Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3
TL;DR: Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence.
Abstract: Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap. Data and Methods. Using information from the third wave of District Level Household Survey (2007-08), we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13-19 years) who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are 'full antenatal care (ANC)', 'safe delivery' and 'postnatal care within 42 days of delivery'. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care. Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother's education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother's education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman's education, full antenatal care, safe delivery care and region of residence. Conclusion. Several socioeconomic and demographic factors affect the utilization of maternal healthcare services among urban adolescent women in India. Promoting the use of family planning, female education and higher age at marriage, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternity services among urban adolescents.
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TL;DR: While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation.
Abstract: Adolescent mothers aged 15–19 years are known to have greater risks of maternal morbidity and mortality compared with women aged 20–24 years, mostly due to their unique biological, sociological and economic status. Nowhere Is the burden of disease greater than in low-and middle-income countries (LMICs). Understanding factors that influence adolescent utilisation of essential maternal health services (MHS) would be critical in improving their outcomes. We systematically reviewed the literature for articles published until December 2015 to understand how adolescent MHS utilisation has been assessed in LMICs and factors affecting service utilisation by adolescent mothers. Following data extraction, we reported on the geographical distribution and characteristics of the included studies and used thematic summaries to summarise our key findings across three key themes: factors affecting MHS utilisation considered by researcher(s), factors assessed as statistically significant, and other findings on MHS utilisation. Our findings show that there has been minimal research in this study area. 14 studies, adjudged as medium to high quality met our inclusion criteria. Studies have been published in many LMICs, with the first published in 2006. Thirteen studies used secondary data for assessment, data which was more than 5 years old at time of analysis. Ten studies included only married adolescent mothers. While factors such as wealth quintile, media exposure and rural/urban residence were commonly adjudged as significant, education of the adolescent mother and her partner were the commonest significant factors that influenced MHS utilisation. Use of antenatal care also predicted use of skilled birth attendance and use of both predicted use of postnatal care. However, there may be some context-specific factors that need to be considered. Our findings strengthen the need to lay emphasis on improving girl child education and removing financial barriers to their access to MHS. Opportunities that have adolescents engaging with health providers also need to be seized. These will be critical in improving adolescent MHS utilisation. However, policy and programmatic choices need to be based on recent, relevant and robust datasets. Innovative approaches that leverage new media to generate context-specific dis-aggregated data may provide a way forward.
112 citations
Cites background or methods from "Utilization of maternal healthcare ..."
...Our review suggests that there is an opportunity to leverage ANC attendance as a platform for advocacy to encourage and stimulate subsequent SBA utilisation by adolescents, especially as all five studies in our review that considered ANC utilisation as a predictor variable reported it as significant for SBA and PNC utilisation [30, 34, 39, 40, 42], which interphases with arguably the most critical period of the entire pregnancy for adolescents - delivery....
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...Most commonly considered predictor variables were age of the mother (11 studies) [31, 33–38, 40–43], education status of mother (10) [30, 34–36, 38–43], wealth quintile (10) [30, 34–36, 38–43], education of the husband (9) [30, 34–36, 39–43], mass media exposure (9) [30, 34–36, 39– 43], parity/birth order (9) [30, 34–36, 39–43], rural/urban residence (8) [34, 36, 38–43], employment status of the woman (7) [30, 34, 36, 38, 40, 42, 43], ethnic group (7) [30, 34, 35, 40–43], geographical region (7) [30, 35, 36, 38, 40–43], religion (7) [30, 35, 36, 38, 40, 41, 43], influence of household head (5) [32, 34, 40, 42, 43], health provider visits (4) [30, 35, 39, 41], and wanted/unwanted child status (4) [35, 39, 42, 43] [Fig....
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...For SBA, wealth quintile was assessed as being statistically significant in all studies that assessed the variable (eight of eight studies) [30, 34–36, 38, 40–42], as well as in all studies that assessed education of the adolescent mother (eight of eight studies) [30, 34–36, 38, 40–42]....
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...(XLSX 31 kb) Abbreviations ANC: Ante-Natal Care; DHS: Demographic Health Survey; ISPOR: International Society for Pharmaco-economics and Outcomes Research; LMICs: Low and middle income countries; MDGs: Millennium development goals; MHS: Maternal Health Service; NFHS: National Family Health Survey; PNC: Post-Natal Care; SBA: Skilled birth attendant; SDGs: Sustainable development goals; STROBE: Strengthening the Reporting of Observational Studies in Epidemiology Funding We thank the Professor Ken Newell Bursary of the Liverpool School of Tropical Medicine for providing funding to support this review....
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...For delivery, characteristic assessed were the presence of skilled birth attendant (SBA) at delivery [30, 31, 33–42] and facility-based delivery [32, 33, 36–39] [Table 1]....
