Age at First Birth in Uttar Pradesh: How Much Has It Actually Changed? Over Inter-NFHS Period?

Culturally, there is always pressure among newly-wed to conceive early and have births in India. Previous studies have documented relationship between age at first birth & fertility, besides the socio-demographic factors that influence age at first birth. The current study aims answering directions and quantum of such relationships using frailty models. The successive rounds of NFHS data (1, 2, 3 & 4) from Uttar Pradesh is used in the study. Fertility in India is characterized as too-early-too-fast. By age-30 majority women would have completed the childbearing. However, the data from NFHS-4 shows some striking changes in the initiation of child bearing in Uttar Pradesh breaking away from the stereotypes of too early too fast characterization. While 44.67 percent of the women aged 30-34 had experienced first birth by age 18 in the year 1992-93 (NFHS-1), the percentages declined during 2015-16 (NFHS-4) to 28.25%. However, by ages 26 majority of women (>95%) aged 30-34 have had experienced first birth. Births at younger age are also a reflection on enforcement of child-marriage restraint act & adherence to legal minimum age at marriage which is 18 for girls & 21 for boys. The data from NFHS-4 have some quality issues. Women aged as low as 5 have shown to have experienced first birth by that age. This may not be possible. The Kaplan Meier survival Graph provided the survival probabilities with respect of each predictor sub groups. The log rank test was used to test the equality of survivor function for each sub group of the predictor variable. The survivor function was significantly different among sub groups of the predictor variables except for the categories of ever use of contraception at NFHS1 and categories of religion across rounds of NFHS data. The Cox Proportional Hazards model was used to study the risk of first birth by socio demographic characteristics. The Frailty model capturing the unobserved heterogeneity in the event time was preferred over standard survival model. For the current study, gamma frailty with Weibull-hazard is used as it fits the data well. Age at marriage and women’s literacy significantly determines the Age at First Birth. The inverse relationship with regard to ever use of contraception needs further analysis. The model also predicts significant frailty with variance parameter (theta) greater than one across the NFHS datasets.

Utilization of free maternity services among mothers aged 18-49 years in Nakuru County, Kenya

Background: In Kenya, the hope of free maternity services (FMS) is to increase the demand for maternity health care services offered by certified health professionals. Thus, this study aimed to determine and understand the utilization level of FMS among mothers aged 18-49 years living in Naivasha Sub-County, Kenya.Methods: A mixed-methods approach collected quantitative and qualitative data through structured questionnaires, health records reviews, focus group discussions, and key informant interviews. The quantitative and qualitative data were analyzed by use of Statistical package for social sciences (SPSS) 20 and content analysis, respectively. The quantitative data results were further subjected to multiple regression analysis.Results: The findings showed that over 80% utilized antenatal care, facility deliveries and postnatal care, but 68% of respondents used family planning. The mothers were found active in their first, second and third pregnancies in utilizing FMS, followed by a sudden decline. The mothers preferred the public health facilities to the private, mission and Non-Governmental Organizations (NGOs). The significant findings influencing the utilization of FMS among the mothers were age (p=0.004), the number of children (p=0.000), age at first birth (p=0.025), household income (p=0.008) and residential area (p=000). The mothers' level of knowledge on FMS had an average score of 80%, obtained by use of the Linkert scale. The radio, television, health facility and community sources were significant with (p=0.000).Conclusions: The decision-makers consider age, the number of children, age at first birth, household income and residential area in the formulation of FMS policies. Further, utilize relevant sources of information on FMS in the community.

Cohort, Policy, and Process: The Implications for Migrant Fertility in West Germany

Although a growing literature explores the relationship between migration and fertility, far less scholarship has examined how migrant childbearing varies over time, including across migrant cohorts. I extend previous research by exploring migrant-cohort differences in fertility and the role of changing composition by education and type of family migration. Using 1984–2016 German Socio-Economic Panel data, I investigate the transition into first, second, and third birth among foreign-born women in West Germany. Results from an event-history analysis reveal that education and type of family migration—including marriage migration and family reunions—contribute to differences in first birth across migrant cohorts. Specifically, more rapid entry into first birth among recent migrants from Turkey stems from a greater representation of marriage migrants across arrival cohorts, while increasing education is associated with reduced first birth propensities among recent migrants from Southern Europe. I also find variation in the risk of higher parity transitions across migrant cohorts, particularly lower third birth risks among recent arrivals from Turkey, likely a result of changing exposures within origin and destination contexts. These findings suggest that as political and socioeconomic circumstances vary within origin and destination contexts, selection, adaptation, and socialization processes jointly shape childbearing behavior.

"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.

