BACKGROUND: Antenatal care (ANC) supports skilled delivery and maternal survival, but evidence on how Ghana's Community-Based Health Planning and Services (CHPS) policy influences ANC access is limited. This study assessed factors associated with ANC access in the Twifo Hemang Lower Denkyira District, Central Region, Ghana. METHODS: In a cross-sectional study, we examined 310 women aged 15-49 years, having children less than 12 months, using a structured questionnaire administered through interviews. ANC initiation was defined as early when the first ANC visit occurred at 0-12 weeks' gestation (first trimester) and late when it occurred at 13 weeks or later. We performed univariate and multivariate logistic regression analyses in Stata 17 and reported adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS: ANC attendance was 93.9%, and 69.1% of women initiated ANC early. Unmarried women (AOR = 0.125, 95%CI:0.012-0.926, p = 0.047) and women who delivered at home (AOR = 0.013, 95%CI:0.001-0.176, p = 0.001) had lower odds of attending at least one ANC visit. Late ANC initiation was associated with household size of 11 or more members (AOR = 3.848, 95%CI:1.914-6.211, p = 0.046), fewer than four ANC contacts (AOR = 6.332, 95% CI: 2.049-9.571, p = 0.001), and CHPS staff home visits (AOR = 1.813, 95%CI:1.014-3.243, p = 0.045). Higher monthly income was associated with lower odds of late ANC initiation (AOR = 0.123, 95%CI:0.024-0.630, p = 0.012). ANC and pregnancy knowledge, receiving care in a CHPS zone, and distance to a CHPS zone were not significantly associated with ANC attendance or timing after adjustment. CONCLUSIONS: ANC attendance and early initiation were relatively high. However, marital status, place of delivery, household size, income, ANC contacts, and CHPS home visits were associated with ANC access. Strengthening community-based and multisectoral interventions may improve timely ANC use and maternal health outcomes.
BMJ openFerguson Saapiire, Charlotte Tawiah, Francis Agbokey, Kenneth Ayuurebobi Ae-Ngibise, Wisdom Kudzo Axame, Frank E Baiden
OBJECTIVE: To explore the readiness of health managers to integrate effective coverage into routine monitoring of maternal and child health (MCH) services in two rural districts of Ghana. METHODS: An exploratory qualitative study was conducted among purposively selected district and subdistrict health managers in Kintampo North and Kintampo South, Ghana. Two rounds of in-depth interviews explored participants' perceptions and implementation considerations regarding the use of effective coverage. Between the two rounds, participants took part in a 3-month pilot implementation phase. This phase included workshops, hands-on training and planning sessions. During this period, participants were trained to compute and interpret effective coverage using routine data and to explore its application to MCH monitoring and evaluation. Data were analysed thematically in NVivo V.17 using Braun and Clarke's six-phase approach. RESULTS: Following the learning sessions, participants reported an understanding of the components of effective coverage and how to compute and apply the indicator using routine district data. They also reported confidence in computing and interpreting the indicator. In the follow-up interviews, participants expressed willingness to integrate the indicator into routine monitoring processes. However, they identified technical and logistical challenges and inadequate data in the current national health information management system. CONCLUSION: Health managers in rural Ghana expressed willingness to integrate effective coverage into the routine monitoring and evaluation of MCH programmes. However, limited availability of routine data within the national health information management system remains a major barrier to implementation.
BMJ openGebeyaw Molla Wondim, Wubegzier Mekonnen, Catherine Arsenault, Anagaw Derseh Mebratie, Margaret E Kruk, Damen Haile Mariam
OBJECTIVES: Antenatal depression is a significant yet under-recognised global public health concern that affects a substantial proportion of women in Ethiopia. This study aimed to examine the magnitude, trajectory and determinants of depressive symptoms among pregnant women. DESIGN: A prospective longitudinal study design was conducted between April 2023 and February 2024. SETTING AND PARTICIPANTS: The study was conducted in Adama Town and the East Shewa Zone of the Oromia Region, Ethiopia. A total of 933 pregnant women who visited the health facility for their first ANC visit were recruited and followed throughout their pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: Antenatal depressive symptoms were measured using the Patient Health Questionnaire-9 through face-to-face interviews and monthly phone calls. The trajectory and determinants of antenatal depressive symptoms were assessed using group-based trajectory modelling and generalised estimating equations. RESULTS: The study found that overall, 30.5% of participants experienced antenatal depressive symptoms, with a lower prevalence at the first measurement point (24.2%) and higher prevalence at the second measurement point (36.9%). Antenatal depressive symptoms were higher during the first trimester (35.6%) compared with the second (19.8%) and third (13.2%) at baseline, and the pattern was consistent across the monthly follow-up period. Moreover, 11.6% of pregnant women had a trajectory of mild-to-moderate depressive symptoms over time. Factors included being currently married (adjusted OR (aOR) 0.53; 95% CI 0.28 to 0.98), having an unintended pregnancy (aOR 1.29; 95% CI 1.03 to 1.62), experiencing intimate partner violence (aOR 2.43; 95% CI 1.67 to 3.56), experiencing at least one pregnancy danger sign (aOR 2.60; 95% CI 2.22 to 3.04), having a history of at least one pregnancy complication (aOR 1.87; 95% CI 1.53 to 2.29), being in the first trimester (aOR 1.45; 95% CI 1.09 to 1.93), having poorer self-reported health (aOR 1.66; 95% CI 1.40 to 1.97) and moderate to low health-related quality of life (aOR 2.43; 95% CI 1.78 to 3.32) were associated with antenatal depressive symptoms. CONCLUSION: Nearly one-third of pregnant women had antenatal depressive symptoms, and one in 10 demonstrated steadily increased depressive symptoms over time. The high burden of antenatal depressive symptoms and their association with preventable social and pregnancy-related factors underscore the need for comprehensive antenatal care services that incorporate mental health screening, psychosocial support and interventions addressing intimate partner violence and pregnancy-related complications.
OBJECTIVES: Maternal health has shifted from a narrow focus on survival to a rights-based paradigm emphasising the quality of the birthing experience. This study explored participants' lived experiences in the Ari Zone, southern Ethiopia, regarding their right to choose their preferred maternal healthcare providers. DESIGN: A qualitative descriptive phenomenological study using face-to-face, semi-structured, in-depth interviews, analysed using Colaizzi's seven-step method with OpenCode software (V.4.2). SETTING: Public maternal healthcare services in the Ari Zone, South Ethiopia Regional State, southern Ethiopia. PARTICIPANTS: 18 postpartum women (n=18), aged 20-39 years, purposively selected from women who had used maternal health services in the Ari Zone at least twice in the preceding 12 months. RESULTS: Four themes emerged. Participants described the healthcare environment as a rigid hierarchy in which top-down provider assignment and resource constraints constrained perceived choice and autonomy. The desire to select a provider was often described as a response to prior obstetric trauma or trusted community narratives about provider conduct. In the absence of formal choice, participants described informal strategies, such as timing visits to trusted shifts or emotionally withdrawing, to exert limited control over their care. They also envisioned person-centred care in which choice of provider was framed as integral to dignity and clinical safety. CONCLUSIONS: Service coverage alone did not capture important dimensions of maternal healthcare quality, including dignity, autonomy and perceived choice. Participants described how provider assignment, limited information about available providers, resource constraints and concerns about provider conduct constrained their perceived ability to exercise choice. In the absence of formal mechanisms for choosing providers, some participants described informal strategies to retain limited control over their care. These findings highlight the importance of strengthening women's participation in decisions about their maternal healthcare and creating care environments that support dignity, respect and autonomy. The findings should be interpreted within the context of this qualitative study and should not be generalised beyond the study population and setting.
Timely postpartum care is critical for the detection and treatment of pregnancy-related conditions and complications, thereby reducing maternal morbidity and mortality. However, attending postpartum care visits can be particularly challenging for low-income individuals. This study examined the correlates of postpartum care visit non-attendance among low-income women using the Andersen Behavioral Model of Health Services Use. Data were analyzed from 671 women enrolled during pregnancy in the South Carolina Midlands Healthy Start Program (2019-2024), a federally-funded program with the aim of improving perinatal outcomes through enhanced care coordination and case management for underserved pregnant and postpartum women. Multiple logistic regression models were used to identify correlates of postpartum visit non-attendance. Participants were predominantly non-Hispanic Black (87.5%) and low-income (90.9% receiving Medicaid). Overall, 27.0% did not attend a postpartum care visit within 12 weeks of delivery. Compared to non-Hispanic White participants, non-Hispanic Black (adjusted odds ratio (AOR): 0.48; 95% confidence interval (CI): 0.25, 0.94) and Hispanic participants (AOR: 0.12; 95% CI: 0.02, 0.66) had lower odds of non-attendance. Participants with a high school diploma/GED or less had higher odds of non-attendance (AOR: 1.83; 95% CI: 1.23, 2.71). Lack of partner involvement (AOR: 1.95; 95% CI: 1.14, 3.32) and frequent experiences of discrimination (AOR: 2.79; 95% CI: 1.22, 6.38) measured using the Everyday Discrimination Scale were also associated with increased odds of non-attendance. This study identified key factors associated with postpartum visit non-attendance among low-income women, including race, education level, partner involvement, and experiences of discrimination. These findings highlight the need to address individual, familial, and contextual factors to improve postpartum care engagement.
