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BACKGROUND: Institutional delivery has been considered one of the important strategies to improve maternal and child health and significantly reduce birth-related complications. However, it is still low in developing countries though there are some improvements. even among the community who has access to the health institutions weather health center and hospital including Somaliland. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in the last 12 months in Ga'an libah district, Marodijeh region, Somaliland. METHODS: The community-based cross-sectional study was conducted among women who gave birth in the last 12 months from September to December 2022. A simple random sampling technique was employed to select study participants from a total of sample population. Data was collected using semi-structural administered questionnaire through interviewing women. Data was collected with online mobile data collection (Kobo collect). SPSS version 25.0 was used for data management, entering and analysis. Bivariate and multivariable logistic regression models were fitted to determine the presence of a statistically significant association between independent variables and the outcome variable with p-value < 0.05. RESULT: Level of Institutional delivery services utilization in Ga'an libah district was 53.9% [95% Cl 48.2-59.6] gave birth at health institutions. Women who can read and write local were (AOR 2.18, 95% CI 1.08-4.56, p<0.01), Women with their husband can be capable to read and write are [(AOR = 6.95, 95% Cl 2.82-21.58, p<0.002]). Additionally, ability to cost transportation for referral [AOR 5.21, 95% Cl 2.44-11.13, p<0.001]. not good services available [AOR 0.07, 95%Cl 0.01-0.10, p<0.02]. lack of maternal health and child knowledge [AOR 0.034, 95% Cl 0.02-0.57, p<0.01]. were observed associated with level of institutional deliver services utilization. CONCLUSION: The institutional delivery service utilization was relatively high compared to national demographic health services in the study area. A large proportion of women gave both at home without a skilled attendant. Therefore, this finding has important policy implications since changes in the cost of the health service and perceived quality would mean changes in client satisfaction as well as their choice, as well emphasize to expectant women can receive medical advice and ambulance for referrals.

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Background: One of the most important health interventions for reducing maternal morbidity and death is the use of maternal healthcare services. In Ethiopia, maternal healthcare services are not well utilized, particularly in rural pastoralist communities, despite their significance. Therefore, the purpose of this study was to evaluate the use of maternal healthcare services and the characteristics that are related to it in the East Borena zone. Techniques: In September 2020, a community-based cross-sectional survey was carried out in Liben with 416 randomly selected mothers. Mothers who had given birth within the 12 months before the study comprised the respondents. Questionnaires given by interviewers were used to gather the data. The data were transferred to SPSS version 20 for analysis after being entered into Epi-Info version 4.1 for coding. The Kolmogorov-Smirnov, Hosmer, and Lemeshow goodness of fit tests were employed, along with descriptive statistics. Additionally, multivariate and binary logistic regression analyses were carried out. 95% CI and the odd ratio were used to examine the relationship between the outcome and predictive variables. Results: At least one prenatal visit was received by 60% of moms. Only 21.2% and 17.5% of women had given birth in a medical facility and made use of early postnatal care services. The use of antenatal care was strongly correlated with maternal education [AOR = 2.43 (95% CI: 1.22-4.89)], decision-making capability [AOR = 2.40 (95% CI: 1.3-23.3)], felt compassionate and respectful treatment [AOR = 0.30 (95% CI: 0.18-0.50)], and intended current pregnancy [AOR = 0.22 (95% CI: 0.12-0.37)]. Moms b/n ages 15-19 had a 3.7-fold higher probability of giving birth in a hospitals than moms b/n ages 35 and 49 [AOR = 1.74 (95% CI: 1.02-3.08)]. Mothers who lived far away were 1.02 times less likely to give birth at a hospital than those who could reach one within an hour (AOR = 1.74;95% CI: 1.02, 3.08). While recent use of antenatal care [AOR = 5.34 (95% CI: 1.96-8.65)], planned current pregnancy, and knowledge of using postnatal care were shown to be strongly correlated with danger indicators [AOR = 2.93 (95% CI: 1.59-5.41)], knowledge of danger signs [AOR = 3.77 (95% CI: 2.16-6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery. Conclusion: Overall the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Thus, promoting institutional services, raising community knowledge, empowering women to make decisions, and enhancing the infrastructure of the health sector.

