risk factors and protective factors is key to intervention strategies when a child is at risk of neglect. Few international studies describe midwives' experiences of identifying children at risk of neglect, and no Swedish studies have been found.
OBJECTIVES
The aim was to describe midwives' experiences of identifying children at risk of neglect.
METHOD
A qualitative method with a phenomenological reflective lifeworld approach. Interviews with ten midwives from two hospitals and six antenatal clinics in the western part of Sweden, with six from antenatal care and four from postpartum care.
RESULTS
The essential structure of midwives' experiences is described as an important dimension of their profession that is a difficult, complex, ambiguous, and divided task. There is a fear of losing the relationship with the woman and worry about misinterpreting signals. Professional differences may arise when midwives are questioned by colleagues on decisions they have made when identifying children at risk of neglect. Midwives expressed their desire to work in a cohesive maternity healthcare system so that the women experience continuity during pregnancy, childbirth, and postpartum care.
CONCLUSIONS
The study shows how midwives, during both antenatal and postpartum care, have an important but difficult task in identifying children at risk of neglect. During pregnancy and postpartum care, midwives in Sweden meet almost all women and therefore have a unique opportunity for early detection and action.
Topics: Child; Delivery, Obstetric; Female; Humans; Midwifery; Parturition; Pregnancy; Prenatal Care; Qualitative Research; Sweden
PubMed: 35240571
DOI: 10.1016/j.srhc.2022.100701 -
Tropical Medicine & International... Apr 2020Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality...
OBJECTIVE
Although substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor-quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.
METHODS
We used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random-intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient-, provider- and facility-level and subnational divisions).
RESULTS
Only 61-66% of basic elements of competent and respectful care were performed. In adjusted models, better-staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV-positive women received higher-quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage-point gap between Nairobi and the Coast region. Quality was also higher in higher-volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient-level characteristics in Malawi.
CONCLUSIONS
Our findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher-volume facilities - along with promotion of respectful care in these facilities - should be considered in sub-Saharan Africa to improve outcomes for mothers and newborns.
Topics: Adolescent; Adult; Delivery, Obstetric; Female; Health Facilities; Humans; Infant, Newborn; Kenya; Malawi; Pregnancy; Prenatal Care; Quality Indicators, Health Care; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 31828923
DOI: 10.1111/tmi.13361 -
Ciencia & Saude Coletiva Mar 2020The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study...
The Prenatal Care and Birth Humanization Program (PHPN) establishes a minimum number of procedures to be provided to all pregnant women during prenatal care. This study aimed to analyze the quality of prenatal care in Sergipe based on the PHPN recommendations. This is a cross-sectional study, with a descriptive and analytic approach, using survey data from the Birth in Sergipe research, conducted from June 2015 to April 2016 with 768 puerperae proportionally distributed among all state maternity hospitals (n = 11). Data were collected from face-to-face interviews and patients' prenatal care cards. The results showed a high coverage of prenatal care (99.3%; n =763), but little more than half of these women started their prenatal care within 16 weeks of gestation (57%; n =435), and 74.7% (n = 570) had six or more visits. We noted that 16.6% (n = 127) of pregnant women were at high risk for complications and almost half continued monitoring prenatal care with professional nurses. Around 61.3% were advised about the maternity care service of reference for delivery, and 29.4% sought more than one health service for childbirth. We concluded that there was a high prenatal care coverage in Sergipe, however, with issues concerning its adaptation to the PHPN.
Topics: Adolescent; Adult; Brazil; Child; Cross-Sectional Studies; Female; Government Programs; Humans; Practice Guidelines as Topic; Pregnancy; Prenatal Care; Quality of Health Care; Young Adult
PubMed: 32159650
DOI: 10.1590/1413-81232020253.13182018 -
Revista Paulista de Pediatria : Orgao... 2021To describe the characteristics of women according to the reported number of benefits of breastfeeding and to verify its association with the duration of this practice... (Observational Study)
Observational Study
OBJECTIVE
To describe the characteristics of women according to the reported number of benefits of breastfeeding and to verify its association with the duration of this practice until the sixth month of the child's life.
METHODS
This was a qualitative and prospective observational study performed with postpartum mothers in two stages (n=78, and after six months n=62). Generalized linear models were used to identify the profile of the mothers as well as to determine the factors associated with the duration of breastfeeding until the sixth month of the child's life.
RESULTS
The profile of women who reported fewer benefits (≤3) was: younger age (p=0.008), with lower schooling (p<0.001), single (p=0.02), unemployed (p=0.04) and who attended prenatal care at the public health service (p=0.01). The analysis of the interaction of these factors indicated that women who had only completed elementary school and who attended prenatal care at the public health service (p<0.001) or privately (p=0.01) reported fewer benefits. Factors such as: level of education, marital status, previous education/training about breastfeeding, place of prenatal care and the reported number of benefits were not associated with the duration of breastfeeding until the sixth month of the child's life.
CONCLUSIONS
The lowest number of breastfeeding benefits was reported by women with elementary education and who undewent prenatal care in the public health system or privately. The number of reported benefits was not associated with the duration of this practice until the age of sixth months of the child.
Topics: Adult; Breast Feeding; Female; Health Knowledge, Attitudes, Practice; Humans; Mothers; Postpartum Period; Pregnancy; Prenatal Care; Prospective Studies; Socioeconomic Factors; Time Factors
PubMed: 33825796
DOI: 10.1590/1984-0462/2021/39/2020101