Budhwani Henna, Hearld Kristine Ria, Harbison Hanne
University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA.
University of Alabama at Birmingham, 563 School of Health Professions Building, 1705 University Boulevard, Birmingham, AL, 35294, USA.
Matern Child Health J. 2015 Oct;19(10):2138-46. doi: 10.1007/s10995-015-1726-x.
This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5.
本研究考察了与巴基斯坦孕产妇保健利用情况相关的个体层面和地区层面因素。利用2012 - 2013年巴基斯坦人口与健康调查数据对五个结果进行建模：孕早期的产前护理、四次及以上产前检查、由熟练医护人员接生、在医疗机构分娩以及接受产后护理。不到一半的分娩产妇在孕早期接受了产前护理，约57%的产妇在分娩时有经过培训的人员在场。超过一半的产妇接受了产后护理。研究发现有证据支持个体层面变量（教育和财富）对所有五项指标的孕产妇保健利用产生积极影响。尽管本研究未发现农村和城市女性之间存在单方面差异，但与城市环境中的母亲相比，农村女性利用产前服务的几率较低。此外，将距离视为障碍的女性接受产后保健的几率较低，但仍会利用产前服务，并且分娩时通常有熟练医护人员在场。当女性居住在产前护理利用率较高的地区时，利用产前护理的几率会增加，而且这种差异在各省的各项指标中都存在。本文的研究结果凸显了巴基斯坦在改善产前、分娩和产后护理方面取得的进展不均衡；差异仍然存在，这可能归因于个体和社区层面的因素，但可以通过共同努力改变国家围绕妇女健康的政策来解决，这应该包括推广基于证据的干预措施，如激励医护人员、促进女童教育以及改善孕妇和刚生产的母亲的交通选择，最终目的是按照联合国千年发展目标5的建议降低孕产妇死亡率。
