Department of Statistics, University of Dhaka, Dhaka, Bangladesh.
PLoS One. 2023 Feb 7;18(2):e0281369. doi: 10.1371/journal.pone.0281369. eCollection 2023.
The World Health Organization recommended a set of five neonatal care practices that are most essential for good health of a newborn. As good essential newborn care (ENC) practice reduces the risk of neonatal morbidity and mortality, this paper focuses how women's multidimensional empowerment index is associated with this practice through the skilled antenatal care. To the best of knowledge, no such study has been conducted yet. The composite index of women's multidimensional empowerments was constructed using family decision, intimate partner violence, social status, healthcare access and economic status of women; and skilled antenatal care was defined if a pregnant woman received eight or more checkups during pregnancy from skilled health professionals.
Data extracted from Bangladesh Demographic and Health Survey, 2017-18 have been utilized in the study. A total of 2441 mothers have been considered who delivered their last live birth at home within three years preceding the survey. A mediation analysis was performed considering the structural equation modeling to find out the adjusted association of women's empowerment on both skilled antenatal care and good ENC practice, but the unadjusted associations were also checked using a chi-square test. To test the indirect as well as total effect of women's empowerment through skilled antenatal care on good ENC practice, bias-corrected standard errors were estimated using a bootstrapping sampling.
Good ENC practice was considerably low in Bangladesh with 7.6% of newborns receiving the practice. Both adjusted and unadjusted analyses showed the significant association of women's empowerment with both skilled antenatal care and good ENC practice. The study revealed that the indirect effect of high empowerment through skilled antenatal care was greater than its direct effect on good ENC practice.
This study explored that the prevalence of good ENC practice can be accelerated through women's empowerment, where skilled antenatal care plays an important mediating role in improving good ENC practice among highly empowered mothers. The study suggests that a woman should follow the latest guidelines recommended by WHO for antenatal care follow-up. Policymakers can modify some of the maternal and child health care interventions based on the research findings.
世界卫生组织推荐了一套五项新生儿护理措施，这些措施对新生儿的健康至关重要。由于良好的基本新生儿护理（ENC）实践可以降低新生儿发病率和死亡率，因此本文重点研究了妇女多维赋权指数如何通过熟练的产前护理与这一实践相关。据我们所知，目前还没有进行过此类研究。妇女多维赋权综合指数是通过家庭决策、亲密伴侣暴力、社会地位、获得医疗保健和妇女经济地位来构建的；如果孕妇在怀孕期间接受了 8 次或更多次由熟练的卫生专业人员进行的检查，则定义为熟练的产前护理。
本研究使用了 2017-18 年孟加拉国人口与健康调查中提取的数据。共考虑了 2441 名母亲，她们在调查前三年内在家中分娩了最后一个活产儿。采用结构方程模型进行中介分析，以发现妇女赋权对熟练产前护理和良好 ENC 实践的调整后关联，但也使用卡方检验检查了未经调整的关联。为了测试妇女赋权通过熟练产前护理对良好 ENC 实践的间接和总效应，使用自举抽样估计了偏置校正标准误差。
孟加拉国良好的 ENC 实践率相当低，只有 7.6%的新生儿接受了该实践。调整后的和未经调整的分析都表明，妇女赋权与熟练产前护理和良好 ENC 实践都有显著关联。研究表明，通过熟练的产前护理，高赋权的间接效应大于其对良好的 ENC 实践的直接效应。
本研究探讨了通过妇女赋权可以加速良好的 ENC 实践的普及，其中熟练的产前护理在提高高赋权母亲良好的 ENC 实践中发挥着重要的中介作用。研究表明，妇女应遵循世卫组织推荐的最新产前护理指南。政策制定者可以根据研究结果修改一些母婴保健干预措施。
