International Institute for Population Sciences (IIPS), Mumbai, Deonar, 400088, India.
BMC Pregnancy Childbirth. 2021 Oct 27;21(1):731. doi: 10.1186/s12884-021-04198-2.
India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India?
The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015-16 in India. The analysis was limited to 107,016 women aged 15-49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC.
Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion.
The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.
印度作为一个发展中国家，在孕产妇和新生儿的死亡率和发病率方面呈现出令人不安的局面。如果能够按照结构化的途径提供从妊娠到产后的连续护理（CoC），则大部分孕产妇和新生儿的死亡是可以避免的。因此，本文试图回答以下研究问题：MNCH 服务的 CoC 完成程度如何？妇女在哪个护理阶段停止接受服务？以及影响印度妇女继续接受孕产妇、新生儿和儿童健康（MNCH）服务的因素有哪些？
本研究利用了印度 2015-16 年进行的国家家庭健康调查（NFHS-4）的数据。分析仅限于在调查前 5 年内生育过活产且其子女已年满 1 岁的 15-49 岁的 107,016 名妇女。采用四个连续的固定效应逻辑回归模型来确定 CoC 完成的预测因素。
印度近 39%的妇女完成了孕产妇和儿童健康的 CoC，接受了所有四种类型的服务（产前护理、机构分娩、产后护理和儿童全面免疫接种），但存在很大的地区差异，从 12%到 81%不等。CoC 中辍学人数最多的是第一阶段，流失率近 38%。此外，教育、财富指数和医疗保险覆盖范围是与 CoC 完成相关的重要因素。
实现孕产妇和儿童健康 CoC 的主要障碍是在连续护理的第一阶段中 ANC 服务的利用率低，因此应解决这一问题，以提高该国的 CoC 完成率。CoC 各个层面的差距表明，印度需要更加关注 CoC 方法。应制定一项战略，将 MNCH 的所有组成部分联系起来，避免辍学，将 MNCH 服务标准化，为每一位妇女和儿童提供服务。