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Background: In developing countries, institutional delivery is a key proven intervention that reduces maternal mortality and can reduce maternal deaths by approximately 16%-33%. In Somalia, only 32% of births are delivered in a health facility with the assistance of a skilled healthcare provider. We aimed to investigate the factors hindering women from giving birth at healthcare facilities in major towns in Somalia, where most of the health facilities in the country are concentrated. Methods: A community-based health survey was carried out in 11 major towns in Somalia between October and December 2021. A structured and pretested questionnaire was used to collect data from 430 women who gave birth in the last five years. Women were recruited through convenient sampling. Descriptive statistics were used to summarize the data, and binary and multivariable logistic regression analysis was performed. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the associations. Results: The overall prevalence of institutional delivery was 57%. Approximately 38% of women living in Mogadishu and 53% living in another ten towns give birth at home. Women who had poor knowledge of the importance of health facility delivery had nearly four times higher odds of delivering at home (AOR 3.64 CI: 1.49-8.93). Similarly, those who did not receive antenatal care (AOR 2.5, CI: 1.02-6.39) and those who did not receive a consultation on the place of delivery (AOR 2.15, CI: 1.17-3.94) were more likely to give birth at home. The reasons for home delivery included financial reasons, the long distance to the health facility, and the fact that it was easier to give birth at home. Conclusion: The study found that home delivery is high in major towns in Somalia and is associated with a lack of understanding of the importance of health facility delivery, not using ANC, and not receiving consultancy about where to give birth. Primary health care should strengthen information, education, and communication activities. Since the health care system in Somalia is overwhelmingly private, the government may consider access to free and within-reach ANC and health facility delivery for women and girls from families who cannot pay the ANC and childbirth delivery cost.

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AIM: Women's empowerment status varies greatly in India according to caste, class, ethnicity and region. This paper aims to investigate the caste/tribe disparity in women's empowerment by region, the main correlates of each domain of empowerment, and the association of women's empowerment with nutritional and health care access outcomes, specifically anaemia, menstrual hygiene, and institutional delivery. METHODOLOGY: Using National Family Health Survey-5 (2019-2021) data, we have created a modified survey-based women's empowerment index (SWPER) using principal component analysis with Oblique varimax rotation. The first four components are interpreted as an attitude to violence, freedom of movement, decision-making power and social independence. Several multivariate regression models were used to understand the factor associated with empowerment and the association of women's empowerment with different health outcomes. RESULTS: The results indicate that women from the forward castes are the most empowered in most domains except decision-making. However, after controlling other background variables, the forward castes women are found to be the most empowered in attitude to violence, whereas Scheduled Castes and Scheduled Tribes women were found to be the most empowered women in decision-making. With regards to social independence, deprived castes women are more empowered than the forward castes women. The likelihood of empowerment in social independence domain increases with increasing wealth. There are wide regional variations in empowerment level between different social groups. Caste/tribe identity plays a significant role in determining health outcomes in India. Among all empowerment domains, social independence emerges as the most significant associated factor with improved health across all caste/tribe groups. CONCLUSION: The path to women's empowerment in India must recognize the intersectionality of caste/tribe identities, and address regional disparities. Social independence emerges as a critical determinant across all caste/tribe groups for improving health. Measures should be taken to empower women through the underlying factors of social independence.

