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Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal

BACKGROUND: Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of h...

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Autores principales: Maru, Sheela, Bangura, Alex Harsha, Mehta, Pooja, Bista, Deepak, Borgatta, Lynn, Pande, Sami, Citrin, David, Khanal, Sumesh, Banstola, Amrit, Maru, Duncan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336683/
https://www.ncbi.nlm.nih.gov/pubmed/28259150
http://dx.doi.org/10.1186/s12884-017-1267-y
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author Maru, Sheela
Bangura, Alex Harsha
Mehta, Pooja
Bista, Deepak
Borgatta, Lynn
Pande, Sami
Citrin, David
Khanal, Sumesh
Banstola, Amrit
Maru, Duncan
author_facet Maru, Sheela
Bangura, Alex Harsha
Mehta, Pooja
Bista, Deepak
Borgatta, Lynn
Pande, Sami
Citrin, David
Khanal, Sumesh
Banstola, Amrit
Maru, Duncan
author_sort Maru, Sheela
collection PubMed
description BACKGROUND: Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear. METHODS: In this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization. RESULTS: Institutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors. CONCLUSION: Comprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization.
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spelling pubmed-53366832017-03-07 Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal Maru, Sheela Bangura, Alex Harsha Mehta, Pooja Bista, Deepak Borgatta, Lynn Pande, Sami Citrin, David Khanal, Sumesh Banstola, Amrit Maru, Duncan BMC Pregnancy Childbirth Research Article BACKGROUND: Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear. METHODS: In this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization. RESULTS: Institutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors. CONCLUSION: Comprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization. BioMed Central 2017-03-04 /pmc/articles/PMC5336683/ /pubmed/28259150 http://dx.doi.org/10.1186/s12884-017-1267-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Maru, Sheela
Bangura, Alex Harsha
Mehta, Pooja
Bista, Deepak
Borgatta, Lynn
Pande, Sami
Citrin, David
Khanal, Sumesh
Banstola, Amrit
Maru, Duncan
Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title_full Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title_fullStr Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title_full_unstemmed Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title_short Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
title_sort impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural nepal
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336683/
https://www.ncbi.nlm.nih.gov/pubmed/28259150
http://dx.doi.org/10.1186/s12884-017-1267-y
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