International journal for equity in healthPiyush Bhatt, Anviti Awasthi
BACKGROUND: In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. However, in districts with scattered settlements, hilly terrain, and difficult-to-reach hamlets, geographic and infrastructural barriers continue to constrain maternal health outcomes. In the tribal district of Barwani, traditional beliefs and cultural preferences further reinforce the community's reliance on home-based deliveries, which increase the risk of preventable maternal and neonatal complications and deaths. To address these intersectional inequities in rural India, the Antara Foundation, a public health nonprofit, piloted a community-led Home Delivery Prevention Model in Pati block of Barwani district. The model aimed to quantify and address barriers contributing to home deliveries through the active involvement of the local community. Institutional delivery was used as a proxy indicator for access to institutional maternal care. OBJECTIVE: This paper documents the implementation of the model that ensures institutional deliveries among pregnant women in 'hard-to-reach' hamlets (faliya) and explores how locally driven, community-led approaches can promote equitable access to public healthcare in remote, indigenous settings. METHODOLOGY: The model, designed in December 2023 with the help of community volunteers, was implemented from January to June 2024. A mixed-methods approach was used, with quantitative analysis of government data to identify pilot areas. Content analysis of the qualitative data, which was collected by the implementation team from pregnant women and their families through FGDs and interviews, informed the community action. A purposive sample of 127 pregnant women was selected across five sub-health centres (SHCs) with the highest number of home deliveries. Data collected was stored, handled and managed ethically throughout the pilot, guided by the Declaration of Helsinki 2024. RESULTS: The intervention demonstrated preliminary improvements in family and local community support, resulting in institutional delivery for 83% of pregnant women who gave birth during the study period. CONCLUSION: This pilot study provides evidence that community-led models, grounded in local participation and integration with public systems, can enhance the uptake of institutional care in regions with high geographic and social inequities.
PloS oneGideon Ikemdinachi Nwankwo, Rejoice Uche Obiora, Delight Mawufemor Agbi, Bisola Olubiyi, Daniel Mumba, Herbert Tafadzwa Kazonda, Isaac Isiko, Edson Mwebesa, Ch…
BACKGROUND: Maternal mortality remains a major public health challenge, particularly in low- and middle-income countries, with Sub-Saharan Africa bearing a disproportionate burden. Nigeria accounts for over one-quarter of all maternal deaths worldwide. This reflects gaps in access to and continuity of maternal healthcare. The continuum of maternal healthcare, which includes antenatal care (ANC), skilled delivery, and postnatal care (PNC) is critical for improving maternal and neonatal outcomes. This study examines the determinants of continuum of maternal healthcare service utilization in Nigeria. METHODS: This study utilized data from 13,596 women (weighted n = 14,183) from the 2024 Nigeria Demographic and Health Survey. Maternal Health Services Utilization (MHSU) was operationalized as a composite outcome (none, partial, adequate) based on ANC attendance, place of delivery, maternal and child PNC. Multilevel multinomial logistic regression models were fitted to assess individual, household, and contextual predictors. Variables significant at p < 0.20 in bivariate analysis were included in multivariable models. Statistical significance was set at p < 0.05. RESULTS: Overall, 44.0% of women did not utilize any services, 44.4% partially utilized services, and only 11.6% achieved adequate utilization. Women with secondary or higher education were significantly more likely to achieve adequate utilization (Relative Risk Ratio (RRR) = 12.10, 95% CI: 8.72, 16.81). Wealth status, media exposure, employment, and health insurance were positively associated with utilization, while higher parity and decision-making barriers reduced utilization. Rural residence was associated with lower utilization (RRR = 0.38, 95% CI: 0.29, 0.49). Distance to health facilities was not significant in the adjusted model. CONCLUSION: Maternal healthcare service utilization in Nigeria remains suboptimal, with significant inequities driven by socioeconomic status, education, and women's autonomy. Strengthening the continuum of care requires multisectoral interventions addressing structural and social determinants of health.
BACKGROUND: Infant mortality refers to the death of an infant before their first birthday. In 2021, approximately 3.8 million infants died worldwide. While interventions have reduced infant mortality rate (IMR) globally, Sub-Saharan Africa (SSA), particularly East Africa, still faces high IMR. Despite many studies, evidence regarding on the impact of spatial effects remain limited. This study aimed to incorporate spatial random effects to identify factors associated with infant mortality. METHODS: Secondary data analysis was conducted using a total weighted sample of 101,532 infants from DHS data collected between 2015 and 2022 in East Africa. STATA version 14 was used for data cleaning, and R version 4.3.1 was used for data analysis. A Bayesian spatial frailty analysis model was fitted, and convergence was checked using trace plot. The model goodness of fit was assessed using Cox-snell residual plot. RESULTS: The IMR was 39.83 per 1000 live births (95% CI: 35.81-44.27). Breastfeeding initiation time after 24 hours (HR = 4.033, 95% CrI: 3.869-4.207), not having antenatal care (ANC) follow-up (HR = 1.534, 95% CrI: 1.259-1.869), maternal age between 15 and 24 years (HR = 1.256, 95% CrI: 1.11-1.411), low birth weight (HR = 1.575, 95% CrI: 1.388-1.770), plurality (HR = 4.0, 95% CrI: 3.334-4.746), parity more than ten (HR = 2.173, 95% CrI-1.4413.125), parity between five and ten (HR = 1.264, 95% CrI: 1.075-1.472), being a male child (HR = 1.276, 95% CrI: 1.149-1.411), and maternal employment status (HR = 0.740, 95% CrI: 0.606-0.909) were factors associated with infant mortality. High frailty was detected in northern and southwestern Malawi and in the western regions of Mozambique, Zambia, and Burundi. CONCLUSION: The pooled IMR was higher than the global estimate of IMR. Infant mortality was associated with maternal, infant, and reproductive factors. In addition, high spatial frailty was observed in some areas, suggesting the presence of unmeasured regional factors related to geographic location. These findings call attention to the need for policies that focus on strengthening antenatal care coverage, promoting early initiation of breastfeeding, improving maternal socioeconomic empowerment, and prioritizing high-frailty areas through resource allocation to reduce infant mortality.
BMC pregnancy and childbirthJoël D Bognini, Toussaint Rouamba, Helen Brotherton, Guétawendé J W Nassa, Athanase M Somé, Diagniagou Lankoandé, Edmond Yabré Sawadogo, Umberto D'Alessandro, …
INTRODUCTION: The World Health Organization recommends a minimum of eight antenatal care (ANC) contacts, with the first visit occurring before the 12th week of gestation, as a strategy to enhance the preparedness of women for institutional delivery and improve perinatal outcomes. The present study aims to assess the prevalence of delayed ANC attendance among pregnant women in rural Burkina Faso and identify associated risk factors. METHODS: This is a secondary analysis of clinical data collected from a randomised-controlled trial (clinicaltrials.gov ref: NCT03199547); conducted between 2018 and 2021 in rural Burkina Faso. We estimated gestational age (GA) at the first ANC visit based on recall information on the last menstrual period provided by study participants or, when such information was unavailable, symphysis-fundal height measurements taken by ANC nurses. We used descriptive methods followed by unadjusted and adjusted logistic regression, informed by an original conceptual framework, to determine the prevalence and risk factors associated with delayed first ANC visit, defined as occurring after the 12th week of gestation. A significance threshold was set at 0.05. RESULTS: Out of the 5250 women enrolled in the study, 2480 (47.2%) had data available from their first ANC visit, and 90.6% (2248/2480) of those women had gestational age estimates. Most women (n = 2037/2248, 90.6%) attended their first ANC after the 14th week of gestation. The main factors associated with this delay were multiparity ≥ 4 pregnancies (OR = 2.26, 95%CI [1.48 - 3.4], p < 0.001) and first ANC visit attended during the dry season (OR = 1.79, 95%CI [1.34 - 2.39], p < 0.001). CONCLUSION: Our study highlights that most pregnant women in rural Burkina Faso attended their first ANC visit later than the WHO recommended timeline, increasing their risk of poor delivery outcome. Although we identified some factors that increased this risk of late ANC attendance, awareness raising interventions are required for the whole population as starting late seems to be the norm.
Journal of global healthRahima Yasin, Yvonne Tam, Arjumand Rizvi, Tyler Vaivada, Ayesha Arshad Ali, Robert E Black, Jai K Das, Zulfiqar A Bhutta
BACKGROUND: Antenatal care strategies encompass a series of interventions delivered to expectant mothers to optimise both their health outcomes and those of their neonate. We summarise the most recent effect estimates for maternal immunisation, screening and management of infections, pre-existing chronic diseases such as hypertension and diabetes, nutrition, psychosocial interventions for smoking cessation, pre-term pre-labour rupture of membranes, administration of corticosteroids for foetal lung maturation, and induction of post-term labour. METHODS: We synthesised effect estimates for antenatal and intrapartum interventions using PubMed and CENTRAL searches (2022-2023) and in consultation with a technical advisory group to determine whether and how new meta-analysed effect estimates could be incorporated into the Lives Saved Tool (LiST) model, as well as which of these estimates should be updated and which should be retained. RESULTS: Tetanus toxoid vaccination during the antenatal period lead to a significant reduction in neonatal mortality. Antibiotics for pre-term pre-labour rupture of membranes and administration of corticosteroids for foetal lung maturation lead to significant reductions in neonatal mortality due to sepsis and prematurity, respectively. Nutritional interventions including balanced protein and energy supplementation and multiple micronutrient supplementation reduced the risks of small-for-gestational-age babies. Insecticide-treated bed-nets for malaria, antibiotic treatment of syphilis, and post-term induction of labour demonstrated significant reductions in the risks of stillbirth. The effect estimates for preterm births contributed to the LiST model for interventions including treatment of asymptomatic bacteriuria, omega-3 fatty acid supplementation, calcium supplementation, and provision of low-dose aspirin for pre-eclampsia, which projected significant reductions in the risks of small-for-gestational-age babies. CONCLUSIONS: The evidence described here highlights the potential impact of implementing high-yield healthcare packages in context-specific settings to effectively improve neonatal survival. These estimates can be used as inputs to model the impact of antenatal care interventions using the LiST.
