Metrics details. The goal of reducing maternal mortality can be achieved when women receive important service components at the time of their maternity care. This study attempted to assess the availability and the components of maternity services according to the perspectives of service users and providers. A linked facility and population-based survey was conducted over three months January to March in North Gondar Zone. Twelve kebeles clusters were selected randomly from six districts to identify maternity clients cared for by skilled providers.
Often, trying to get pregnant, being pregnant, or the birth of a baby can increase the risk for depression. Table 2 Important service components received by women during their ANC visit and delivery care by types of skilled attendants, North Gondar, Full size table. This often happens between 45—55 years of age. Pre-pregnancy counselling can facilitate informed decision-making. All A-Z Seekmeup directory health reproductive pregnancy and topics. A woman has reached menopause when she has not had a period for 12 months in a row. Essential interventions service components provided before pregnancy, during pregnancy, delivery, and postpartum are outlined in the WHO documents and lancet Seekmeup directory health reproductive pregnancy and [ 1415 ]. Background Utilization of maternal health services by skilled providers, Lilyette minimizer bras proximate indicator of maternal survival, is very low in Ethiopia. Protecting your reproductive system also means having control of your health, if and when, you become pregnant. This study has had certain limitations.
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- It is important that workplaces have an understanding of how to encourage healthy work-life balance.
- But some jobs involve exposures that are harmful to pregnant or breast feeding women.
- As one of the fastest-growing segments of the U.
A planned pregnancy is likely to be a healthier one, as unplanned pregnancies represent a missed opportunity to optimise pre-pregnancy health. This can lead to adverse health impacts for the mother, including obstetric complications and antenatal and postnatal depression, as well as for the child, including low birthweight and developmental abnormalities. There are multiple risk factors for unplanned pregnancy, including lower educational attainment, younger age, smoking and substance misuse.
In , the under conception rate in England was Although this was the lowest rate recorded since comparable statistics were first produced in , teenagers remain the group at highest risk of unplanned pregnancy. Contraception is important for all heterosexual women of reproductive age, regardless of whether they are planning a pregnancy, as it enables them to effectively control if and when they desire to conceive. The contraceptive consultation also offers an opportunity for optimising health and a longer time period to address risk factors in advance of pregnancy, if this is a desired goal.
Therefore, taking a population approach to contraception alongside addressing other aspects of health improvement is likely to be an effective way to address health needs in preparation for pregnancy at a later date. Women who do not reach contraceptive services proactively can benefit from opportunistic contraceptive and preconception advice.
The preconception period presents an opportunity for intervention, when women and men can adopt healthier behaviours in preparation for a successful pregnancy and positive health outcomes.
This includes:. By not addressing these risk factors, women and their children are at greater risk of poor outcomes. Maternal and paternal obesity is one example where there is an increased risk of many major adverse maternal and perinatal outcomes.
Achieving weight loss requires a longer period of time to address adequately before pregnancy, and is therefore an area where changes could be made earlier than the traditional preconception period of 3 months. There is also increasing evidence for the impacts of a global increase in male obesity on outcomes.
Paternal obesity has been linked to impaired fertility by affecting sperm quality and quantity, as well as an increased risk of chronic disease in future generations.
Reproductive health needs to be part of day-to-day business for many key services, and support for healthy behaviour change must be important for all. Health Matters is a resource for professionals which brings together the latest data and evidence, makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action.
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Yet working mothers can also struggle to balance their career and work demands with reproductive plans and caregiving. National and State Data Sheets Get the latest national and state data on over 75 measures documenting adolescent health. Bookmark This Page Tell-a-Friend. Diagnosis and Tests. Find family planning services.
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Metrics details. The goal of reducing maternal mortality can be achieved when women receive important service components at the time of their maternity care. This study attempted to assess the availability and the components of maternity services according to the perspectives of service users and providers.
A linked facility and population-based survey was conducted over three months January to March in North Gondar Zone. Twelve kebeles clusters were selected randomly from six districts to identify maternity clients cared for by skilled providers. Then 12 health centers and 3 hospitals utilized by the corresponding cluster population were selected for facility survey.
However, the majority of them were not fully functioning for EmOC according to their level. Signal functions including administration of anticonvulsants and assisted vaginal delivery were missing in seven and five of the 12 health centers, respectively.
Only one hospital met the criteria for comprehensive emergency obstetric care performed cesarean section. About However, important components of both the routine and emergency maternity care services were incomplete.
