Trends, wealth inequalities and the role of the private sector in caesarean section in the Middle East and North Africa : A repeat cross-sectional analysis of population-based surveys

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Improving women's health postpartum The impact of provision of written information

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Companion of choice at birth: factors affecting implementation

Abstract Background Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators. Methods Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors. Results Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers. Conclusion Prior to introducing companion of choice at birth, understanding providers’ attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women’s privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births

Impact of written information on women's use of postpartum services: a randomised controlled trial.

BACKGROUND: This study evaluates the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum. METHODS: All women having a live birth at 4 private hospitals in Lebanon were eligible. The sample consisted of 187 women in the intervention and 191 in the control arms. An intervention booklet was developed following a qualitative study of women's information needs; placebo material was 2 leaflets about childproofing the house. Field workers administered a baseline questionnaire to recruit all eligible women, and conducted follow-up interviews 6-20 weeks postpartum at the women's residences. The written material was handed out to women just before discharge from hospital. At the baseline interview, interviewers and women were blinded to the nature of the written material. Outcome measures were a postpartum visit to a health professional after discharge and before the follow-up interview, and satisfaction with maternity care received during pregnancy, delivery and postpartum. RESULTS: Satisfaction with care during the postpartum period was 57.2% in the intervention and 38.9% in the control arm (p<0.001). Some 85% of women in the intervention arm had a postpartum visit compared to 55% in the control arm (p<0.001). CONCLUSION: In the context of high female literacy, the intervention is effective and requires few resources

A simple way to increase service use: triggers of women's uptake of postpartum services.

OBJECTIVE: To examine the socio-demographic and service-related determinants of utilisation of postpartum services. DESIGN: Data were used from a single-blind, randomised controlled trial aimed at changing women's knowledge, attitude and behaviour regarding certain postpartum health issues by providing written information via a specially prepared booklet. SETTING: Four private hospitals, two in Beirut and two in the Bekaa region, were selected. All were privately owned and one in Beirut was a teaching hospital. SAMPLE: All women delivering a live birth in the designated hospitals during a three- to four-month period were recruited into the study. Of the 503 eligible women, 450 agreed to complete the initial questionnaire and 378 completed the postpartum interviews. METHODS: Eight trained female interviewers collected the baseline data. On discharge, interviewers handed each woman a sealed and numbered envelope containing the intervention booklet or the placebo leaflets. Interviewers were blind about the allocation group of women. Interviewers conducted follow up assessment at women's residence 6-20 weeks after delivery. MAIN OUTCOME MEASURES: Any postpartum visit with or without a preset appointment. RESULTS: Multivariable analysis with adjusted ORs show that women given an appointment for their postpartum visit were more likely to having had that visit (OR = 6.8, 95% CI 6.2-7.4). In the absence of such an appointment, university education (OR = 3.6, 95% CI 2.6-4.7), information on maternal health (OR = 4.9, 95% CI 4.0-5.8) and the intervention booklet (OR = 2.9, 95% CI 2.0-3.9) were important determinants of a postpartum visit. CONCLUSION: Giving women appointments for postpartum visits, or written or verbal information on maternal health can increase their use of health services