Journal of global healthKrista Whitley, Polina Lebedeva, Andre Craig Christie, Annabelle Sim, Desere Thompson, Sally Hukpati, Lakshmi Balaji
BACKGROUND: Despite sustained national progress in maternal and child health, maternal mortality in the Philippines remains uneven across regions and socioeconomic groups. Women in poor, rural, and conflict-affected areas experience substantially higher maternal mortality than those in higher-income and urban populations. We aimed to assess subnational inequities in maternal mortality and estimate the potential impact and cost-effectiveness of prioritised maternal health interventions in Philippine regions with maternal mortality ratios exceeding the national benchmark. METHODS: We conducted an equity analysis and developed an investment case using the UNICEF Equitable Impact Sensitive Tool (EQUIST). Regional maternal mortality ratios were based on 2019 subnational estimates, with the 2017 national maternal mortality ratio used as the benchmark for regional stratification. Intervention effectiveness estimates were drawn from published evidence syntheses and global clinical guidelines, and EQUIST's costing module draws on LiST and the Marginal Budgeting for Bottlenecks approach. Three intervention packages were modelled: upgrading basic and comprehensive emergency obstetric and newborn care facility readiness; ensuring universal availability of uterotonics and magnesium sulphate; and expanding access to modern contraception among adolescents, women from poor households, and high-parity women. Projected maternal deaths averted, disability-adjusted life years averted, and cost per DALY were estimated through 2030. RESULTS: Our modelling suggested that prioritised intervention packages could avert approximately 1,000-2,500 maternal deaths cumulatively through 2030. Facility readiness upgrades were projected to avert 1,000-1,500 maternal deaths, life-saving commodities 1,500-2,000, and modern contraception expansion 2,000-2,500. Sensitivity analysis varying key inputs by ±15% produced corresponding sensitivity ranges of 850-1,750, 1,275-2,300, and 1,700-2,875 maternal deaths averted, respectively. Modern contraception expansion had the lowest modelled cost per DALY averted at approximately US$150, compared with USD 300 for life-saving commodities and USD 450 for facility readiness upgrades. CONCLUSIONS: Maternal mortality in the Philippines remains concentrated among disadvantaged subnational populations. Equity-targeted investments, combined with strengthened emergency obstetric care, reliable life-saving commodities, and expanded access to modern contraception, can achieve substantial mortality reductions at highly cost-effective levels.
JAMA health forumLynn M Yee, Joe Feinglass, Brittney R Williams, Laura Diaz, Viridiana Carmona-Barrera, Ying Cheung, Ka'Derricka Davis, Chen Yeh, Charlotte M Niznik, Michelle A…
IMPORTANCE: Postpartum care in the US is fragmented and inadequate, with major disparities in quality. Patient navigation is a promising health services intervention to improve health care provision and reduce disparities. OBJECTIVE: To evaluate whether postpartum patient navigation improved postpartum health care quality among people with low incomes. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at a single urban academic medical center from January 2020 to July 2024 and included English- or Spanish-speaking pregnant people 16 years or older with Medicaid insurance. Data analysis started in October 2024. INTERVENTION: Participants were randomly assigned to 1 year of patient navigation vs usual care. Those randomized to navigation received individualized services that were designed to overcome postpartum-specific barriers to care from a trained lay navigator. MAIN OUTCOMES AND MEASURES: The primary outcome, as ascertained from medical records, was receipt of 6 care elements considered to be essential to optimal postpartum care by 12 weeks postpartum. Secondary outcomes included the proportion of components received by 12 weeks and receipt of health services at 11 to 13 months. RESULTS: A total of 405 people (mean [SD] age, 28.2 [5.7] years; 10 [2%] were Asian, multiracial, or another race; 166 [41%] were Hispanic; 202 [50%] were non-Hispanic Black; and 27 [7%] were non-Hispanic White) were randomized (203 [50%] in patient navigation; 202 [50%] received usual care). The frequency of the primary outcome (ie, receipt of all 6 essential components of postpartum care) was similar between the groups (19 [9.4%] in patient navigation vs 16 [7.9%] in usual care; P = .60). However, the mean (SD) proportion of components received was significantly higher among navigation recipients (71% [17%] vs 64% [23%]; P = .002). Three components drove this difference: postpartum visit completion (195 [96%] vs 161 [80%]; P < .001), receipt of all indicated anticipatory guidance (131 [65%] vs 104 [51%]; P = .01), and postpartum depression screening and care (174 [86%] vs 145 [72%]; P < .001). At 11 to 13 months, participants randomized to navigation were more likely to have attended a primary care visit, be using their desired family planning method, and have received depression screening and linkage, cardiometabolic screening, and recommended vaccines. CONCLUSIONS: The results of this randomized clinical trial suggest that although patient navigation did not result in a higher frequency of achieving all 6 components of postpartum care, the proportion of care components received was significantly higher. At 1 year postpartum, those randomized to patient navigation demonstrated multiple improved health services outcomes, including more frequent transition to primary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03922334.
Journal of global healthTyler Vaivada, Yvonne Tam, Georgia Dominguez, Li Jiang, Rachel Lee Him, Oviya Muralidharan, Davneet Sihota, Leila Harrison, Robert E Black, Zulfiqar A Bhutta
BACKGROUND: The period immediately after birth represents a highly vulnerable time for newborns, particularly in contexts without access to high-quality secondary care for small and/or sick newborns. Scaling up existing evidence-based interventions can avert much of the mortality and morbidity that occurs during the neonatal period. We summarise the evidence for interventions delivered postnatally and propose a set of effect estimates for inclusion in the Lives Saved Tool (LiST). METHODS: We first conducted a set of systematic reviews and updates on the most recent evidence from randomised controlled trials on the effectiveness of interventions for reducing neonatal mortality and associated risk factors. We then assessed the evidence using standardised set of considerations alongside an iterative consultation process with newborn care experts to determine whether and how new meta-analysed effect estimates could be incorporated into the LiST model, as well as which of these estimates should be updated and which should be retained. RESULTS: We proposed a new set of interventions that involve three packages of newborn care: a basic package (i.e. primary/community, secondary hospital care), a referral care package (i.e. tertiary care), and a package of promising innovative interventions whose evidence base is still developing. We included five new interventions within the updated LiST model's basic and referral packages: nasal continuous positive airway pressure coupled with preterm supportive care, newborn referral and transportation, animal-derived surfactant, prophylactic antifungals, and antibiotic stewardship. Three new interventions were proposed for the innovation package: magnesium sulphate for neuroprotection in asphyxiated newborns, topical emollient therapy, and probiotics/synbiotics for hospitalised preterm newborns. CONCLUSIONS: We synthesised the evidence base for the impact of a package of effective postnatal interventions for neonates for an updated LiST model. The new interventions and updated effect estimates can provide more accurate projections of potential impacts on neonatal survival for different intervention coverage scale-up scenarios in low- and middle-income countries.
Journal of global healthFrancis Sarial Ganancial, Vivian Chia-Rong Hsieh
BACKGROUND: Achieving Sustainable Development Goal (SDG) 3, particularly targets 3.1 (reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births) and 3.8 (universal health coverage), requires sustained reductions in maternal mortality and equitable access to essential maternal health services (MHS). Despite global progress, large disparities persist. Low- and middle-income countries (LMICs) account for more than 90% of maternal deaths worldwide, largely reflecting gaps in access to essential MHS. However, multi-country evidence examining how improvements in MHS during the SDG period translate to reductions in MMR remains limited. This study assessed disparities in MHS coverage and their associations with MMR across LMICs. METHODS: We conducted a longitudinal panel analysis of 137 LMICs, using country-level data from the World Health Organization Global Health Observatory and the World Bank from 2015 to 2023. Indicators included coverage of at least four antenatal care visits (ANC4+), facility-based delivery (FBD), and skilled birth attendance (SBA). We estimated associations between MHS coverage and MMR using generalised linear mixed models with a gamma-log link, with analyses stratified by country income group and maternal education. RESULTS: The median MMR of the 137 LMICs declined from 109.3 to 85.5 deaths per 100,000 live births from 2015 to 2023. Coverage of FBD and SBA increased by 5.6% and 5.0%, respectively. Higher coverage of ANC4+ (β = -0.01, P = 0.02) and FBD (β = -0.01, P = 0.03) was significantly associated with lower MMR. These associations were stronger in lower-middle-income and upper-middle-income countries than in low-income countries. Stratified analyses showed larger reductions in MMR among women with moderate-to-high levels of maternal education. CONCLUSIONS: Although maternal mortality decreased during the SDG period, progress remains insufficient and inequitable. Strengthening equitable access to essential MHS is critical to accelerating MMR reductions and supporting progress toward SDG targets in LMICs.