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TL;DR: In this article, the authors analyzed the effect of early marriage on educational inequality by looking at the impact of whether women had married young on their children's schooling outcomes for 25-32 countries in 2000 and 2010 for Sub Saharan Africa.
58 citations
TL;DR: Maternal health programs should be designed to encourage young women to receive adequate antenatal care visits and target poor, less educated, rural, young women who live in mountain regions, are of Janajati ethnicity and have at least one child as such women are less likely to choose institutional delivery in Nepal.
Abstract: Objectives To identify the determinants of institutional delivery among young married women in Nepal. Design Nepal Demographic and Health Survey (NDHS) data sets 2011 were analysed. Bivariate and multivariate logistic regression analyses were performed using a subset of 1662 ever-married young women (aged 15–24 years). Outcome measure Place of delivery. Results The rate of institutional delivery among young married women was 46%, which is higher than the national average (35%) among all women of reproductive age. Young women who had more than four antenatal care (ANC) visits were three times more likely to deliver in a health institution compared with women who had no antenatal care visit (OR: 3.05; 95% CI: 2.40 to 3.87). The probability of delivering in an institution was 69% higher among young urban women than among young women who lived in rural areas. Young women who had secondary or above secondary level education were 1.63 times more likely to choose institutional delivery than young women who had no formal education (OR: 1.626; 95% CI: 1.171 to 2.258). Lower use of a health institution for delivery was also observed among poor young women. Results showed that wealthy young women were 2.12 times more likely to deliver their child in an institution compared with poor young women (OR: 2.107; 95% CI: 1.53 to 2.898). Other factors such as the age of the young woman, religion, ethnicity, and ecological zone were also associated with institutional delivery. Conclusions Maternal health programs should be designed to encourage young women to receive adequate ANC (at least four visits). Moreover, health programs should target poor, less educated, rural, young women who live in mountain regions, are of Janajati ethnicity and have at least one child as such women are less likely to choose institutional delivery in Nepal.
58 citations
TL;DR: It is suggested that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.
Abstract: Antenatal care (ANC) reduces adverse health outcomes for both mother and baby during pregnancy and childbirth. The present study investigated the enablers and barriers to ANC service use among Indian women. The study used data on 183,091 women from the 2015-2016 India Demographic and Health Survey. Multivariate multinomial logistic regression models (using generalised linear latent and mixed models (GLLAMM) with the mlogit link and binomial family) that adjusted for clustering and sampling weights were used to investigate the association between the study factors and frequency of ANC service use. More than half (51.7%, 95% confidence interval (95% CI): 51.1-52.2%) of Indian women had four or more ANC visits, 31.7% (95% CI: 31.3-32.2%) had between one and three ANC visits, and 16.6% (95% CI: 16.3-17.0%) had no ANC visit. Higher household wealth status and parental education, belonging to other tribes or castes, a woman's autonomy to visit the health facility, residence in Southern India, and exposure to the media were enablers of the recommended ANC (≥4) visits. In contrast, lower household wealth, a lack of a woman's autonomy, and residence in East and Central India were barriers to appropriate ANC service use. Our study suggests that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.
46 citations
Cites result from "Utilization of maternal healthcare ..."
...These findings are consistent with previous studies conducted in India [34,35], as well as other LMICs, including Nigeria [18], Pakistan [36], and Kenya [37]....
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TL;DR: The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence.
Abstract: Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health inequities, including maternal health, and understand their mechanism of influence, which might be important in addressing maternal health inequities in India. Our review aims to map and summarize the evidence on social determinants influencing maternal health in India and understand their mechanisms of influence by using a maternal health-specific social determinants framework. A scoping review was conducted of peer-reviewed journal articles in two databases (PubMed and Science Direct) on quantitative and qualitative studies conducted in India after 2000. We also searched for articles in a search engine (Google Scholar). Forty-one studies that met the study objectives were included: 25 identified through databases and search engines and 16 through reference check. Economic status, caste/ethnicity, education, gender, religion, and culture were the most important structural factors of maternal health service use and maternal mortality in India. Place of residence, maternal age at childbirth, parity and women’s exposure to mass media, and maternal health messages were the major intermediary factors. The structural factors influenced the intermediary factors (either independently or in association with other factors) that contributed to the use of maternal health service or caused maternal deaths. The health system emerged as a crucial and independent intermediary factor of influence on maternal health in India. Issues of power were observed in broader social contexts and in the relationships of health workers which led to differential access to maternal healthcare for women from different socioeconomic groups. The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence. Given the limitations of this study, we indicate the areas for further research pertaining to the framework and maternal health.
44 citations
References
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TL;DR: The Commission on Social Determinants of Health (CSDH) as mentioned in this paper was created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it.
7,335 citations
Posted Content•
TL;DR: This work estimates the relationship between household wealth and children’s school enrollment in India by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights, and shows that this index is robust to the assets included, and produces internally coherent results.
