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IntroductionIn this era of SDG countries relatively achieving maternal and newborn health geographic coverage are moving to a new paradigm called completion of maternal and new born care continuum (MN- CoC). Measuring the influence of significant others: partner/or husband and community engagement are considered as pivotal and one of the pillar strategies to achieve of completion of MN-CoC. Unfortunately, there is a lack of policy framework for partner and/or husband involvement in pregnancy, childbirth and postnatal care and when exists there is a gap in policy and practice in developing countries context. Articulating and endorsing such policy is likely to promote husband and/or partner encouragement and support during at the enrollment to maternal and newborn care continuum (MN-CoC). Hence, quantifying the level of MN-CoC partner dynamics on antenatal care visit and/or discussion about where to deliver the index child at and identifying its correlates among a panel of six weeks postpartum women provides evidence for the policy articulation endeavor by the Federal Health Ministry of the Federal Democratic Republic of Ethiopian and developmental partners working on reproductive and maternal and newborn health care.MethodsCommunity based nationally representative longitudinal data collected from a panel of pregnant and six weeks postpartum women were further analyzed. A total of 2,207 six weeks postpartum women who were married and/or living a partner were included in this analysis which was adequate to yield an unbiased estimates for MN-CoC partner dynamics. Multinomial logistics regression was run to identify correlates of partner Dynamics. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05.ResultsThe proportion of partner and/or husband dynamics on MN-CoC of among six weeks postpartum women who reported that their partner and/or husband encouraged them to go to clinic for ANC and discussed with them about place of delivery for the index child was nearly 2/3 (64.67%; 62.21%, 67.04%).Besides, nearly one in 5 of them reported that their husband and/or partner did not encourage (18.2%; 16.64%, 20.33) and encouraged either of the first two MN-CoC two domains (17.08%, 15.25%, 19.10%). The region women residing, being in a polygamy marriage, contraceptive ever use history, attainment secondary/higher education and index child delivery place were found to contribute for the variation in MN-CoC partner dynamics.The finding calls up on regionally sensitive activities and efforts with public-private partnership in service provision and targeting women with polygamy which in turn empower women to control over their fertility through increasing higher education enrollment, and diversifying access to contraceptive commodities are hoped to improve MN-CoC partner dynamics thereby enabling women in completing maternal and new born care continuum. Such endeavors and interventions are hoped to facilitate the ministry and other developmental partners’ comprehensive efforts to address the MN-CoC partner and/or partner dynamics in terms of policy articulation, advocacy, implementation, evaluation and revising it to fit its purpose and attain the desired targets.Author Plain English SummaryPurpose of Conducting the StudyIn every community, pregnancy and childbirth are expected to be joyful and positive experiences for the mother, the newborn and as well as for the families, however, neonatal, infant and maternal mortality is unacceptably high in low and middle income countries including Ethiopia. It is experienced not as the joyful event it should be, but as a dangerous and frightening time in their lives.In order to address such considerable problem, in the SDG era the focus of policy articulation, program concentration and research undertaking in maternal and newborn health care has shown a paradigm shift of measuring the completion of maternal, newborn care continuum (MN-CoC) by streamlining resources that were invested independently on each care continuum domains.Besides, WHO recommended completion of the three main domains of the maternal and newborn care continuum as pivotal strategy to improved maternal and new born health outcomes.Accordingly, partner encouragement, support and accompany during antenatal care, childbirth and postnatal care is one of the proposed strategy for pregnant women to be enrolled, retained and complete the maternal and new born care continuum including in sought care in the extended six postpartum period in particular and the inter pregnancy period in general. This is based on the evidence pool on the influence of significant others surrounding the women, notably; the community where they are residing and their partner and/or husband on health service use is considerably high.Determining the level of partner dynamics on the MN-CoC domains and identify its correlates is critical to track the progress of the proposed strategy. Nationally representative data collected from a panel of pregnant and six weeks the six post-partum women were used.Added Value of the StudyNearly 1 in 5 panel of women by their six week postpartum reported that they did not received any encouragement on the two first domains MN-CoC during their index pregnancy. Regional variation was observed in the level of partner dynamics at maternal and newborn care continuum enrollment domains (MN- CoC) and the variation was also explained by contraceptive ever use history as well. Women in polygamy marriage were less encouraged to go to clinic for ANC and lower opportunity to discuss where to deliver the index child with their partner and/or husband. .Implication of the StudyThe Federal Democratic Republic of Ethiopian Health Ministry and developmental partners need to articulate and endorse male involvement policy with region specific integrated public private strategies which improve women autonomy to control over their fertility and women higher education enrollment with a focus on women with polygamy so as to increase partner dynamics on MN-CoC.Partner encouragement on the first two domains of is key to enroll and retain pregnant women within the MN- CoC.There is a need to strengthen postpartum family planning counseling and diversifying the provision. Similarly women in polygamy needs attention.The need for installing preconception care in the health system to be provided in and around pregnancy and child birth; particularly the inter pregnancy preconception care package.