African journal of reproductive healthEsther M Mphake, Boitshwarelo Km Ngake, Martin Palamuleni, Ishmael Kalule-Sabiti, Phuti Ngwepe
Despite improved health infrastructure in South Africa, antenatal care (ANC) initiation before 20 weeks stipulated by the World Health Organization requires attention.1 Early and regular ANC improves pregnancy outcomes through screening, counselling, and preventive interventions. This descriptive cross-sectional case study investigated socio-demographic factors associated with ANC initiation timing in Eersterust, South Africa.Data from 419 women (aged 18-49 years) were collected using structured questionnaires and analysed at univariate, bivariate, and binary logistic regression levels. Binary logistic results revealed employment status, country of origin, and parity as significant predictors. Employed respondents [AOR 2.23 (CI: 1.43-3.50)], women with parity of 1 [AOR: 1.80 (CI: 1.04-3.12)], and South African-born women [AOR: 1.54 (CI: 0.94-2.53)] had the highest odds of initiating ANC earlier than 20 weeks.Addressing employment barriers, non-citizenship of South Africa, and high parity may facilitate earlier ANC engagement. These significant factors should inform ANC policy design and review to increase utilization and encourage early initiation. Future programmes should target unemployed women and women with multiple children to improve maternal and infant health outcomes.
Health services researchRebecca A Gourevitch, Jessica L Cohen, Tara Shakley, Sung Min Park, Mary Beth Landrum, Meredith B Rosenthal, Mark W Friedberg, Anna D Sinaiko
OBJECTIVE: To examine whether out-of-pocket costs during pregnancy and delivery affect use of postpartum care. STUDY SETTING AND DESIGN: Because health insurance deductibles and limits reset annually, the timing of childbirth within that year quasi-randomly assigns people to different levels of cost-sharing during pregnancy+delivery versus postpartum. We use a novel instrumental variable approach that leverages this variation to analyze whether higher maternity spending due to delivering early in the plan year affects postpartum care utilization. The exposure is maternity out-of-pocket spending, and the instrument is whether the delivery was in the first three versus last 3 months of the enrollee's health plan year; the primary outcome is use of any outpatient care postpartum. We analyze maternity episodes among Blue Cross Blue Shield of Massachusetts enrollees who gave birth, 2019-2023. DATA SOURCES AND ANALYTIC SAMPLE: Commercial health insurance enrollment and claims data for individuals with continuous enrollment during pregnancy, delivery, and 3-months postpartum (N = 51,337). PRINCIPAL FINDINGS: Out-of-pocket costs for those delivering at the start versus the end of their health plan year were, on average, 21% higher for pregnancy+delivery care and 58% lower for postpartum care. A $100 increase in pregnancy+delivery out-of-pocket spending led to a 0.53 percentage point (95% CI [0.28, 0.79]) increase in use of any outpatient postpartum care (sample mean: 82.5%). Higher pregnancy+delivery out-of-pocket costs also led to significant increases in the number of outpatient contact days, visits for preventive/well care, visits for mental health, and other visits. CONCLUSIONS: Higher pregnancy+delivery out-of-pocket costs due to delivering early in the plan year corresponded to lower postpartum out-of-pocket costs and led to modest increases in postpartum care. This suggests that lower postpartum cost-sharing may increase postpartum care use. Policies that lower those costs may be effective in increasing use of postpartum care.
The Australian & New Zealand journal of obstetrics & gynaecologyAilsa Borbolla Foster, Harriet Calvert, Madeleine Hinwood, Caroline Kuhne, Jennifer Haxton, Nicole Bennett, Jon Hyett, Felicity Park
INTRODUCTION: Preeclampsia is a major contributor to maternal and perinatal morbidity. First-trimester predictive models for preterm preeclampsia have better efficacy than history-based screening for prevention of this adverse pregnancy outcome. There are, however, few data describing implementation of this method of screening at a population level within public healthcare. MATERIALS AND METHODS: A retrospective service evaluation compared a historical cohort receiving standard maternity care and a contemporary cohort managed through the Initial Maternity Assessment and Planning (IMAP) service, a redesigned antenatal care approach focused on early multidisciplinary specialist maternity assessment and algorithm-based preeclampsia screening prior to 14 weeks gestation. Singleton pregnancies within a metropolitan public hospital catchment were included. The primary outcome was preterm preeclampsia (leading to birth < 37 weeks). Secondary clinical outcomes included early-onset preeclampsia (leading to birth < 32 weeks), severe maternal preterm preeclampsia, and rates of potential aspirin-related obstetric complications. Secondary service outcomes included gestation at first visit and rates of early aspirin therapy for women at elevated risk. RESULTS: Historical and contemporary cohorts included 5 004 and 6 036 pregnancies, respectively. Median gestation at first visit decreased from 20 to 12 weeks. Analysis demonstrated a 49% reduction in the odds of preterm preeclampsia (0.91% to 0.60%; aOR 0.51, 95% CI 0.31-0.82) and a 59% reduction in the odds of severe preterm preeclampsia (0.38% to 0.20%; aOR 0.43, 95% CI 0.19-0.91). No significant differences were observed in early-onset or term preeclampsia, fetal growth restriction, or complications related to antiplatelet therapy. The screen positive rate fell from 9.0% to 7.2%, while aspirin recommendation for high-risk women increased from 23.9% to 77.8% overall and 98.2% in those receiving FMF screening. CONCLUSION: A comprehensive, population-based multidisciplinary first-trimester assessment service, prioritizing FMF preeclampsia screening, can be successfully implemented within a public health setting and may be associated with lower odds of adverse clinical outcomes.
Frontiers of health services managementWendy Clarke Wilcox
New York City's (NYC) maternal health crisis drew close attention in the late 2010s, driven by alarming data: Approximately 30 women died annually during childbirth in NYC, Black non-Hispanic women were 12 times more likely to die than white women, and more than 3,000 women experienced life-threatening birth complications each year. In response, NYC committed $12.8 million in July 2018 to reduce maternal mortality and eliminate racial disparities.NYC Health + Hospitals (H+H)-the nation's largest public health system, serving 1.1 million patients annually with roughly 15,000 births per year-became the primary vehicle for this initiative. With 80 percent of the system's deliveries covered by Medicaid and a patient population that is 51.2 percent Hispanic and 27.1 percent Black, H+H is uniquely positioned to lead the fight against maternal health inequity.Three flagship programs anchor H+H's response to the city's maternal mortality rate. The OB Simulation Program, launched in 2012 and expanded in 2018, was the first in the nation to use mannequins of color to train thousands of providers in obstetric emergencies. The Maternal Home Program, piloted at H+H's Kings County Hospital in 2019 and scaled system-wide by 2021, has served more than 10,341 patients, generating more than 33,000 referrals for social, behavioral health, and community resources. The Cardio-Obstetrics Program located at Kings County Hospital targets cardiovascular disease-the leading cause of maternal death among Black women-through screening, education, and community outreach. These programs are a health equity imperative, made more urgent by impending federal Medicaid cuts resulting from the H.R.1 One Big Beautiful Bill Act (passed on July 4, 2025).
BACKGROUND: Perinatal health research on, with or by Aboriginal and/or Torres Strait Islander women has grown in recent decades. Research methodologies comprise theoretical frameworks, researcher standpoints and chosen methods, which inform research processes and outcomes. For maximum research benefit and impact for Aboriginal and Torres Strait Islander communities, methodologies should be culturally authentic and rigorous. This paper aims to examine research methodologies used to inform the body of evidence regarding perinatal health and/or well-being for Aboriginal and Torres Strait Islander women in Australia. METHODS AND ANALYSIS: This protocol follows a process as described by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (the PRISMA-ScR). A team approach will be used throughout the review process. A preliminary search of databases for peer-reviewed research articles was undertaken on 10 February 2026, from inception up until this date, and included PubMed, CINAHL (EBSCOhost), Informit Indigenous Collection (Informit) and Scopus. Independent double screening will occur, where title and abstract screening will locate Australian research articles focusing on Aboriginal/Torres Strait Islander women during the perinatal period (up to 1 year post birth), with no date limit. Data extraction will be guided by the Population/Concept/Context (PCC) framework and use a standardised data extraction form. Multi-method analysis will include descriptive data, tables and/or visual graphs and qualitative content analysis. ETHICS AND DISSEMINATION: A research ethics application was not required for this scoping review. The voices of Aboriginal and Torres Strait Islander women should inform and be embedded throughout the design, delivery and evaluation of maternity services aiming to serve Aboriginal and Torres Strait Islander women. It is anticipated that findings from this scoping review will be disseminated publicly at conferences and with community research partners, to support the development and adoption of research approaches that are ethical, culturally grounded and meaningfully aligned with Aboriginal and Torres Strait Islander community priorities.
Mymensingh medical journal : MMJM K Khan, S B Hossain, M J I Nabil, S H Shihab, M F S Porna, J F Promy, M N U Sakib, A Shafin, P Chakrabarti, A Biswas, S I Semonti, K M M Hoque, S Yeasmin, R …
Maternal and child health (MCH) is one of the bases of public health, however, specific research on antenatal care, child health practices and delivery outcomes remain limited in Bangladesh. This study aimed to assess the MCH situation among women attending a tertiary care hospital. It was a cross-sectional survey conducted from September 2025 to October 2025 among 460 purposively selected women attending the Antenatal Care Clinic of Mymensingh Medical College Hospital (MMCH) for an antenatal checkup. Face to face interview with a structured questionnaire was used to collect data on sociodemographic characteristics, reproductive history, child care practices, antenatal visits and delivery outcomes and then analyzed descriptively. The mean age of respondents was 26.56±4.7 years, among whom 83.5% were aged between 17-30 years. Most women had only secondary (35.0%) and primary (33.7%) levels of education. Majority were housewives (93.0%) with having 1-2 children (82.2%). Mean monthly household income was 22,998.91±11,641.31 Bangladeshi Taka. Most (97.2%) of the women fed colostrum and 90.2% completed immunization to their babies, while 5.2% of families experienced death of children of under-five years, mainly due to pneumonia, diarrhea and unknown causes. Mean antenatal care visit was 3.48±2.08, where 4.6% had no visits. 73.3% delivered their babies in the hospitals; however, 57.2% needed lower uterine cesarean section. Deliveries were mostly conducted by doctors (73.7%). The study found that most participants accessed antenatal care and institutional delivery, with high rates of colostrum feeding and child immunization, however, gaps exist in antenatal coverage, mode of delivery and prevention of child mortality. A systematic approach with targeted interventions is essential to improve MCH outcomes in Bangladesh.
The Australian & New Zealand journal of obstetrics & gynaecologyWee Ming Wong, Ching Mei Loo, Susan Roberts, Grace Branjerdporn
BACKGROUND: Suicide in the peripartum is a leading cause of death in Australia. Appropriate screening and response to self-harm and suicidality during antenatal appointments is key to reducing the risk of suicide. AIM: The study explores the knowledge, confidence and behavioural changes resulting from an educational intervention for midwives in assessing and making appropriate referrals based on self-harm and suicide risks in antenatal women, as screened by question ten of the Edinburgh Postnatal Depression Scale (EPDS) eliciting thoughts of self-harm in the previous 7 days. MATERIALS AND METHODS: Educational workshops aimed at improving midwives' confidence and capabilities in conducting suicide risk assessments, developing safety plans and understanding referral pathways were completed. Changes to medical documentation in relation to risk assessment and follow-up actions were reviewed pre- and post- the education sessions. RESULTS: Midwives' (N = 115) self-reported knowledge and confidence increased from pre- to post-education. Pre-intervention, 86 (5.87%) antenatal women answered question ten positively on the EPDS. Medical documentation revealed that more midwives were able to screen for the frequency and persistence of suicidal thoughts following the training. CONCLUSION: While education enhanced knowledge and confidence as well as resulted in improvements to some risk assessment practices, further systemic and organisational support may be necessary to achieve consistent and comprehensive risk assessments and adherence to recommended follow-up actions in clinical practice. The study underscores the critical role of continuous training for midwives in self-harm/suicide assessment, particularly given the significant maternal mortality associated with suicide.
OBJECTIVE: To quantify persistence and transition dynamics of county obstetric service absence and assess whether birth volume and physician supply add predictive information beyond prior-year status. STUDY SETTING AND DESIGN: National longitudinal county-year panel study (2015-2023). Obstetric service absence was defined using a 2-year confirmation rule, with contemporaneous status used for the 2015 baseline year to reduce misclassification. We estimated annual conditional transition probabilities (entry and exit) and modeled current-year absence as a function of prior-year absence and year fixed effects, with and without contemporaneous birth volume and physician supply. DATA SOURCES AND ANALYTIC SAMPLE: All US counties (N = 3144) observed annually. Obstetric service availability was identified from Centers for Medicare & Medicaid Services Provider of Services files. Residence-based births, physician supply, and bed capacity were obtained from the Area Health Resources Files. Population denominators for women aged 15-44 were drawn from the American Community Survey. PRINCIPAL FINDINGS: Obstetric service absence was highly persistent. County prevalence was stable (34.2% in 2015 and 34.2% in 2023). Population exposure declined: the share of women aged 15-44 residing in counties without services decreased from 6.5% to 5.3%, and the share of births to residents of such counties decreased from 6.6% to 5.7%. Annual transitions were rare (entry ≤ 0.4%; exit ≤ 0.9%), and conditional stay probabilities were ≥ 0.991 for both presence and absence. In lagged-status models, prior-year absence strongly predicted current absence (0.994); adding birth volume and physician supply did not materially change the estimate (0.993). CONCLUSIONS: On policy-relevant timescales, obstetric service absence behaves as a high-inertia system state. Rare transitions and dominance of prior status suggest slow adjustment, with implications for closure prevention and targeting support near volume and workforce feasibility thresholds.
BMJ open qualityMandy Wang, Alison Brand, Martin Plymoth, Judy Chen, Therese McGee
Eliminating cervical cancer requires high screening participation levels. Pregnancy is an opportunity to reach under-screened women, but clinician-collected speculum examination is a barrier to uptake. Patient self-collected cervical screening tests (SC-CST) using a vaginal swab for detection of human papillomavirus (HPV) may offer a solution. The objective of this study was to evaluate the outcomes and implementation of a comprehensive programme embedding SC-CST into antenatal care.This is a prospective quality improvement study in a tertiary hospital servicing a population with one of the lowest cervical screening rates nationally. Pregnant women attending public maternity care and eligible for screening under national guidelines were included. Screening histories were obtained from the national registry to identify screen-overdue or never-screened women for SC-CST offer. Staff education and patient information encouraged participation. Test packs facilitated specimen collection. Referral pathways were created for abnormal results. Main outcome measures include reach, effectiveness, implementation and maintenance of quality improvement.From 19 February 2024 to 31 July 2025, 48.0% (2492/5190) of eligible pregnant women required a CST, 69.7% were offered SC-CST and 93.7% accepted. Cervical screening rates increased 22-fold from 3.0% prior to the programme to 65.3%. Parous women were offered SC-CST at lower rates than nulliparous women (66.5% vs 74.1%; p=0.024). Women residing in the lowest socioeconomic quintile had lower acceptance rates (91.9% vs 94.8%; p=0.024). Being overseas-born and need for interpreter were not barriers to SC-CST offer or acceptance rates. Results were high risk HPV-negative in 88.1%, HPV 16/18 positive in 1.9%, HPV non-16/18 positive in 9.1% and invalid in 0.9%. Colposcopy was performed for 41 women, with 7 cases of biopsy-confirmed high-grade squamous intraepithelial lesion requiring treatment.Introduction of SC-CST into antenatal care is an effective strategy to improve cervical screening rates and was highly acceptable to pregnant women. Programme sustainability requires additional resources, staff engagement, and timely follow-up.
Revista da Escola de Enfermagem da U S PÇiler Çokan Dönmez, Tuba Güner Emül
OBJECTIVE: This study aimed to evaluate the effect of prenatal genetic counseling on pregnant women's anxiety levels and attitudes towards prenatal diagnostic tests. METHOD: This randomized controlled trial was conducted on 66 pregnant women who visited the Medical Genetics outpatient clinic of Adana City Hospital between September and December 2022. Data were collected using descriptive information forms, the State-Trait Anxiety Inventory (STAI-S), Prenatal Screening and Diagnostic Tests Attitude Questionnaire (PSDTAQ). Data were analyzed using change-score analysis, linear mixed-effects models including group, time, and group × time interaction, and ANCOVA adjusted for baseline score, income, education, and gestational age. Effect sizes and 95% confidence intervals were also calculated. RESULTS: After adjustment for baseline values and potential confounders, prenatal genetic counseling significantly reduced STAI-S scores and improved PSDTAQ scores compared with routine care (p < 0.001). CONCLUSION: These findings support the potential role of nurse-led prenatal genetic counseling in reducing anxiety and improving attitudes toward prenatal testing. Larger multicenter studies with longer follow-up are required before educational or policy recommendations can be made.
BMJ openDelia Horn, Abimbola Leslie, Renny Ssembatya, Erika M Edwards, Joyce Nayiga, Frank Williams, Micheal Ssenoga, Alphonsus Matovu, Kristen DeStigter
OBJECTIVES: To determine the association between prenatal ultrasound (US) services, referral patterns and maternal and neonatal outcomes surrounding delivery in rural Uganda. Our hypothesis was that the introduction of third trimester ultrasound services would lead to more mothers being referred to a higher level of care for delivery. DESIGN: This study combined data on referrals and health outcomes pre- and post- the introduction of ultrasound with data from a retrospective analysis of Health Center III records. SETTING: This study was conducted in rural Uganda at 7 Health Center III sites (primary care sites) in four districts from June 2022 to October 2023. The study sites included three sites in the West Nile Region, which serves a predominantly refugee population, and four sites in the Southwestern Uganda Region. PARTICIPANTS: Participants were women who presented for care at the Health Center III sites during the study period and their neonates. All were black African, most were Ugandan citizens. A total of 2861 mothers were enrolled. Complete outcome data were obtained on 2617 mothers and their 2639 infants. INTERVENTION: The intervention was antenatal ultrasound scans offered during the third trimester of pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome was the proportion of pregnant women referred to a higher level of care. Secondary outcomes included the proportion of neonates receiving neonatal resuscitation in the form of bag-mask ventilation at delivery, proportion of mothers with postpartum haemorrhage within 1 day of delivery, neonatal death within the first 28 days of delivery, stillbirth, Apgar score and maternal death within the first 42 days of delivery. RESULTS: The introduction of prenatal ultrasound in these rural low-income country settings was associated with a difference in rates of referral to a higher level of care for delivery from 6.0% before introduction of US to 13.6% post-introduction (p<0.0001) as well as in mode of delivery in the study population (p<0.0001). There was an increase in antenatal referrals but a decrease in intrapartum referrals and a decrease in referrals for cephalopelvic disproportion with the introduction of ultrasound. Most mothers who were referred to a higher level of care followed these recommendations. There was a decrease in the proportion of neonatal mortality and stillbirth among mothers who received ultrasounds and were referred to a higher level of care, but this was not statistically significant. There was no difference in neonatal or maternal morbidity or mortality. CONCLUSIONS: The introduction of prenatal ultrasound in a rural low-income country was associated with more referrals to a higher level of care and a change in the timing of referral. The introduction of prenatal ultrasound in this setting may help to identify high-risk pregnancies and to reduce emergent intrapartum transportation.