Improving the functional capacity of health facilities for the delivery of routine maternity and EmOC services are needed. Utilization of maternal health services by skilled providers, a proximate indicator of maternal survival, is very low in Ethiopia.
One of the key factors for the utilization of skilled maternal care is access to and availability of health care facilities. Evidences from many developing countries, including Mali, South Africa, Zambia, Paraguay, Uganda and Tanzania indicate that the proximity of maternal health services to users and a reliable transportation system to link the community and health facilities are critical for maternal service utilization [ 2 — 5 ].
The availability of basic and comprehensive emergency obstetric care signal functions in a health care system are crucial for maternal survival [ 6 ]. Signal functions, including parenteral antibiotics, anticonvulsants and oxytocics, manual removal of placenta, removal of retained products, assisted vaginal delivery and neonatal resuscitation at basic emergency obstetric care facility with the addition of cesarean delivery and blood transfusion at comprehensive emergency obstetric care facility used to treat direct obstetric complications cause the majority of maternal deaths [ 7 ].
In order to have a better health care access, Ethiopia has introduced a three-tier health care delivery system. Level two is a general hospital covering a population of 1—1.
Once the mother arrives at the health facility, she has to have access to a medical professional who has the skills and equipment to give the necessary services. However, in many developing countries, health facilities do not perform their expected functions according to their level. Similar studies revealed the fact that facilities were not performing what they were supposed to [ 10 ]. Studies showed that many facilities suffered from staff training deficiencies that hindered the provision of specific services.
In many settings, midlevel providers such as midwives were not trained or authorized to perform some of the key procedures expected from a skilled attendant. A study in Benin, Ecuador, Jamaica, and Rwanda showed a wide gap between current evidence based standards and current levels of provider competence. In the study, providers answered Pre-service training is also not a guarantee.
In Ethiopia, many of the previous studies have reported ANC, delivery and postnatal care coverage as utilization of maternal services. Essential interventions service components provided before pregnancy, during pregnancy, delivery, and postpartum are outlined in the WHO documents and lancet article [ 14 , 15 ].
In the country, there is limited evidence about specific service components and the performance of health facilities at the time of maternity care.
This study was planned to assess the availability and components of maternity services in both routine and emergency situations according to providers and users perspectives in North Gondar. As suggested in the manuals [ 16 ], the facility survey was linked to the population-based survey sample areas.
According to the figures from the central statistical agency, , this zone had an estimated total population of 2,,, about In the zone, there is only one referral hospital with a comprehensive emergency obstetric care. There are also about a hundred health centers and two district hospitals. The zone, which is the largest of the region, has a difficult topography.
In order to get a sufficient number of maternal care users, a total of twelve clusters or kebeles the lowest administrative units having clear geographical boundary and administrations were selected randomly from six districts, namely Dembia, Lay Armachiho, West Belessa, Metema, Debark and Dabat. All women who had births one-year preceding the survey and who received maternal care during pregnancy and delivery were included in the sample.
In the selected clusters, and of the eligible women were skilled antenatal and delivery care users. One of the options for sampling facilities in a linked survey is determine the nearest facility, or facilities, to each population-based survey cluster and conduct the facility survey in all identified. In this approach, the sample size is improved by assuring that the number of facilities is no less than the number of population-based clusters.
Based on this recommendation, we have identified one basic essential obstetric care facility health center utilized by the cluster population for each selected cluster kebele. Twelve health centers and three hospitals serving the selected kebele population were included for the facility survey.
During observation, a checklist containing infrastructure, equipment, drugs and supplies, and laboratory tests was prepared. In addition, all midlevel skilled care providers who were directly involved in maternity care at these health centers and district hospitals 38 skilled providers were interviewed about their training and skills for different types of procedures. A skilled attendant is an accredited health professional who has been educated and trained to proficiency in the skills needed to manage normal uncomplicated pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns [ 18 , 19 ].
In this study, skilled providers included midwives, nurses, health officers and doctors. Health officers are those trained for four years to get their Bachelors degree and they work as clinician in the rural set up health centers. Thirty-six data collectors and supervisors 2 data collectors and 1 supervisor for each kebele were trained and deployed for identifying and interviewing maternal care users. The interviews were conducted using the local language Amharic after the questionnaire was pretested for cultural appropriateness and clarity.
To conduct the facility-based survey, 14 experienced health professionals were recruited. After the appropriate coding, the data was entered in Epi Info version 3.
During data collection, the study participants were asked for consent and informed to interrupt the interview on desire.