IntroductionIn this era of SDG countries relatively achieving maternal and newborn health geographic coverage are moving to a new paradigm called completion of maternal and new born care continuum (MN- CoC). Measuring the influence of significant others: partner/or husband and community engagement are considered as pivotal and one of the pillar strategies to achieve of completion of MN-CoC. Unfortunately, there is a lack of policy framework for partner and/or husband involvement in pregnancy, childbirth and postnatal care and when exists there is a gap in policy and practice in developing countries context. Articulating and endorsing such policy is likely to promote husband and/or partner encouragement and support during at the enrollment to maternal and newborn care continuum (MN-CoC). Hence, quantifying the level of MN-CoC partner dynamics on antenatal care visit and/or discussion about where to deliver the index child at and identifying its correlates among a panel of six weeks postpartum women provides evidence for the policy articulation endeavor by the Federal Health Ministry of the Federal Democratic Republic of Ethiopian and developmental partners working on reproductive and maternal and newborn health care.MethodsCommunity based nationally representative longitudinal data collected from a panel of pregnant and six weeks postpartum women were further analyzed. A total of 2,207 six weeks postpartum women who were married and/or living a partner were included in this analysis which was adequate to yield an unbiased estimates for MN-CoC partner dynamics. Multinomial logistics regression was run to identify correlates of partner Dynamics. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05.ResultsThe proportion of partner and/or husband dynamics on MN-CoC of among six weeks postpartum women who reported that their partner and/or husband encouraged them to go to clinic for ANC and discussed with them about place of delivery for the index child was nearly 2/3 (64.67%; 62.21%, 67.04%).Besides, nearly one in 5 of them reported that their husband and/or partner did not encourage (18.2%; 16.64%, 20.33) and encouraged either of the first two MN-CoC two domains (17.08%, 15.25%, 19.10%). The region women residing, being in a polygamy marriage, contraceptive ever use history, attainment secondary/higher education and index child delivery place were found to contribute for the variation in MN-CoC partner dynamics.The finding calls up on regionally sensitive activities and efforts with public-private partnership in service provision and targeting women with polygamy which in turn empower women to control over their fertility through increasing higher education enrollment, and diversifying access to contraceptive commodities are hoped to improve MN-CoC partner dynamics thereby enabling women in completing maternal and new born care continuum. Such endeavors and interventions are hoped to facilitate the ministry and other developmental partners’ comprehensive efforts to address the MN-CoC partner and/or partner dynamics in terms of policy articulation, advocacy, implementation, evaluation and revising it to fit its purpose and attain the desired targets.Author Plain English SummaryPurpose of Conducting the StudyIn every community, pregnancy and childbirth are expected to be joyful and positive experiences for the mother, the newborn and as well as for the families, however, neonatal, infant and maternal mortality is unacceptably high in low and middle income countries including Ethiopia. It is experienced not as the joyful event it should be, but as a dangerous and frightening time in their lives.In order to address such considerable problem, in the SDG era the focus of policy articulation, program concentration and research undertaking in maternal and newborn health care has shown a paradigm shift of measuring the completion of maternal, newborn care continuum (MN-CoC) by streamlining resources that were invested independently on each care continuum domains.Besides, WHO recommended completion of the three main domains of the maternal and newborn care continuum as pivotal strategy to improved maternal and new born health outcomes.Accordingly, partner encouragement, support and accompany during antenatal care, childbirth and postnatal care is one of the proposed strategy for pregnant women to be enrolled, retained and complete the maternal and new born care continuum including in sought care in the extended six postpartum period in particular and the inter pregnancy period in general. This is based on the evidence pool on the influence of significant others surrounding the women, notably; the community where they are residing and their partner and/or husband on health service use is considerably high.Determining the level of partner dynamics on the MN-CoC domains and identify its correlates is critical to track the progress of the proposed strategy. Nationally representative data collected from a panel of pregnant and six weeks the six post-partum women were used.Added Value of the StudyNearly 1 in 5 panel of women by their six week postpartum reported that they did not received any encouragement on the two first domains MN-CoC during their index pregnancy. Regional variation was observed in the level of partner dynamics at maternal and newborn care continuum enrollment domains (MN- CoC) and the variation was also explained by contraceptive ever use history as well. Women in polygamy marriage were less encouraged to go to clinic for ANC and lower opportunity to discuss where to deliver the index child with their partner and/or husband. .Implication of the StudyThe Federal Democratic Republic of Ethiopian Health Ministry and developmental partners need to articulate and endorse male involvement policy with region specific integrated public private strategies which improve women autonomy to control over their fertility and women higher education enrollment with a focus on women with polygamy so as to increase partner dynamics on MN-CoC.Partner encouragement on the first two domains of is key to enroll and retain pregnant women within the MN- CoC.There is a need to strengthen postpartum family planning counseling and diversifying the provision. Similarly women in polygamy needs attention.The need for installing preconception care in the health system to be provided in and around pregnancy and child birth; particularly the inter pregnancy preconception care package.
Background Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country’s population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility. Methods Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant’s characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23). Conclusion Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.
Introduction In Ethiopia, there is a decrease in percentage of women who receive method information index counseling service from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally, and less than 40% of these services provided are high quality. Therefore, the aim of this study was to identify modern contraceptive users-related factors at individual level and community level associated with missed opportunities of method information index plus counseling. Methods This study used the datasets from the 2019 Performance Monitoring for Action Ethiopia Survey, which comprised a total of 8,365 households (98.9%) and 7,988 women (98.8%). The data analysis was done with Stata version 14. Using multilevel mixed effect logistics regression, both individual and community-level factors were found to be associated with missed opportunities of method information index plus counseling. a P -value of less than 0.05 was used to declare statistical significance. The association was presented using an adjusted odds ratio with a 95% confidence interval. Results The study shows that the prevalence of missed opportunity MII + family planning counseling among current modern contraceptive users was 81% (79.15, 82.66) and factors significantly associated with missed opportunities of method information index plus counselling are educational status, low level of media exposure, religion, receiving the service in health centers and health posts, never heard of any other methods, number of children at first contraceptive use and region. Conclusions In Ethiopia 81% of women had a missed opportunities of MII + counseling service. In order to address this, we recommend policy makers to focus on training of health care workers and pharmacists about MII + counseling, and establishing ways to improve access to media exposure.
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