Singh Ranjana, Neogi Sutapa B, Hazra Avishek, Irani Laili, Ruducha Jenny, Ahmad Danish, Kumar Sampath, Mann Neelakshi, Mavalankar Dileep
Indian Institute of Public Health, Delhi, India.
Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, Haryana, 122002, India.
J Health Popul Nutr. 2019 May 27;38(1):13. doi: 10.1186/s41043-019-0173-5.
BACKGROUND: Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh (UP) and examines its determinants. METHODS: Data from a baseline survey of UP Community Mobilization (UPCM) project (2013) was utilized. A cross-sectional sample of currently married women (15 to 49 years) who delivered a baby 15 months prior to the survey was included. Information was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care (ANC), delivery and postnatal care (PNC) services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. RESULTS: Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group (SHG) membership had no association with the utilization of maternal health services. CONCLUSIONS: Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group.
背景：合理利用产前和产后护理服务对降低孕产妇死亡率和婴儿死亡率起着重要作用。本文评估了北方邦（UP）农村妇女在孕期、分娩期和产后对医疗服务的利用情况，并探讨了其决定因素。 方法：利用了UP社区动员（UPCM）项目（2013年）基线调查的数据。纳入了在调查前15个月分娩的目前已婚妇女（15至49岁）的横断面样本。从分布在北方邦五个区的2208名妇女那里收集了信息。收集了社会人口学特征、产前护理（ANC）利用情况、分娩和产后护理（PNC）服务的信息。为了研究孕产妇保健服务利用的决定因素，纳入的变量包括三次产前检查、机构分娩和分娩后42天内的产后护理。在调整协变量后，使用单独的多层次随机截距逻辑回归来考虑在街区和村委会层面的聚类情况。 结果：83%的妇女接受了任何产前检查。其中，61%的妇女报告进行了三次或更多次产前检查。尽管68%的妇女在医疗机构分娩，但29%的妇女住院至少48小时。26%的妇女报告在分娩后42天内接受了任何产后护理。在调整分析中，孕期与医护人员接触次数增加的妇女、接触大众媒体的妇女和非边缘化妇女在孕期进行至少三次产前检查的可能性更大。非边缘化妇女和进行了至少三次产前检查的妇女比其对应人群在机构分娩的可能性更大。孕期与医护人员的接触、边缘化、至少三次产前检查和机构分娩是产后护理服务利用的重要决定因素。自助小组（SHG）成员身份与孕产妇保健服务的利用无关。 结论：孕产妇保健服务的利用率较低。与医护人员的接触和边缘化成为服务利用的重要因素。尽管与利用情况无关，但自助小组可用于在小组内外传递医疗保健信息。
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