<p>In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions. My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment. Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor. Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social, professional and industrial discourses overwhelms the salutogenic factors that should protect normal birth. A re-focussed commitment to providing continuity of care across the labour continuum, home visiting in early labour, enhancing physiological birth support in both the relational and environmental realms, averting the obstetric gaze and prioritising women’s needs over institutional needs represent the best way forward as strategies to resist the inexorable rise of obstetric intervention. Midwives are well-positioned to respond to this call. Reclaiming their expertise in support of physiological first birth by driving the practice and research agenda presents the optimal way to “move things forward” for women.</p>

"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.

<p>In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions. My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment. Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor. Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social, professional and industrial discourses overwhelms the salutogenic factors that should protect normal birth. A re-focussed commitment to providing continuity of care across the labour continuum, home visiting in early labour, enhancing physiological birth support in both the relational and environmental realms, averting the obstetric gaze and prioritising women’s needs over institutional needs represent the best way forward as strategies to resist the inexorable rise of obstetric intervention. Midwives are well-positioned to respond to this call. Reclaiming their expertise in support of physiological first birth by driving the practice and research agenda presents the optimal way to “move things forward” for women.</p>

Socio-demographic and environmental risk factors associated with multiple under-five child loss among mothers in Bangladesh

Background Despite the substantial decline in child mortality globally over the last decade, reducing neonatal and under-five mortality in Bangladesh remains a challenge. Mothers who experienced multiple child losses could have substantial adverse personal and public health consequences. Hence, prevention of child loss would be extremely desirable during women’s reproductive years. The main objective of this study was to determine the risk factors associated with multiple under-five child loss from the same mother in Bangladesh. Methods In this study, a total of 15,877 eligible women who had given birth at least once were identified from the 2014 Bangladesh Demographic and Health Survey. A variety of count regression models were considered for identifying socio-demographic and environmental factors associated with multiple child loss measured as the number of lifetime under-five child mortality (U5M) experienced per woman. Results Of the total sample, approximately one-fifth (18.9%, n = 3003) of mothers experienced at least one child’s death during their reproductive period. The regression analysis results revealed that women in non-Muslim families, with smaller household sizes, with lower education, who were more advanced in their childbearing years, and from an unhygienic environment were at significantly higher risk of experiencing offspring mortality. This study also identified the J-shaped effect of age at first birth on the risk of U5M. Conclusions This study documented that low education, poor socio-economic status, extremely young or old age at first birth, and an unhygienic environment significantly contributed to U5M per mother. Therefore, improving women’s educational attainment and socio-economic status, prompting appropriate timing of pregnancy during reproductive life span, and increasing access to healthy sanitation are recommended as possible interventions for reducing under-five child mortality from a mother. Our findings point to the need for health policy decision-makers to target interventions for socio-economically vulnerable women in Bangladesh.

Continuity of maternal healthcare services utilisation in Indonesia: analysis of determinants from the Indonesia Demographic and Health Survey

ObjectiveWHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100 000 live births, which exceeds the target of Sustainable Development Goals (<70 per 100 000 live births). Receiving at least four times antenatal care (ANC4+) and skilled birth attendant (SBA) during childbirth is crucial for preventing maternal and neonatal deaths. The study aims to assess the determinants of ANC4 +and SBA independently, evaluate the distribution of utilisation of ANC4 + and SBA services, and further investigate the associations of two levels of continuity of services utilisation in IndonesiaDesignData from the Indonesia Demographic and Health Survey, a cross-sectional and large-scale national survey conducted in 2017 were used.SettingThis study was set in Indonesia.ParticipantsThe study involved ever-married women of reproductive age (15–49 years) and had given birth in the last 5 years prior to the survey (n=15 288). The dependent variables are the use of ANC4 + and SBA. Individual, family and community factors, such as age, age at first birth, level of education, employment status, parity, autonomy in healthcare decision-making, level of education, employment status of spouses, household income, mass media consumption residence and distance from health facilities were also measured.ResultsResults showed that 11 632 (76.1%) women received ANC4 + and SBA during childbirth. Multivariate analysis revealed that age, age at first birth, and parity have a statistically significant association with continuity of services utilisation. The odds of using continuity of services were higher among women older than 34 years (adjusted OR (aOR) 1.54; 95% CI 1.31 to 1.80) compared with women aged 15–24 years. Women with a favourable distance from health facilities were more likely to receive continuity of services utilisation (aOR 1.39; 95% CI 1.24 to 1.57).ConclusionsThe continuity of services utilisation is associated with age, reproductive status, family influence and accessibility-related factors. Findings demonstrated the importance of enhancing early reproductive health education for men and women. The health system reinforcement, community empowerment and multisectoral engagement enhance accessibility to health facilities, reduce financial and geographical barriers, and produce strong quality care.

Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa

Background Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. Methods Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. Results Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. Conclusion Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.

“Counting those never bubble over” Estimated prevalence and its determinants of obstetric fistula among childbearing women in 14 African countries: Multilevel Analysis

Background Obstetric fistula is a leakage between genital tract and urinary tract and/or between genital tract and rectum. The commonest cause of obstetric fistula is prolonged labour which magnify in the areas of poor prenatal and emergency obstetric care. In Africa, there is poor of quality of obstetric care and poor social support for those who faced fistula. Obstetric fistula shatters the life of the women and the consequence is nasty while multicounty level estimate on the magnitude and determinates of fistula were nil. Multicounty level of estimate of the magnitude of fistula is important to design and fill the gaps of quality of obstetric care and design the appropriate corrective intervention mechanisms of obstetric fistula. Therefore, this study aimed the estimate the magnitude of obstetric fistula and its determinants among childbearing women in 14 Africa countries based on recent demographic and health survey data. Methods Secondary data were used from 14 African demographic and health survey database. The data were extracted based on the objective the study and previous literatures. Data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, recoding, and for further multilevel analysis. The appropriateness of multilevel analysis were checked by Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC). Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done accordingly. Variables with p-value ≤0.05 declared as statistical significant with outcome variable for the study. The adjusted odds ratio with 95% confidence interval was used as measure of association. Results The magnitude of obstetric fistula was 0.84 [95%CI: 0.79, 0.88]. Maternal age >=41 years [AOR=1.38; 95% CI:1.01,1.93], urban residence [AOR=0.69; 95%CI: 0.53,0.89], women who attended secondary education [AOR=0.59; 95% CI: 0.45,0.77], women who attended higher education [AOR=0.40; 95% CI: 0.25,0.65], female household head [AOR=0.78; 95% CI: 0.64,0.95], husbands who attended primary education [AOR=0.80; 95% CI: 0.65, 0.98], women who give their first birth 16-20years [AOR=0.78; 95% CI: 0.66,0.92], 21-25 years [AOR=0.66; 95% CI: 0.53,0.84], ≥26 years [AOR=0.67; 95% CI: 0.48, 0.92], history of terminating pregnancy [AOR=1.51; 95% CI: 1.29, 1.77] and awareness on fistula [AOR=0.35; 95% CI: 0.26,0.45) were the determinants of obstetric fistula identified in this study. Conclusion The magnitude of obstetric fistula in 14 African countries were high as compared with the world health organization estimate. Maternal age, residence, educational status, husband’s educational status, sex of household head, age at first birth, history of terminating pregnancy and awareness on obstetric fistula were the determinants identified in this study. Therefore, health interventions that reduce the occurrence of obstetric fistula could be designed to address the women who lives in rural area, no formal education, male-headed household, husbands who never attended formal education, and women who had terminated pregnancy should be addressed in advance. Policies and programs of fistula should be tailored the women which characterized as living in rural area, non-educated, young age at first birth and no awareness on fistula as well as male headed households. Evidence based multicounty interventions were highly recommended to eliminate obstetric fistula and to achieve sustainable development goal.

First Birth at Home or in Hospital in Aotearoa/New Zealand: Intrapartum Midwifery Care and Related Outcomes

<p>A woman's first birth experience can be a powerfully transformative event in her life, or can be so traumatic it affects her sense of 'self' for years. It can influence her maternity future, her physical and emotional health, and her ability to mother her baby. It matters greatly how her first birth unfolds. Women in Aotearoa/New Zealand enjoy a range of options for provision of maternity care, including, for most, their choice of birth setting. Midwives who practice in a range of settings perceive that birth outcomes for first-time mothers appear to be 'better' at home. An exploration of this perception seems warranted in light of the mainstream view that hospital is the optimal birth setting. The research question was: "Do midwives offer the same intrapartum care at home and in hospital, and if differences exist, how might they be made manifest in the labour and birth events of first-time mothers?" This mixed-methods study compared labour and birth events for two groups of first-time mothers who were cared for by the same midwives in a continuity of care context. One group of mothers planned to give birth at home and the other group planned to give birth in a hospital where anaesthetic and surgical services were available. Labour and birth event data were collected by a survey which was generated following a focus group discussion with a small group of midwives. This discussion centred around whether these midwives believed their practice differed in each setting, and what influenced care provision in each place. Content analysis of the focus group data saw the emergence of four themes relating to differences in practice: midwives' use of space, their use of time, the 'being' and 'doing' of midwifery and aspects relating to safety. Survey data were analysed using SPSS. Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth. The study offers some insights into how the woman's choice of birth place affects the care provided by midwives, and how differences in care provision can relate to differences in labour and birth event outcomes.</p>