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Background: Maternal and neonatal mortality is a global problem that is highly prevalent in low- and middle-income countries, including Ethiopia. Maternal delay in seeking institutional delivery services utilization plays a significant role in determining maternal and neonatal health outcomes. Although studies have been conducted on institutional delivery service utilization in Ethiopia, little is known about factors for delays in seeking care for institutional delivery services. Objective: This study aimed to assess the delay in seeking institutional delivery services and associated factors among immediate postpartum mothers in public health facilities in Gondar, northwest Ethiopia. Methods: A facility-based cross-sectional study was conducted from July 15 to September 10, 2022. A total of 391 participants were selected using systematic random sampling. Data were collected through face-to-face interviews using structured, pretested, and interviewer-administered questionnaires. Data were entered into EpiData version 4.6, and the analysis was conducted using Statistical Package for Social Science version 26. The multivariable logistic regression model was fitted and the level of significance was set at p ≤ 0.05. Result: The prevalence of delay in seeking institutional delivery was 49.10% (95% confidence interval [CI]: 44.13, 54.08). Rural residence (adjusted odds ratio [AOR] = 2.51; 95% CI: 1.43-4.41), no antenatal care visits (AOR: 2.87; 95% CI: 1.34-6.13), unplanned pregnancy (AOR: 2.98; 95% CI: 1.78-5.01), poor decision-making autonomy in maternity care services (AOR: 1.98; 95% CI: 1.15-3.40), and poor birth preparedness plan (AOR: 4.88; 95% CI: 2.79-8.53) were significantly associated with delays in seeking institutional delivery. Conclusion: Delays in seeking institutional delivery services were high. It is better to promote women's decision-making power in their own health care. In addition, it is better to arrange programs that will improve maternal and child health service utilization.

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BACKGROUND: Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. METHODS: An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. RESULTS: In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. CONCLUSION: This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.

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INTRODUCTION:  The coronavirus disease 2019 (COVID-19) pandemic has substantially disrupted essential maternal and infant healthcare services due to the diversion of resources. The imposition of lockdown was one of the critical strategies to flatten the curve in several countries, including India. This led to restricted access to pregnancy-related care, immunization services, and had an impact on home-based newborn care. We aimed to determine the effect of the COVID-19 lockdown on institutional deliveries and child healthcare services in a residential community of East Delhi. METHODS: This community-based, comparative study was conducted between January 2021 and August 2022. Seventy-seven families experiencing childbirth during the COVID-19 lockdown period (24th March 2020 to 30th November 2020) were compared with an equivalent number of families having childbirth during the corresponding period preceding the lockdown (24th March 2019 to 30th November 2019). The study involved face-to-face interviews conducted using a pretested and pre-validated interviewer-administered schedule. RESULTS: We found that non-institutional deliveries were substantially higher in the during-lockdown group (n=11, 14.3%) compared to the before-lockdown group (n=1, 1.3%) (OR=12.67 [1.59, 100.73]). Additionally, a significantly lower proportion of pregnant women received a minimum of four antenatal checkups (OR=8.26 [2.71, 25.23]), as well as iron and calcium supplementation during the lockdown. Reasons for non-institutional deliveries primarily included unavailability and denial of delivery services, as well as the fear of exposure to COVID-19 infection, as highlighted in our study. A significantly lower proportion [OR=6.07 (2.56, 14.42)] of children were found to be immunized-for-age, along with a substantial delay in vaccination among those born during the lockdown period. There was a significant decrease in home visits by community health workers during both the antenatal and postnatal periods amidst the lockdown. Moreover, the proportion of children exclusively breastfed for six months was notably lower [OR=2.32 (1.17, 4.63)], and the age until which exclusive breastfeeding was continued was lower in the during-lockdown group. Regarding healthcare-seeking behavior, services were sought by the families of 95.5% of children who fell sick during the lockdown period. Approximately 45.2% of families procured medicines from private health facilities, while about one-third acquired them from non-registered medical practitioners (NRMPs). CONCLUSION: The COVID-19 lockdown significantly affected maternal and child healthcare services, leading to adverse outcomes across various crucial aspects. Institutional deliveries, antenatal care, community health worker visits, child immunization, and healthcare-seeking behavior were all adversely affected. In times of natural disasters like pandemics, it is crucial to establish specific provisions ensuring uninterrupted maternal and child healthcare throughout the lockdown. Integrating health education into essential services becomes imperative within the pandemic preparedness plan.

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BACKGROUND: Despite a commendable rise in the number of women seeking delivery care at public health institutions in South India, it is unclear if the benefit accrues to wealthier or poorer socio-economic groups. The study's aim was to investigate at how the public subsidy is distributed among Indian women who give birth in public hospitals in the southern regions. METHODS: Data from the Indian Demographic Health Survey's fifth wave (NFHS-5, 2019-21) was used in this study. A total of 22, 403 were institutional deliveries across all the southern states of India were included. Out-of-pocket expenditure (OOPE) on childbirth in health institutions was the outcome variable. We used summary statistics, Benefits Incidence Analysis (BIA), concentration index (CI), and concentration curve (CC) were used. RESULTS: Most women in the lowest, poorest, and medium quintiles of wealth opted to give birth in public facilities. In contrast, about 69% of mothers belonging to highest quintile gave birth in private health institutions. The magnitude of CI and CC of institutional delivery indicates that public sector usage was concentrated among poorer quintiles [CIX: - 0.178; SE: 0.005; p < 0.001] and private sector usage was concentrated among wealthier quintiles [CIX: 0.239; SE: 0.006; p < 0.001]. Benefit incidence analyses suggest that middle quintile of women received the maximum public subsidy in primary health centres (33.23%), followed by richer quintile (25.62%), and poorer wealth quintiles (24.84%). These pattern in the secondary health centres was similar. CONCLUSION: Poorer groups utilize the public sector for institutional delivery in greater proportions than the private sector. Middle quintiles seem to benefit the most from public subsidy in terms of the median cost of service and non-payment. Greater efforts must be made to understand how and why these groups are being left behind and what policy measures can enhance their inclusion and financial risk protection.

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BACKGROUND: This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15-49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). METHODS: The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. RESULTS: The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. CONCLUSIONS: Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15-49 y.

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Globally, around 13.6 million maternal deaths occurred in the last 25 years. Ethiopia accounts one of the highest global maternal deaths, with more than 50% of births taking place at home. Hence, the aim of this study was to determine institutional delivery utilization in Waka town. Community based cross sectional study is the study design chosen. The study was conducted, on mothers having a history of at least 1 birth within the last 2 years, who were selected by a systemic random sampling (K=2), from both kebeles, which is selected by a simple random sampling from the 2 kebeles in the study area. For data collection, an interview with questionnaire containing both closed and open-ended questions, along with non-participant observation method was employed. For analysis, descriptive statistics, along with bivariate and multivariate analytical method was computed. Statistical significance was considered at p < 0.05, and the strength of statistical association was assessed by odds ratio (OR) with 95% confidence interval. The prevalence of institutional delivery service utilization in Waka town was found to be 89.4%. Educational status, marital status, intention of the pregnancy, ANC follows up, and Knowledge of birth complications have shown significant association.

Dans le monde, environ 13,6 millions de décès maternels ont eu lieu au cours des 25 dernières années. L'Éthiopie connaît l'un des taux de mortalité maternelle les plus élevés au monde, avec plus de 50 % des naissances ayant lieu à domicile. Par conséquent, le but de cette étude était de déterminer l'utilisation des prestations institutionnelles dans la ville de Waka. L'étude transversale communautaire est le modèle d'étude choisi. L'étude a été menée auprès de mères ayant des antécédents d'au moins 1 naissance au cours des 2 dernières années, sélectionnées par un échantillonnage aléatoire systémique (K = 2), parmi les deux kebeles, sélectionnées par un échantillonnage aléatoire simple parmi les 2. kebeles dans la zone d'étude. Pour la collecte des données, un entretien avec un questionnaire contenant à la fois des questions fermées et ouvertes, ainsi qu'une méthode d'observation des non-participants ont été utilisés. Pour l'analyse, des statistiques descriptives, ainsi qu'une méthode analytique bivariée et multivariée ont été calculées. La signification statistique a été considérée à p <0,05 et la force de l'association statistique a été évaluée par le rapport de cotes (OR) avec un intervalle de confiance de 95 %. La prévalence de l'utilisation des services de prestation institutionnels dans la ville de Waka était de 89,4 %. Le statut éducatif, l'état civil, l'intention de grossesse, le suivi des soins prénatals et la connaissance des complications à la naissance ont montré une association significative.