OBJECTIVE: We endeavor to investigate the impact of perinatal teach-back method health education combined with comprehensive nutritional intervention on maternal and infant health outcomes in gestational diabetes mellitus (GDM) patients. METHODS: A retrospective analysis was conducted on 120 GDM patients, who were divided into a control group (January 2023-June 2023, routine health education) and an observation group (July 2023-January 2024, teach-back method health education plus comprehensive nutritional intervention) (n = 60 each) based on admission time. Maternal fasting blood glucose level, childbirth self-efficacy, and health-promoting lifestyle scores were compared. Maternal and infant health outcomes, including delivery mode, postpartum hemorrhage, preterm birth, macrosomia, and neonatal asphyxia, as well as maternal nursing satisfaction, were also compared. RESULTS: After the intervention, the observation group exhibited lower fasting blood glucose levels, higher scores in outcome expectations, self-efficacy expectations, and childbirth self-efficacy, higher HPLPII subscale scores, lower incidences of postpartum hemorrhage, preterm birth, macrosomia, and neonatal asphyxia, a higher spontaneous vaginal delivery rate, and higher overall nursing satisfaction rate than the control group (all P < 0.05). CONCLUSION: Perinatal teach-back health education combined with comprehensive nutritional intervention is positively associated with better maternal and neonatal pregnancy outcomes and improved physiological and psychological status in women with GDM.
BMC pregnancy and childbirthNarayani Paudel Ghimire, Pranab Dahal, Agneta Josephson, Sunil Kumar Joshi, Katarina Swahnberg
BACKGROUND: Promoting respectful maternity care is a crucial indicator of quality maternal healthcare. However, evidence from global studies indicates that 22% -100% women experience at least one form of disrespect and abuse during facility-based births, with research conducted in Nepal reporting a prevalence of 100%. Therefore, implementing targeted interventions for healthcare providers is essential to reduce instances of disrespect and abuse of women and to foster respectful maternity care. Forum Play represents a promising approach in this regard. OBJECTIVES: To explore the staff perspectives on disrespect and abuse of women during facility-based births and to assess the feasibility and acceptability of a Forum Play intervention in promoting respectful maternity care in Nepal. METHODS: Three half-day Forum Play workshops were conducted among hospital staff of a tertiary hospital in Kathmandu, Nepal, in November 2023. Eleven doctors, 14 nurses and 11 administrative staff were recruited for the workshops by using purposive sampling. Separate workshops were organized for the respective groups. At the end of each workshop, a focus group discussion was conducted using a semi-structured interview guide. All discussions were audio-recorded and non-verbal cues were noted by two note-takers. A total of 27 hospital staff participated in the discussions, including seven administrative staff, 10 doctors, and 10 nurses. Data analysis utilized inductive qualitative content analysis, allowing codes and categories to be developed directly from participants' responses as guided by Graneheim and Lundman. RESULTS: Data derived from the focus group discussions was divided into two parts: (i) staff perspectives on disrespect and abuse of women during facility-based births and (ii) Staff reflection on Forum Play in promoting respectful maternity care. Four categories were generated from the data: (1) Structural and systemic drivers of disrespect and abuse, (2) Social and interpersonal determinants of disrespect and abuse, (3) Personal and professional transformation through Forum Play, (4) Acceptance and institutional feasibility of Forum Play. These categories were extracted based on 11 subcategories classified from the codes derived from the data. Participants' reflections on the Forum Play workshop were very promising. Forum Play was identified as an innovative, interesting and acceptable method of intervention. CONCLUSION: Disrespect and abuse during facility-based births arise from structural, social, and interpersonal factors and violate women's fundamental human rights. Participants' reflections indicate that Forum Play is an innovative and acceptable intervention that can raise awareness and support personal and professional growth among healthcare providers, suggesting its potential as a practical approach for promoting respectful maternity care. However, further testing is needed to confirm its feasibility and effectiveness.
Women and birth : journal of the Australian College of MidwivesPauline Sartori, Charlotte Chappet, Mélanie Deronzier, Heidi Deswaziere, Léa Charrier, Clara Blanc, Léo Pomar
PROBLEM: Human Cytomegalovirus is the most common congenital infection worldwide, yet recommended hygiene measures to prevent maternal infection are difficult to implement consistently during pregnancy. BACKGROUND: Despite their effectiveness, adherence to hygiene recommendations remains suboptimal, suggesting a gap between recommendations and women's everyday realities. AIM: This study aimed to assess the real‑world applicability of hygiene recommendations for the prevention of cytomegalovirus during pregnancy in French-speaking Switzerland and to explore perceived barriers to their implementation. METHODS: A mixed‑methods design was used. Quantitative data were drawn from two cross‑sectional surveys conducted among pregnant or postpartum women (n = 834) and perinatal healthcare professionals (n = 341) to identify recommendations perceived as difficult to apply. These findings informed semi‑structured interviews with 12 mothers of young children, which explored barriers and facilitators to adherence. FINDINGS: Quantitative analyses identified avoiding contact with children's bodily fluids and ensuring partner adherence as the most challenging recommendations. Qualitative findings confirmed these challenges and identified three key barriers: insufficient and unclear information, high mental load linked to caregiving responsibilities, and recommendations perceived as only partially feasible in everyday life. Participants emphasised the need for clearer, pragmatic guidance and shared family involvement to support implementation. DISCUSSION: The findings highlight a misalignment between hygiene recommendations and women's experiences. CONCLUSION: Cytomegalovirus prevention strategies should prioritise clearer and actionable recommendations, improved professional training, and family-centred communication that avoids overburdening pregnant women. Integrating digital tools, prenatal education, and public awareness initiatives may enhance adherence and support more equitable prevention.
Archives of women's mental healthSunghyun Chung, Lawrence Watkins
PURPOSE: Maternal anxiety is a clinically relevant mental health concern during pregnancy and may contribute to reduced fetal growth, particularly when co-occurring with prenatal tobacco use. To examine the individual and contextual associations of maternal anxiety and prenatal tobacco use with infant birth weight using 2021-2023 Pregnancy Risk Assessment Monitoring System data. The analytic sample included 29,288 mothers nested within 11 states or jurisdictions. METHODS: Two-level linear mixed models were estimated to predict continuous infant birth weight, with a random slope for maternal anxiety to assess whether the anxiety-birth weight association varied across states or jurisdictions. RESULTS: Prenatal tobacco use was associated with an approximately 219-gram reduction in birth weight (p < .001), while maternal anxiety was associated with an approximately 60-gram reduction (p < .001). State-level prevalence of anxiety and tobacco use did not directly predict birth weight; however, the association between maternal anxiety and birth weight varied across states or jurisdictions. CONCLUSIONS: These findings support integrated prenatal care approaches that combine maternal mental health screening, tobacco cessation support, and attention to contextual systems that may shape maternal and infant health.
Journal of mother and childJennifer Abbass-Dick, Adrianna Trifunovski, Aisha Hussain, Manon Lemonde, Catherine Shaw, Keri Durocher
BACKGROUND: Breastfeeding is the optimal infant feeding method; however, cessation rates remain high across many developed nations. Support for mothers can be improved through breastfeeding education that spans the entire perinatal period. Due to the number of healthcare providers involved, delivery of breastfeeding education must be consistent and tailored to individual needs. Digital innovations are a potential solution to enhance accessibility and consistency in breastfeeding education delivery. How to best implement these solutions in clinical settings is not yet known. MATERIALS AND METHODS: We used a non-experimental, exploratory descriptive survey to collect mothers' and providers' experiences of breastfeeding education, and their perceptions of how an eHealth resource can be adapted and implemented to standardise breastfeeding education. RESULTS: The surveys were completed by 93 providers and 78 mothers. Mothers reported receiving education from diverse providers across the perinatal period, with varying information at different time points. Information was received on many topics that changed at various times. Oral communication was ranked as the most frequent education method. Both groups reported that online videos and websites would be the most effective digital solutions to support breastfeeding education. CONCLUSION: Providers play a crucial role in supporting mothers through education delivery that spans the entire perinatal period. By integrating the findings, accessibility and consistency of breastfeeding education could be enhanced by implementing the eHealth resource across organisations in a health region.
Journal of global healthSafia S Jiwani, Martin K Mutua, Kadari Cisse, Choolwe Jacobs, Anne Njeri, Mwiche Musukuma, Godfrey Adero, Ashley Sheffel, Melinda K Munos, Elizabeth Stierman, …
BACKGROUND: In sub-Saharan Africa, maternal and newborn deaths remain disproportionately higher among low-income populations, and they are associated with delivery in poorly equipped facilities and a shortage of staff to manage birth complications. We measured facility readiness to provide essential maternal and newborn health services and its association with women's experience of person-centred maternity care (PCMC), and we compared facilities serving and not serving informal settlements in Nairobi, Lusaka and Ouagadougou cities. METHODS: We conducted a health facility assessment in public and private facilities serving select urban informal settlements in Nairobi, and we used existing data in Lusaka and Ouagadougou. We computed readiness indices for labour and delivery care, and small and/or sick newborn care (SSNC) in each city, and used t tests to compare them across facilities serving and not serving informal settlements. We linked women's self-reported PCMC scores to the labour and delivery readiness score of the facility they attended and ran 2-level linear regression models testing the association between facility readiness and PCMC scores. RESULTS: Facility readiness scores were computed among 18, 38, and 138 facilities offering delivery services in Nairobi, Lusaka and Ouagadougou respectively. Mean labour and delivery readiness scores in facilities serving informal settlements ranged from 55.9% in Ouagadougou to 73.6% in Lusaka; SSNC readiness ranged from 37.2% in Ouagadougou to 61.3% in Nairobi. While facilities serving informal settlements had statistically significantly poorer readiness in Lusaka and Ouagadougou, key items such as newborn caps, registers, guidelines, and staff trained in Kangaroo Mother Care were lacking across both areas. We found no significant association between facility readiness and PCMC. CONCLUSIONS: All facilities have substandard readiness for essential maternal and newborn health services, but those serving informal settlements are more disadvantaged. Investments in service readiness and quality of care remain critical.
BACKGROUND: Perinatal depression is a global health concern linked to adverse maternal and neonatal outcomes. Although evidence-based psychological interventions, such as interpersonal psychotherapy (IPT), are effective, women lack access to in-person perinatal care. Smartphone-based interventions may offer scalable support; however, evidence from randomized controlled trials (RCTs) evaluating IPT-informed smartphone interventions remains limited. This study assessed the acceptability and efficacy of an IPT-informed smartphone intervention for perinatal mental well-being. METHODS: Participants were recruited nationwide through online advertisements and postcards. In this nonblinded RCT, 350 pregnant women were assigned to a fully self-guided smartphone application (intervention) or usual care (control). No minimum depression symptom score was required for participation. Acceptability in the intervention group at 8 weeks after enrolment was indicated by the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8J) scores of ≥17. Efficacy was defined as the change in Patient Health Questionnaire-9 (PHQ-9) scores from baseline to 8 weeks following enrolment. Depressive symptoms were assessed at 1 month postpartum. RESULTS: The application achieved acceptability, with 90.2% (157/174) of participants scoring ≥17 on the CSQ-8J. No significant between-group differences in depressive symptoms were observed during pregnancy (standardized mean difference (SMD) = 0.11). At 1 month postpartum, the intervention group exhibited significantly lower depressive symptom scores (SMD = 0.28). CONCLUSIONS: The smartphone application was highly acceptable. While no significant differences in depressive symptoms were observed during pregnancy, differences favoring the intervention group were observed at 1 month postpartum. An IPT-informed smartphone intervention may represent a promising approach to perinatal mental health support.
BMJ openJessica Thomas, Eleri Owen-Jones, Mariya Kovalenko, Anna Clark, Sana Usman, Suzanne Beattie-Jones, Danielle Thornton, Jayanta Banerjee, Neelam Heera-Shergill, …
INTRODUCTION: Around 4% of babies are in breech presentation at the end of pregnancy but up to 43% of these are missed by abdominal palpation alone. Since women in the UK without additional risk factors do not routinely receive a scan in the third trimester, around 1%-2% of women present with undiagnosed breech presentation in labour, which is associated with poorer outcomes for both mothers and babies. Research suggests a point-of-care ultrasound (PoCUS) scan in late pregnancy could improve the rate of breech presentation detection. The Sono-breech study aims to determine the diagnostic accuracy and acceptability of handheld scans performed by midwives for fetal presentation at 36 weeks and how cost-effective this would be to implement in routine antenatal care in the National Health Service (NHS). METHODS AND ANALYSIS: Prior to delivering the study, midwives receive training for the detection of presentation and fetal heart rate using handheld ultrasound equipment.The study will take place in at least 10 NHS Trusts across England selected to ensure a diverse participant population and to include under-researched settings. Between 35+0 and 36+6 weeks' gestation, women who consent to the study will receive a scan for fetal presentation performed by a midwife using a handheld PoCUS device alongside routine antenatal checks, including palpation. Before the end of the next day, they will receive a conventional ultrasound scan performed by a practitioner deemed already competent at obstetric scanning. This scan will be considered the gold standard for presentation. All results will be recorded in the Sono-breech REDCap database. Women with babies in non-cephalic presentations will be referred to their local NHS Trust pathway for further management. Diagnostic accuracy (sensitivity and specificity) will be computed from the comparison between findings at the midwife-performed scan and the conventional ultrasound scan.Birth outcome data will be collected from the participants' medical notes after they have given birth. Aggregate birth data regarding the rate of undiagnosed non-cephalic births will be collected from all women who deliver at each site.Midwives who take part in the study will be invited to participate in focus groups or interviews about the implementation of the scan into routine care. Non-participant observation will take place during midwife training sessions and antenatal clinics in specific participating trusts.6-12 weeks after birth, some women will be invited to take part in an interview to explore their experience with the handheld scan.6 weeks after birth, all women will be sent two questionnaires by email. These questionnaires will be used in combination with the birth outcome data and NHS tariffs to calculate the cost-effectiveness of introducing the handheld scan into routine antenatal care in the NHS.Study registration ISRCTN11748052. ETHICS AND DISSEMINATION: The study has obtained approval from the West Midlands-South Birmingham Research Ethics Committee and was approved by the Health Research Authority and Health and Care Research Wales. Publication will be in line with the National Institute of Health and Care Research (NIHR) Open Access policy.
Archives of women's mental healthArmenda Bialas, Julia Rollison, Jessica L Sousa, Rachel K Landis, Laura J Faherty
PURPOSE: Perinatal behavioral health conditions are a leading cause of maternal morbidity and mortality. Telehealth can reduce access barriers, but availability of implementation guidance specific to the perinatal period is unknown. METHODS: We conducted a comprehensive environmental scan of 71 organizational websites and nine semi-structured clinician interviews to identify clinician-facing telehealth implementation resources geared towards those practicing in the United States. RESULTS: Twenty organizations (28%) published perinatal telehealth materials; sixteen provided nineteen unique resources specific to perinatal telebehavioral health. Most resources (n = 14) provided broad guidance relevant to the perinatal period, while six addressed prenatal telehealth care. No resources provided postpartum-specific guidance. Interviews revealed mixed perspectives on the adequacy of clinical guidance resources. CONCLUSION: Limited and outdated resources, particularly the absence of postpartum‑specific guidance, suggest the need for coordinated, perinatal‑specific telebehavioral health implementation materials.
Women and birth : journal of the Australian College of MidwivesElysse Prussing, Jenni Doust, Frances Guy, Olivia Tierney
BACKGROUND: Climate change is an escalating concern for maternal and newborn health. Maternity care, particularly through high-intervention, hospital-based practices, generates substantial environmental waste. Midwifery Continuity of Care (MCC) models are known to reduce unnecessary interventions and improve safety and satisfaction of care, whilst suggesting potential reduction in environmental impacts. However, limited evidence exists evaluating the carbon footprint of MCC compared with standard medically led care. AIM: To evaluate whether a Midwifery Group Practice (MGP) model generates lower carbon emissions than medically led standard maternity care in an Australian regional setting. METHODS: A quantitative retrospective analysis was conducted using de-identified routinely collected clinical data from 2024 to 2025 at one regional maternity service. Carbon footprint estimates (kgCO₂e) using validated calculations from Spil et al. (2024), were applied to key clinical outcomes; including mode of birth, analgesia use, suturing, and postnatal length of stay. The kgCO₂e for women receiving MGP were compared with those receiving standard care. FINDINGS: Data from 210 MGP and 129 standard care participants showed consistently lower emissions in the MGP cohort. The mean estimated emissions per episode of care were lower in the MGP cohort compared with the standard care cohort (52.87 kgCO₂e vs 99.51 kgCO₂e), representing approximately half the carbon footprint. CONCLUSION: Episodes of care in the MGP cohort were associated with substantially lower estimated carbon emissions than those in the standard-care cohort within this regional maternity services. These findings suggest MGP as an effective low-carbon maternity care strategy aligned with national sustainability and net-zero targets.
BMJ openYali Luo, Quanfu Zhang, Jiahong Chen, Weizhen Mai, Dingyan Lv, Bo Liu, Wei Wang
BACKGROUND: Syphilis remains a significant global health burden, with congenital syphilis (CS) posing a major threat to child health. China has implemented the elimination of mother-to-child transmission (EMTCT) programme for syphilis through integrated strategies. However, few studies have analysed granular data along the entire cascade of care to identify specific bottlenecks. OBJECTIVE: We aimed to characterise the implementation status of integrated interventions in Baoan District, Shenzhen, and to identify risk factors associated with suboptimal indicators. METHODS: This retrospective cross-sectional study used data from the information system for the prevention of mother-to-child transmission of syphilis in Baoan District (2017-2024). Indicators were compared between the pre-practice (2017-2018) and post-practice (2019-2024) periods using Pearson's χ² test. Joinpoint regression models were used to estimate annual percentage change (APC) during the post-practice period. Univariate and multivariable logistic regression analyses were used to identify factors associated with indicators failing to meet predefined targets. RESULTS: A total of 752 pregnant women with syphilis and 769 exposed liveborn infants were finally included. Compared with the pre-practice period, significant upward trends were observed in the post-practice period across all process indicators (all p<0.05), while no statistically significant decline in live birth CS incidence was observed between the two periods (2.92 vs 1.59 per 100 000 live births, p=0.70). During 2019-2024, antenatal screening coverage (APC=0.23, p=0.01) and first-trimester screening coverage (APC=6.79, p=0.01) showed significant upward trends. However, adequate treatment coverage plateaued (APC=0.41, p=0.67), with the 2024 rate of 87.74% (below the 90% target). Multivariable analysis identified four independent risk factors for inadequate treatment: ethnic minority background (aOR=2.41, 95% CI 1.09 to 5.35), first antenatal visit at ≥13 weeks (aOR=2.30, 95% CI 1.09 to 4.84), <5 antenatal visits (aOR=3.14, 95% CI 1.55 to 6.33) and partner not tested for syphilis (aOR=2.07, 95% CI 1.07 to 4.01). CONCLUSIONS: EMTCT process indicators showed favourable trends during the integrated implementation period in Baoan District. However, gaps in achieving the treatment adequacy target highlight critical bottlenecks. Targeted interventions for high-risk populations, including ethnic minorities, women with late or insufficient antenatal care and those with untested partners, are essential to further achieve EMTCT goals.
BMJ openAdama Baguiya, Amanda C Palmer, Saleem Jessani, Kerry J Schulze, Melinda K Munos, Monica M Pasqualino, Ethan K Gough, Nicole Cunningham, Fred Van Dyk, Sarah Sa…
INTRODUCTION: The WHO recommends antenatal calcium supplementation (1500-2000 mg/day) to prevent pre-eclampsia in settings with low dietary calcium intake. Implementation is limited partly due to the need for three daily doses, although a lower 500 mg dose may be non-inferior. Current guidelines also recommend separating calcium from iron-containing supplements because concurrent intake may inhibit iron absorption. This individually randomised, controlled, non-inferiority trial will test whether co-administration of calcium and multiple micronutrient supplement (MMS) (CaMMS) is non-inferior to separate administration for haematological and iron status. METHODS AND ANALYSIS: We will recruit 1600 women at 6<20 weeks' gestation in Burkina Faso and Pakistan, evaluating non-inferiority independently in each setting, which differ in anaemia aetiology and diets. Participants will be randomly assigned to (a) take United Nations International Multiple Micronutrient Antenatal Preparation Multiple Micronutrient Supplements (30 mg elemental iron) and 500 mg elemental calcium together in the morning or (b) take MMS in the morning and calcium in the evening. Venous blood will be collected at 6<20, 20<24, and 30<34 weeks' gestation to measure complete blood count, ferritin, soluble transferrin receptor, hepcidin and erythropoietin. The primary outcome is haemoglobin concentration at 30<34 weeks. Co-administration will be considered non-inferior if the lower bound of the 95% CI for the difference in haemoglobin exceeds the non-inferiority margin of -3 g/L. Enrolment commenced in Pakistan on 25 August 2025 and in Burkina Faso on 12 September 2025. ETHICS AND DISSEMINATION: This protocol was approved by the Johns Hopkins School of Public Health Institutional Review Board, the Comité d'Ethique pour la Recherche en Santé, the Aga Khan University Ethics Review Committee and the Pakistan National Bioethics Committee. Findings will be disseminated through in-country meetings and in the peer-reviewed literature. TRIAL REGISTRATION NUMBER: NCT06568315.
BMJ openOludayo Adeyemi Olosunde, Oswald Zion N Onunwa, Oluwasuen B Osundina, Adebisi O Olosunde, Temitope O Olajubu, Charity E Odufu, Florence Pamilerin
OBJECTIVE: To assess traditional birth attendant (TBA) service utilisation and associated factors among women of reproductive age in Ife Central Local Government Area, Osun State, Nigeria. DESIGN: A community-based cross-sectional study guided by Andersen's Behavioural Model. SETTING: Community settings in Ife Central Local Government Area, Osun State, Nigeria. PARTICIPANTS: Women who had delivered within the preceding 24 months were selected using a multistage sampling technique involving the selection of wards, households, and one eligible woman per household. The calculated minimum sample size was 369 after adjusting for a 10% non-response rate. Of the 366 questionnaires distributed, 316 were completed and analysed, giving a response rate of 86.3%. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was self-reported ever use of TBA services. Secondary measures comprised associations between TBA service utilisation and prespecified sociodemographic, healthcare access and sociocultural factors. These associations were assessed using χ² tests and multivariable logistic regression at a 5% significance level. RESULTS: Of the 316 respondents, 61.4% reported ever using TBA services. In bivariate analyses, TBA service utilisation was significantly associated with inadequate transportation access, a non-positive experience with facility-based maternal services, previous denial of services, exclusion from maternal healthcare decision-making, community approval of TBA use and cultural accommodation by TBAs (all p<0.05). In the fully adjusted model, seven factors remained independently associated with TBA service utilisation: age 27-38 years compared with 15-26 years (adjusted OR (AOR)=3.62, 95% CI 1.62 to 8.07), tertiary education compared with no formal or primary education (AOR=0.17, 95% CI 0.04 to 0.65), adequate transportation access (AOR=0.41, 95% CI 0.17 to 0.97), health insurance covering maternity services (AOR=0.24, 95% CI 0.08 to 0.68), a positive experience with facility-based maternal services (AOR=0.21, 95% CI 0.09 to 0.50), previous denial of care (AOR=2.47, 95% CI 1.17 to 5.24) and community approval of TBA use (AOR=2.38, 95% CI 1.06 to 5.36). The model demonstrated acceptable calibration (Hosmer-Lemeshow χ²(8)=7.839, p=0.449), good discrimination (area under the receiver operating characteristic curve=0.836) and no substantial multicollinearity (all variance inflation factors <3.6). CONCLUSIONS: TBA service utilisation was associated with maternal age, educational attainment, transportation access, health insurance coverage for maternity services, experiences with facility-based maternal services, previous denial of care and community approval of TBA use. These findings highlight the need to improve access to acceptable facility-based maternal healthcare, address barriers to receiving care and incorporate culturally responsive approaches into maternal health services.
PloS oneJuliana Ofosua Addo, Douglas Aninng Opoku, Julius Kwabena Karikari, Emmanuel Konadu, Mercy Addae, Francis Kwabena Kyei, Mawuse Kanfra, Obed Kwabena Offe Ampons…
BACKGROUND: Previous studies on Fear of Childbirth (FoC) across sub-Saharan Africa have typically reported prevalence separately by parity or treated it as a covariate in multivariable analyses, with little attention given to identifying parity-specific determinants. However, first-time mothers and those with previous birth experiences may require different forms of antenatal support. To address this gap, we assessed the prevalence of FoC and identified parity-specific determinants among antenatal care attendees in Ghana to inform targeted interventions. METHODS: A facility-based cross-sectional study was carried out among pregnant women attending antenatal care (ANC) at a primary healthcare facility in Kumasi. Data were collected using an interviewer-administered questionnaire. The primary outcome of the study, FoC, was assessed using the English version of the Wijma Delivery Expectation/Experience Questionnaire (W-DEQ). Additional data included sociodemographic and obstetric characteristics. Stratified multivariable linear regression models were applied to identify parity-specific determinants among the participants. RESULTS: Of the 282 women who participated in the study, 22% had high-to-severe FoC. Nulliparous women (median: 46.0, IQR: 37.0-66.0) reported significantly higher median W-DEQ scores than parous women (median: 39.0, IQR: 32.0-58.5). In a parity-stratified analysis, among nulliparous women, factors such as a history of family abuse (adjusted Β = 16.32, 95% CI: 2.50 to 30.14) and late ANC booking (adjusted Β = 13.13, 95% CI: 1.43 to 24.84) were significantly associated with FoC. Among parous women, factors such as secondary education (adjusted Β = -7.63, 95% CI: -14.88 to -0.37), intimate partner violence (adjusted Β = 10.87, 95% CI: 0.69 to 21.04), unplanned pregnancy (adjusted Β = 8.38, 95% CI: 2.51 to 14.26), and strong family support (adjusted Β = -27.94, 95% CI: -38.77 to -17.11) were significantly associated with FoC. CONCLUSION: FoC is common among this cohort of pregnant women, and its determinants differed by parity and across parity-specific factors. The parity-stratified determinants underscore the need for parity-tailored psychosocial care at ANC, incorporating targeted screening and support procedures aligned with parity-associated risk pathways to enhance maternal well-being.
PloS oneJakia Sultana Mim, Md Shihab Mostafa, Bodrunnahar Barna, Ahmed Nuzat Sadia, Raisul Islam, Abdullah Al Islam
BACKGROUND: Bangladesh has achieved notable progress in maternal and child health; however, maternal and neonatal mortality remain high, partly due to inadequate access to skilled birth attendants (SBA) during delivery. This study aims to identify key socioeconomic and demographic factors influencing SBA utilization in Bangladesh. METHODS: Data were obtained from the 2022 Bangladesh Demographic and Health Survey (BDHS), a nationally representative cross-sectional survey which was conducted from June 27 to December 12, 2022. The outcome variable was skilled birth attendants during delivery, defined as attendants provided by a doctor, nurse, or midwife. Descriptive statistics and chi-square tests were used for initial analysis, followed by binary logistic regression to identify significant determinants. Additionally, the inclusion of machine learning models provides an additional classification framework that improves classification performance and helps identify important predictors, complementing traditional regression analysis. RESULTS: From the study, 67.94% of women utilized skilled birth attendants during childbirth. Higher maternal education, household wealth, antenatal care utilization, and urban residence were significantly associated with greater SBA utilization. Women with higher education had substantially higher odds of using SBA than those with no education (AOR = 4.10, 95% CI: 1.94-8.66, p < 0.001), while rural women had lower odds than urban women (AOR = 0.64, 95% CI: 0.47-0.88, p = 0.006). Women who attended four or more ANC visits were also more likely to use SBA than those with no ANC visits (AOR = 2.92, 95% CI: 1.72-4.96, p < 0.001). Women from the richest households had higher odds of SBA utilization compared with those from the poorest households (AOR = 1.77, 95% CI: 1.11-2.81, p = 0.016). Among the machine-learning models, Random Forest achieved the highest numerical accuracy (0.82). CONCLUSION: Education, economic status, ANC utilization, and place of residence were identified as key factors associated with skilled birth attendants during delivery in Bangladesh using the binary logistic regression model. Moreover, the machine learning models were used separately to classify SBA. Targeted interventions focusing on disadvantaged and rural populations can help improve equitable access to maternal healthcare. However, differences related to religion and region should be interpreted cautiously, as they may reflect broader socioeconomic and cultural factors rather than direct effects.