All participants signed written agreements consent forms. All facilities hospitals and health centers reported that they had ANC and family planning FP services. However, findings from the interview with skilled maternal care users indicated that out of the women who gave birth one year preceding the survey, only Similarly, three-fourths of the births took place at health centers assisted by nurses or midwives.
None of the health centers visited had laboratory services for testing syphilis. A total of five health centers and all three hospitals fulfilled the criteria for signal functions for basic emergency obstetric care, but only Gondar Hospital fulfilled all the signal functions for comprehensive emergency obstetric care. Of the signal functions, parenteral antibiotics and oxytocics were practiced by all the facilities visited except one health center.
However, important functions, including the administration of anticonvulsants and assisted vaginal delivery were missing in three-fifths and two-fifths of the health centers, respectively. The observation of facilities showed that essential drugs, including antibiotics, intravenous fluids, vaccines and contraceptives were available in the 15 selected facilities. Supplies, like gloves and syringes were also adequate.
However, pieces of equipment number of facilities out of 15 facilities in brackets , including thermometers 5 , sphygmomanometers 7 , foetoscopes 2 , delivery set 5 , episiotomy set 5 , vacuum extractor 10 , blank partograph 7 , MVA set 8 , bag and mask for neonatal resuscitation 7 , sterilizer 5 and refrigerator 8 were either missing or nonfunctional at the time of visiting facilities.
Similarly, private consultation rooms 5 , delivery room 5 , toilet facilities 7 , water supply 8 and drainage system in the labor room 13 were unsatisfactory. Interview with providers directly involved in assigned to maternity care at basic obstetric care facilities health centers and district hospitals was done to assess providers training and their skills. Nonetheless, they routinely performed other procedures, like protecting privacy, explaining procedures, informing about the progress of labor and possible outcomes, as well as comforting the laboring mother.
However, the majority of the facilities were not fully functioning for emergency obstetric care EmOC according to their level. In health centers basic EmOC facilities , parenteral anticonvulsants and assisted vaginal delivery were often missing. In the hospitals, cesarean section and blood transfusion were not available. Evidences showed that these functions were commonly unavailable in many other areas [ 9 , 20 ]. Only one hospital met the criteria for comprehensive EmOC performed cesarean section.
This hospital is serving about three million people of the zone and the surrounding areas. The findings also indicated that many pregnant women who developed obstetric complications were not benefiting from their care.
Such functions require enabling environment like facilities and skilled professionals. In many of the visited facilities, important pieces of equipment were either missing or not functional. The absence of such tests has a clear effect on screening services during maternity care.
This was a common challenge identified by other studies [ 21 ]. The use of partograph to monitor labor progress helps to take life saving action in a timely manner. However, few providers used partograph consistently. In addition, about one-third had no skill to manage preeclampsia and post-abortion complications. Training deficiencies and skill retention problems were among the major bottlenecks to have quality maternal care in many developing countries [ 11 , 22 ].
Providing incomplete poor quality maternal service had damaging effect on health-seeking behavior of mothers. The linked data analysis, as continuation of this study, indicated that utilization of skilled maternal care by individual woman depends on the joint effect of individual, household, communal and facility characteristics.
Our analysis indicated that the presence of all the six signal functions in the nearby basic essential obstetric care facility health center positively contributed to the utilization of all indicators of skilled maternal services, and its effect was significant on skilled attendance rate [ 23 ].
They rarely used doctors or specialists. After criticisms on the traditional ANC the risk approach , the new approach that is focused antenatal care emphasizes the quality of service. In this study, the implementations of the important components of ANC services were incomplete.
Many mothers did not receive various antenatal screening services. Tetanus immunization, iron supplementation, counseling and advice on nutrition, birth preparedness and readiness for possible complication were lower than expected. The identified gap in all areas of service components indicated that the current antenatal care service could be challenged to achieve the goal of focused ANC.
Like the ANC, many women who had delivery care by a skilled attendant did not receive important services. Providers also paid little attention to counseling and advice on different types of maternal and childcare. In this regard, the poor skills of providers may be the main causes of the unsatisfactory services. In many developing countries, competency and skill retention of providers are the major concerns for skilled birth attendance [ 12 , 24 ].
This study has had certain limitations. During the interview, for example, women faced difficulties to differentiate types of skilled providers. To minimize the problem, data collectors did further clarifications by collecting information on types of providers from health institutions that gave the services. Because of the cross-sectional design of the study, recall and interviewer bias were also potential limitations.