Improved maternal health since the ICPD: 20 years of progress

Thomas, Timothy A.; Gausman, Jewel; Lattof, Samantha R.; Wegner, Mary Nell; Kearns, Annie D; Langer, Ana

doi:10.1016/j.contraception.2014.06.026

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…In Mali, Upadhyay and colleagues found that women who had higher autonomy towards sexual violence tended to have more children, perhaps because higher fertility is regarded as a sign of autonomy 54 55. Another explanation for the inverse associations that we observed might be that more empowered women in Chad, Mali and Senegal might be more likely to successfully refuse to use maternal healthcare services that they perceive to be inadequate 56–60…”

Section: Discussionmentioning

confidence: 52%

Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

et al. 2019

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ObjectivesTo examine the association between women’s autonomy and the utilisation of maternal healthcare services across 31 Sub-Saharan African countries.Design, setting and participantsWe analysed the Demographic and Health Survey (DHS) (2010–2016) data collected from married women aged 15–49 years. We used four DHS measures related to women’s autonomy: attitude towards domestic violence, attitude towards sexual violence, decision making on spending of household income made by the women solely or jointly with husbands and decision making on major household purchases made by the women solely or jointly with husbands. We used multiple logistic regression analyses to examine the association between women’s autonomy and the utilisation of maternal healthcare services adjusted for five potential confounders: place of residence, age at birth of the last child, household wealth, educational attainment and working status. Adjusted ORs (aORs) and 95% CI were used to produce the forest plots.Outcome measuresThe primary outcome measures were the utilisation of ≥4 antenatal care visits and delivery by skilled birth attendants (SBA).ResultsPooled results for all 31 countries (194 883 women) combined showed weak statistically significant associations between all four measures of women’s autonomy and utilisation of maternal healthcare services (aORs ranged from 1.07 to 1.15). The strongest associations were in the Southern African region. For example, the aOR for women who made decisions on household income solely or jointly with husbands in relation to the use of SBAs in the Southern African region was 1.44 (95% CI 1.21 to 1.70). Paradoxically, there were three countries where women with higher autonomy on some measures were less likely to use maternal healthcare services. For example, the aOR in Senegal for women who made decisions on major household purchases solely or jointly with husbands in relation to the use of SBAs (aOR=0.74 95% CI 0.59 to 0.94).ConclusionOur results revealed a weak relationship between women’s autonomy and the utilisation of maternal healthcare services. More research is needed to understand why these associations are not stronger.

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Section: Discussionmentioning

confidence: 52%

Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

et al. 2019

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“…Our work shows that vaccines may also help to narrow gender disparities by a conceptual framework that links improvements in health to dimensions of gender equity, and that the magnitude of such effects can be quantified. Furthermore, we have shown that those effects improve the same dimensions that have been identified as essential to gender equity, where gaps still remain [17,64].…”

Section: Discussionmentioning

confidence: 66%

The impact of vaccination on gender equity: conceptual framework and human papillomavirus (HPV) vaccine case study

Portnoy

Clark

Ozawa

et al. 2020

Int J Equity Health

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Background: Although the beneficial effects of vaccines on equity by socioeconomic status and geography are increasingly well-documented, little has been done to extend these analyses to examine the linkage between vaccination and gender equity. In this paper, evidence from the published literature is used to develop a conceptual framework demonstrating the potential impact of vaccination on measures of gender equity. This framework is then applied to human papillomavirus (HPV) vaccination in three countries with different economic and disease burden profiles to establish a proof of concept in a variety of contexts. Methods: We conducted a literature review examining evidence on the linkage between health outcomes and dimensions of gender equity. We utilized the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to estimate cervical cancer incidence and deaths due to HPV types 16/18 by age in each country. We estimated labor force participation and fertility effects from improvements in health, and converted these into inputs consistent with those used to calculate the United Nations Gender Inequality Index to assess gender equity. Results: In our case study, we found that HPV vaccination among girls could help narrow socioeconomic gender disparities by quantifying the main pathways by which HPV vaccination improves health, which enables improvement in gender equity indicators such as labor force participation and maternal mortality ratios. While these improvements are small when averaged over the entire population, the components measuredlabor force participation and maternal mortality ratioaccount for 50% of the index scores. Conclusions: This proof of concept model is a starting point to inform future health and economic analyses that might incorporate the impact of gender equity as an additional impact of vaccination in improving the health and well-being of the population.

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“…Adapting a standard global framework and identifying a set of indicators that are feasible to measure and, if improved, will result in better outcomes can help to guide stakeholders to improve the quality of maternal and neonatal health services. Policymakers, program leaders, and service providers need to better understand and measure quality [11,12], and what affects quality variations, in order to improve service delivery effectiveness and efficiency [12]. To do so, data is required from multiple sources from services at multiple levels, to inform the broader health information and policymaking sphere [13,14].…”

Section: Introductionmentioning

confidence: 99%

Translating international guidelines for use in routine maternal and neonatal healthcare quality measurement

Chang

Hossain

Sarker

et al. 2020

Global Health Action

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Background: Improving facility-based quality for maternal and neonatal care is the key to reducing morbidity and mortality rates in low-and middle-income countries. Recent guidance from WHO and others has produced a large number of indicators to choose from to track quality. Objective: To explore how to translate complex global maternal and neonatal health standards into actionable application at the facility level. Methods: We applied a two-step process as an example of how the 352 indicators in WHO's 2016 Standards for Improving Quality of Maternal and Newborn Care in Health Facilities might be reduced to only those with the strongest evidence base, associated with outcomes, and actionable by facility managers. We applied Hill criteria and assessed whether indicators were within the control of facility managers. We next conducted a rapid review of supporting literature and applied GRADE analysis, retaining those with scores of 'moderate' or 'high'. To understand the utility and barriers to measuring this limited set of indicators in practice, we undertook a case study of hypothetical measurement application in two districts in Bangladesh, interviewing 25 clinicians, managers, and other stakeholders. Results: From the initial 352 indicators, 56 were retained. The 56 indicators were used as a base for interviews. Respondents emphasized the practical challenges to the use of complex guides and the need for parsimonious and actionable sets of quality indicators. Conclusions: This work offers one way to move towards a reduced quality indicator set, beginning from current WHO guidance. Despite study limitations, this work provides evidence of the need for reduced and evidence-based sets of quality indicators if guides are to be used to improve quality in practice. We hope that future research will build on and refine our efforts. Measuring quality effectively so that evidence guides and improves practice is the first step to assuring safe maternal and neonatal care.

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Improved maternal health since the ICPD: 20 years of progress

Cited by 23 publications

References 21 publications

Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010–2016

The impact of vaccination on gender equity: conceptual framework and human papillomavirus (HPV) vaccine case study

Translating international guidelines for use in routine maternal and neonatal healthcare quality measurement

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