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BACKGROUND: Non-institutional delivery is one of the major reasons that results in high mortality rates for a mother and her neonate. The World Health Organization estimates that only 43% of mothers have access to skilled delivery services. A recent Ethiopian Mini Demographic Survey indicated that more than half of Ethiopian women have given birth non-institutionally. This shows that maternal health remains a major public health challenge in Ethiopia, irrespective of the government's measures for institutional delivery. So, the aim of this study was to assess the practice of non-institutional delivery and its associated factors among women who gave birth in the study area. METHODS: A community-based cross-sectional study was carried out on 260 study participants from June 1 to July 1, 2022, in Boloso Bombe Woreda. Data collection was done using a structured questionnaire, and systematic sampling techniques were used to select the study subjects. The data was entered into the EPI data version 3.1 and analyzed using SPSS version 25. The adjusted odds ratio, along with 95% confidence intervals, was used, and the level of statistical significance was declared at a P-value of 0.05. RESULT: Out of 260 women interviewed, 252 (97%) pregnant women participated in the interview. The prevalence of non-institutional delivery among study participants was 68.7% (95% CI: 63.1-72.9). Mothers who were a daily laborer [AOR = 6.6;95%CI(3.6(1.2-11.2), last pregnancy planned [AOR = 0.4; 95%CI (0.4(0.2-0.8)), an absence of antenatal care contacting history [AOR = 3.3; 95%CI (1.3-8.6)], respondents' knowledge on the labor complication [AOR = 3; (95%CI); 3.5(2.2-6.1)], and place of first delivery [AOR = 8.7 95%CI(3.2-23)] were factors that significantly associated with practice of non-institutional delivery. CONCLUSION: This study indicated that the majority of study participants practiced non-institutional delivery in this study area. Thus, we strongly recommend that all responsible bodies take immediate action, such as community health education on pregnancy-related complications, encouraging ANC visits, and raising awareness of the advantages of preventing non-institutional delivery in order to reduce non-institutional pregnancy practices and improve the factors identified.

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Objective: A community dialogue intervention with an appreciative inquiry approach was undertaken to improve institutional delivery and child immunisation coverage in a hard-to-reach province, namely, Kandahar, in Afghanistan. This study aimed to evaluate the intervention's effectiveness in promoting institutional delivery and child immunisation. Study design: A pre-post intervention evaluation study. Methods: An intervention and a non-intervention district were selected in Kandahar. Children aged under 5 years participated in surveys at baseline (October 2018) and follow-up (Post-intervention: November 2019). We analysed age, sex, place of birth, and confirmed immunisation coverage data concerning 1046 and 927 children pre- and post-interventions, respectively. Changes in institutional delivery and confirmed immunisation status were evaluated using net intervention effect and difference-in-difference (DID) analysis. Results: Institutional delivery rates increased from 66.3% to 83.6% (p = 0.016) in the intervention district and decreased from 71.3% to 46.7% (p < 0.001) in the non-intervention district, with a net intervention effect of 41.9%. Full immunisation coverage among children aged 12-23 months and 24-35 months significantly increased from 26.4% to 76.9% (p < 0.001) and from 40.0% to 78.6% (p < 0.001), respectively, in the intervention district, whereas coverage significantly decreased in the non-intervention district. The net intervention effects were 59.1% and 44.8% for children aged 12-23 months and 24-35 months, respectively. The DID analysis also revealed significant differences in outcomes after intervention at follow-up. The results concerning antigen-specific immunisation coverage indicated a significant increase in immunisation coverage in the intervention district. Conclusions: The appreciative inquiry-based community dialogue intervention considerably increased institutional delivery and child immunisation coverage, even in a hard-to-reach province in Afghanistan.

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BACKGROUND: Maternal mortalities remain high in the Lao People's Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011-12 and 2011-12 to 2017. METHODS: We used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011-12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women's age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. RESULTS: The coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011-12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values. CONCLUSION: There was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011-12 while between 2011-12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011-12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.

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BACKGROUND: Increased coverage for institutional delivery (ID) is one of the essential factors for improved maternal and child health (MCH). Though, ID increased over time, out-of-pocket expenditure (OOPE) for the care-seeking families had been found to be growing, parallelly. Hence, we estimated OOPE in public and private health centres for ID, along with their sources and attributing factors and compared state and union territory-wise, so that financial risk protection can be improved for MCH related services. METHODS: We used women's data from the National Family Health Survey, 2019-2021 (NFHS-5). Reproductive aged women (15-49 years) delivering one live child in last 5 years (n = 145,386) in any public or private institutions, were included. Descriptive statistics were presented as frequency and proportions. OOPE, was summarized as median and interquartile range (IQR). To estimate the extent for each covariate's effect, linear regression model was conducted. RESULTS: Overall median OOPE for ID was Rs. 4066 (median OOPE: private hospitals: Rs.25600, public hospitals: Rs.2067). Health insurance was not sufficient to slash OOPE down at private facilities. Factors associated significantly to high OOPE were mothers' education, elderly pregnancy, complicated delivery, birth order of the latest child etc. CONCLUSION: A standard norm for ID should be implemented as a component of overseeing and controlling inequality. Aiding the needy is probably just one side of the solution, while the focus is required to be shifted towards reducing disparity among the health facilities, so that the beneficiaries do not need to spend on essential services or during emergencies.

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El parto institucional es un proceso complejo, sobre todo desde la experiencia vivida de las madres de la zona rural de Perú. Objetivo. Develar las vivencias y expectativas de la mujer rural en el parto institucional en un hospital de Cajamarca. Metodología. Estudio con enfoque cualitativo con diseño fenomenológico. Se aplicó como técnica de recolección de datos la entrevista a profundidad, como instrumento se usó una guía de preguntas orientadoras relacionada con ¿cuáles son las vivencias y expectativas de la mujer rural frente al parto institucional en el Hospital Regional Docente de Cajamarca?, la cual ha permitido acercarse al fenómeno en estudio. Hallazgos. Se obtuvieron 5 discursos de puérperas que se atendieron el parto en este nosocomio, al momento de la recolección de datos. Los discursos fueron grabados y transcritos, procediendo a la elaboración de las unidades de significado con el respectivo análisis ideográfico y nomotético, dando origen a 52 unidades de significado, sintetizadas en 4 categorías, siendo: significado del parto para la mujer rural, necesidad de apoyo emocional y físico; el proceso del parto institucional y finalmente el nacimiento del bebé. A manera de cierre. Las vivencias y expectativas de las mujeres procedentes de la zona rural, revelan que se requiere un enfoque diferenciado en la atención de parto institucional.

Institutional childbirth is a complex process, especially from the lived experience of mothers in rural Peru. Objective. To reveal the experiences and expectations of rural women in institutional childbirth in a hospital in Cajamarca. Methodology. Qualitative study with phenomenological design. An in-depth interview was used as a data collection technique, and a guide of guiding questions related to the experiences and expectations of rural women regarding institutional childbirth in the Regional Teaching Hospital of Cajamarca was used as an instrument to approach the phenomenon under study. Findings. At the time of data collection, five speeches were obtained from puerperal women who attended childbirth in this hospital. The speeches were recorded and transcribed, proceeding to the elaboration of the units of meaning with the respective ideographic and nomothetic analysis, giving rise to 52 units of meaning, synthesized in 4 categories, being: meaning of childbirth for the rural woman, need for emotional and physical support; the process of institutional childbirth and finally the birth of the baby. By way of conclusion. The experiences and expectations of women from rural areas reveal the need for a differentiated approach to institutional childbirth care.

