Nurses\u27 Alumnae Association Bulletin - Volume 6 Number 9

Remember the Relief Fund Welcome! Miss Childs Financial Report Calendar of Coming Events Lest You Forget! Attention Review of the Alumnae Association Meetings Institutional Staff Nurses\u27 Section Report of Staff Activities - 1947-1948 Private Duty Section The White Haven Division Barton Memorial Division Remember the Relief Fund Student Nurses\u27 Activities Jefferson Scores Again The Clara Melville Scholarship Fund Interesting Activities of the Nurses\u27 Home Committee of the Women\u27s Board Exclusive for Nurses Changes in the Maternity Division Gray Lady Musical Therapy Service Memorial Service Honoring Mrs. Bessie Dobson Altemus The Blood Donor Center The Hospital Pharmacy Medical College News Remember the Relief Fund Administrative Staff and Faculty of the School of Nursing Streptomycin Changes in the Staff at Jefferson Hospital Care of the Thoracic Surgical Patient Miscellaneous Items Marriages New Arrivals Deaths The Bulletin Committee Attention, Alumnae New Addresse

Examining the “Urban Advantage” in Maternal Health Care in Developing Countries

Andrew Channon and colleagues outline the complexities of urban advantage in maternal health where the urban poor often have worse access to health care than women in rural areas

Still too far to walk: Literature review of the determinants of delivery service use

BACKGROUND: Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. METHODS: We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. RESULTS: There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. CONCLUSION: Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality