Sharma Shantanu, Bhardwaj Aditya, Arora Kanishtha, Akhtar Faiyaz, Mehra Sunil
Department of Reproductive Maternal Child and Adolescent Health, MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave II, Greater Kailash, New Delhi, India.
J Family Med Prim Care. 2023 Aug;12(8):1516-1524. doi: 10.4103/jfmpc.jfmpc_1891_21. Epub 2023 Aug 29.
Universal maternal health coverage (UHC) envisages access to quality healthcare services by pregnant and lactating women without any financial hardship. Our present study attempts to assess the UHC for maternal health services and their determinants, including access to quality antenatal care (ANC), quality postnatal care (PNC), and child immunization among the marginalized populations of India.
It was a community-based cross-sectional study across five states of India among pregnant or lactating women. Quality ANC score was calculated using four indicators, including ANC registration month, attendance of four or more ANC visits, receiving at least one tetanus toxoid injection, and consumption of 100 iron-folic acid (IFA) tablets. Similarly, quality PNC care score was calculated using four indicators, including PNC within 48 h, breastfeeding initiation time, institutional delivery, and accessing conditional maternity benefit scheme. Logistic or generalized linear regression was used to depict associations depending on the outcome variables.
A total of 12,976 pregnant women's and 18,061 lactating mothers' data were analyzed. Illiterate women, women from below the poverty line, and rural areas had low-quality ANC and PNC scores compared with their counterparts. Marginalized women had lower odds of immunization of children and lower quality PNC scores than nonmarginalized.
Sociodemographic factors, such as caste, education of women, area of residence, and economic status, are major determinants of quality ANC and PNC scores and immunization of children. Hence, interventionists ought to design community-based interventions that address the challenges in the uptake of health services.
全民孕产妇健康覆盖旨在让孕妇和哺乳期妇女能够获得优质医疗服务，且不会面临任何经济困难。我们目前的研究试图评估孕产妇健康服务的全民覆盖情况及其决定因素，包括印度边缘化人群获得优质产前护理（ANC）、优质产后护理（PNC）以及儿童免疫接种的情况。
这是一项基于社区的横断面研究，在印度五个邦的孕妇或哺乳期妇女中开展。使用四个指标计算优质ANC得分，包括ANC登记月份、四次或更多次ANC就诊的出勤率、至少接受一次破伤风类毒素注射以及服用100片铁叶酸（IFA）片。同样，使用四个指标计算优质PNC护理得分，包括48小时内的PNC、开始母乳喂养时间、机构分娩以及获得有条件的产妇福利计划。根据结果变量使用逻辑回归或广义线性回归来描述关联。
共分析了12976名孕妇和18061名哺乳期母亲的数据。与识字女性、贫困线以上女性和城市地区女性相比，文盲女性、贫困线以下女性和农村地区女性的ANC和PNC得分较低。边缘化女性的儿童免疫接种几率较低，PNC得分质量也低于非边缘化女性。
种姓、女性教育程度、居住地区和经济状况等社会人口学因素是优质ANC和PNC得分以及儿童免疫接种的主要决定因素。因此，干预措施制定者应设计基于社区的干预措施，以应对获得卫生服务方面的挑战。