O parto institucional é um processo complexo, especialmente a partir da experiência vivida pelas mães na zona rural do Peru. Objetivo. Revelar as experiências e expectativas das mulheres rurais em relação ao parto institucional em um hospital de Cajamarca. Metodologia. Estudo qualitativo com desenho fenomenológico. Utilizou-se a entrevista em profundidade como técnica de coleta de dados, e um guia de perguntas orientadoras relacionadas às experiências e expectativas das mulheres rurais em relação ao parto institucional no Hospital Regional de Ensino de Cajamarca foi utilizado como instrumento, o que nos permitiu abordar o fenômeno em estudo. Resultados. No momento da coleta de dados, foram obtidos cinco discursos de mulheres no pós-parto que haviam dado à luz nesse hospital. Os discursos foram gravados e transcritos, procedendo-se à elaboração das unidades de significado com a respectiva análise ideográfica e nomotética, dando origem a 52 unidades de significado, sintetizadas em 4 categorias, sendo elas: significado do parto para a mulher rural, necessidade de apoio emocional e físico; o processo de parto institucional e, finalmente, o nascimento do bebê. À guisa de conclusão. As experiências e expectativas das mulheres das áreas rurais revelam a necessidade de uma abordagem diferenciada para a assistência ao parto institucional.

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Background: Since 2000, the Ethiopian ministries of health and other stakeholders have taken some measures to enhance institutional delivery. However, the Ethiopian Demographic Health Survey 2019 report indicated that more than 50% of Ethiopian reproductive-age women gave birth outside health facilities. Therefore, the purpose of this study was to assess the practice of noninstitutional delivery among women who gave birth at Boloso Bombe Woreda (district) in southern Ethiopia. Methods: A community-based cross-sectional study was carried out on 252 study participants from June to July 2022 in Boloso Bombe Woreda. Data collection was done using a structured questionnaire and systematic sampling techniques were used to select the study subjects. Data were entered into the EPI data, version 3.1, and analyzed using SPSS, version 25. Adjusted odds ratios (AORs), along with 95% confidence intervals (CIs), were used and the level of statistical significance was declared at a p-value of 0.05. Results: In this study, 252 participants completed the survey, with a 97% response rate. The prevalence of noninstitutional delivery among study participants was 68.7% (95% CI: 63.1-72.9). In this study, mother's occupation, such as working as a daily laborer (AOR = 3.6; 95% CI [1.2-11.2]); absence of antenatal care history (AOR = 3.3; 95% CI [1.3-8.6]); poor knowledge of labor complications (AOR = 3.5; 95% CI [2.2-6.1]); and place of first delivery (AOR = 8.7; 95% CI [3.2-23]) were factors that were positively and significantly associated with the practice of noninstitutional delivery. However, last pregnancy planned was negatively associated with the practice of noninstitutional delivery (AOR = 0.4; 95% CI [0.2-0.8]). Conclusions: This study indicated that the majority of study participants practiced noninstitutional delivery in this study area. Therefore, we strongly recommend that all responsible bodies should take immediate action to reduce the practice of noninstitutional delivery and improve those identified factors.

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INTRODUCTION: The quality of maternity care in Tamil Nadu has significantly improved in the past few years and various public health initiatives have helped to reduce crucial indicators like Maternal Mortality Ratio and Infant Mortality Rate. The improvement in quality of interface between the mothers and service providers in term of language, behaviour and attitude for ensuring 'Respectful Maternity Care' would support further enhancement of maternal and new born outcomes. Delivery of appropriate and respectful care to each pregnant woman would not only go a long way in reducing mortality and morbidity for the woman and new-born but also help in improved cognitive development of the baby. OBJECTIVE: To assess the quality of delivery care practices provided during normal delivery among women accessing public health facilities in Tamil Nadu. METHODS: A descriptive evaluation study was conducted from May to December 2018 in 16 facilities across 14 districts in Tamil Nadu. The health facilities were stratified according to the level of services, Government Medical College hospitals (MC), District headquarter hospitals (DHQ), Sub-district hospitals (SDH), and PHCs, 4 facilities in each category were selected. Data was collected by direct observation using a facility observation check list in an Android-based tablet application. Informed consent was obtained from all participants. RESULTS: A total of 1006 pregnant women out of 2242 women who had normal delivery were assessed and included in the study. More than 50% of deliveries were conducted by nurses and midwives and the perinatal and maternal outcomes were found to be good. The parameters for the respectful maternity care were recorded. Routine care monitoring parameters helped to reduce mortality rate and improved delivery care. CONCLUSION: The state though has achieved substantial success in promoting institutional delivery practices, still needs certain crucial improvements in the quality of respectful maternal care during the delivery.

The overall pooled prevalence of disrespectful maternity care in India was 71.31% (95% CI 39.84­102.78) where every individual study prevalence ranged from 20.9 to 100%. Institutional delivery is 100 percent in Puducherry and Tamil Nadu (NFHS V) and hence it is important to assess the quality of maternity care provided in public healthcare facilities in the state. The improvement in the quality of the interface between the women and service providers in terms of language, behavior, and attitude for ensuring 'Respectful Maternity Care' would thus contribute to positive outcomes for women and their newborns, and also to ensure the cognitive development of children later in life.

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Introduction India is responsible for the second-highest maternal deaths and the greatest burden of stillbirths worldwide. The cost of intranatal services is an important determining factor, especially in developing countries like India. Most studies report the cost of delivery from the patient's perspective, but there is a lack of studies from the health system's perspective. This present study aimed to bridge this gap by estimating the overall and unit costs of various types of deliveries at a tertiary-level hospital in Rajasthan, India. Methods The cost estimation of intranatal services was conducted in a tertiary-level teaching hospital in Jaipur, Rajasthan. This cost analysis undertook the health system's perspective, using bottom-up costing methodology. Data on all the resources (capital/recurrent) used for the delivery of intranatal care from April 2020 to March 2021 were collected. Sensitivity analysis was done to account for any variability in cost components on overall intranatal service cost. Results The annual cost of intranatal care services at the tertiary care hospital was INR 149,011,957 (USD 1,988,152). The unit cost per vaginal delivery was INR 8,244.4 (USD 109.9) and the unit cost per cesarean section was INR 10,696.2 (USD 142.7). Among various heads of expenditure, 'human resource' costs were predominant, accounting for 47.7% of the total costs, followed by 'building/space' and 'overhead' costs, accounting for 30.59% and 11.1%, respectively. Conclusion The results may help plan and manage intra-natal care services in Rajasthan. Apart from the judicious utilization of resources, the findings of the study may also serve as a basis for future health economic studies.

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Background: Conflict-affected areas are considered to contribute a substantial proportion of worldwide maternal deaths. However, research on maternal health care in conflict-affected countries is very limited. In the absence of recent data, it is impossible to monitor progress made in mitigating the effect of conflict on maternal survival. As a result, this study targeted to assess institutional delivery services usage and influencing factors in a fragile and conflict-affected situation in Sekota town, Northern Ethiopia. Methods: A community-based cross-sectional study was employed among 420 mothers in Sekota town, Northern Ethiopia from July 15th to 30th, 2022. The desired sample size was determined using a single population proportion formula. The data were collected by using interviewer administered structured questionnaire; entered via EpiData version 4.6 and analyzed using SPSS version 25 software. To identify the associated factors, a bivariable and multivariable logistic regression model was applied. The level of significance was declared at a p-value of <0.05. An adjusted odds ratio with a 95% confidence interval was considered to see the strength of the association between dependent and independent variables. Results: Of the total respondent, 202 (48.1%), 95% CI: (43.0%, 53.0%) mothers utilized institutional delivery service. The use of institutional delivery services was associated with the maternal educational level of secondary school and above (AOR = 2.06, 95% CI: 1.08-3.93), antenatal care during the most recent pregnancy (AOR = 5.24, 95% CI: 3.01-9.11), being informed on birth preparedness and complication readiness (AOR = 1.93, 95% CI: 1.23-3.02) and displacement of the respondents from their usual place of residence due to conflict (AOR = 0.41, 95% CI: 0.21-0.68). Conclusion: Institutional delivery service utilization was very low in the study setting. Healthcare for women in conflict-prone areas requires critical attention and should be given priority during the conflict. More prospective research is needed to fully understand and reduce the impact of conflict on maternal and neonatal health care.

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BACKGROUND: Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS: A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS: Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION: Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

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