Abstract: The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators - is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households, although this gap varies considerably across states. To estimate the relationship between household wealth and the probability that a child (aged 6 to 14) is enrolled in school, Filmer and Pritchett use National Family Health Survey (NFHS) data collected in Indian states in 1992 and 1993. In developing their estimate Filmer and Pritchett had to overcome a methodological difficulty: The NFHS, modeled closely on the Demographic and Health Surveys, measures neither household income nor consumption expenditures. As a proxy for long-run household wealth, they constructed a linear asset index from a set of asset indicators, using principal components analysis to derive the weights. This asset index is robust, produces internally coherent results, and provides a close correspondence with data on state domestic product and on state level poverty rates. They validate the asset index using data on consumption spending and asset ownership from Indonesia, Nepal, and Pakistan. The asset index has reasonable coherence with current consumption expenditures and, more importantly, works as well as - or better than - traditional expenditure-based measures in predicting enrollment status. The authors find that on average a child from a wealthy household (in the top 20 percent on the asset index developed for this analysis) is 31 percent more likely to be enrolled in school than a child from a poor household (in the bottom 40 percent). This paper - a product of Poverty and Human Resources, Development Research Group - is part of a larger effort in the group to inform educational policy. The study was funded by the Bank`s Research Support Budget under the research project Educational Enrollment and Dropout (RPO 682-11).
4,966 citations
"Utilization of maternal healthcare ..." refers methods in this paper
...Wealth index is generally used as a proxy for the economic status of the household (Filmer & Pritchett, 2001; Montgomery et al., 2000)....
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TL;DR: In this paper, a method for estimating the effect of household economic status on educational outcomes without direct survey information on income or expenditures is proposed and defended, which uses an index based on household asset ownership indicators.
Abstract: This paper has an empirical and overtly methodological goal. The authors propose and defend a method for estimating the effect of household economic status on educational outcomes without direct survey information on income or expenditures. They construct an index based on indicators of household assets, solving the vexing problem of choosing the appropriate weights by allowing them to be determined by the statistical procedure of principal components. While the data for India cannot be used to compare alternative approaches they use data from Indonesia, Nepal, and Pakistan which have both expenditures and asset variables for the same households. With these data the authors show that not only is there a correspondence between a classification of households based on the asset index and consumption expenditures but also that the evidence is consistent with the asset index being a better proxy for predicting enrollments--apparently less subject to measurement error for this purpose--than consumption expenditures. The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators- is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households.
4,661 citations
TL;DR: The health of young people has been largely neglected in global public health because this age group is perceived as healthy, however, opportunities for prevention of disease and injury in this agegroup are not fully exploited.
1,673 citations
"Utilization of maternal healthcare ..." refers background in this paper
...Hence, it is not surprising that despite accounting for only 11% births worldwide, adolescent women carry 23% of overall burden of disease (in terms of disability adjusted life years) due to pregnancy and childbirth among women of all ages (Gore et al., 2011; Mangiaterra et al., 2008)....
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TL;DR: In this paper, the main states of India are broadly grouped into two demographic regimes, i.e., northern kinship/low female autonomy and southern kinship /high female autonomy, and the analysis suggests that family social status is probably the most important element in comprehending Indias demographic situation.
Abstract: The main states of India are broadly grouped into 2 demographic regimes. In contrast to states in the north southern states are characterized by lower marital fertility later age at marriage lower infant and child mortality and comparatively low ratios of female to male infant and child mortality. The division between the 2 regimes broadly coincides with the division areas of northern kinship/low female autonomy and southern kinship/high female autonomy. The analysis suggests that family social status is probably the most important element in comprehending Indias demographic situation. Women in the south tend to be more active in the labor force are more likely to take innovative action in adopting fertility control and are more apt to utilize health services for themselves and their children. Changes in India are also compared to those other South Asian countries. (authors modified) (summaries in ENG FRE SPA)
1,502 citations
"Utilization of maternal healthcare ..." refers background in this paper
...Higher levels of socioeconomic development and better functioning of the public health system can be some of the factors behind the better performance of the states belonging to the South and the West regions....
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...Utilization of maternal health care services in Southern India....
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...The utilization of maternal health care services among mothers from the Southern region is higher than among mothers from other regions....
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...Adolescent mothers in the South and the West are two (OR = 1.953, CI = 1.365–2.795) and four (OR = 4.757, CI = 3.372–6.711) times more likely to use of full antenatal care than their counterparts in the North....
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...The six regions consist of North (Jammu and Kashmir, Himachal Pradesh, Punjab, Haryana, Rajasthan, Delhi and Uttaranchal), Central (Uttar Pradesh, Madhya Pradesh and Chhattisgarh), East (Bihar, Jharkhand, West Bengal and Orissa), North-East (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura), West (Gujarat, Maharashtra and Goa), and South (Andhra Pradesh, Karnataka, Kerala and Tamil Nadu)....
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