Cybermedlife - Therapeutic Actions Home Birth

Reinscribing the birthing body: homebirth as ritual performance.

Abstract Title: Reinscribing the birthing body: homebirth as ritual performance. Abstract Source: Med Anthropol Q. 2011 Dec ;25(4):519-42. PMID: 22338293 Abstract Author(s): Melissa Cheyney Article Affiliation: Department of Anthropology, Oregon State University, USA. Abstract: In this article, I examine the clinical practices engaged in by U.S. homebirth midwives and their clients from the beginning of pregnancy through to the immediate postpartum period, deconstructing them for their symbolic and ritual content. Using data collected from open-ended, semistructured interviews and intensive participant-observation, I describe the roles ritual plays in the construction, performance, and maintenance of birth at home as a transgressive rite of passage. As midwives ritually elaborate approaches to care to capitalize on their semiotic power to transmit a set of counterhegemonic values to participants, they are attempting, quite self-consciously, to peel away the fictions of medicalized birthing care. Their goal: to expose strong and capable women who"grow"and birth babies outside the regulatory and self-regulatory processes naturalized by modern, technocratic obstetrics. Homebirth practices are, thus, not simply evidence-based care strategies. They are intentionally manipulated rituals of technocratic subversion designed to reinscribe pregnant bodies and to reterritorialize childbirth spaces (home) and authorities (midwives and mothers). Article Published Date : Dec 01, 2011

Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy.

Abstract Title: Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. Abstract Source: J Allergy Clin Immunol. 2011 Nov ;128(5):948-55.e1-3. Epub 2011 Aug 27. PMID: 21872915 Abstract Author(s): Frederika A van Nimwegen, John Penders, Ellen E Stobberingh, Dirkje S Postma, Gerard H Koppelman, Marjan Kerkhof, Naomi E Reijmerink, Edward Dompeling, Piet A van den Brandt, Isabel Ferreira, Monique Mommers, Carel Thijs Article Affiliation: Frederika A van Nimwegen Abstract: BACKGROUND: Both gastrointestinal microbiota composition and cesarean section have been linked to atopic manifestations. However, results are inconsistent, and the hypothesized intermediate role of the microbiota in the association between birth mode and atopic manifestations has not been studied yet. OBJECTIVES: We sought to investigate the relationship between microbiota composition, mode and place of delivery, and atopic manifestations. METHODS: The Child, Parent and Health: Lifestyle and Genetic Constitution Birth Cohort Study included data on birth characteristics, lifestyle factors, and atopic manifestations collected through repeated questionnaires from birth until age 7 years. Fecal samples were collected at age 1 month (n = 1176) to determine microbiota composition, and blood samples were collected at ages 1 (n = 921), 2 (n = 822), and 6 to 7 (n = 384) years to determine specific IgE levels. RESULTS: Colonization by Clostridium difficile at age 1 month was associated with wheeze and eczema throughout the first 6 to 7 years of life and with asthma at age 6 to 7 years. Vaginal home delivery compared with vaginal hospital delivery was associated with a decreased risk of eczema, sensitization to food allergens, and asthma. After stratification for parental history of atopy, the decreased risk of sensitization to food allergens (adjusted odds ratio, 0.52; 95% CI, 0.35-0.77) and asthma (adjusted odds ratio, 0.47; 95% CI, 0.29-0.77) among vaginally home-born infants was only found for children with atopic parents. Mediation analysis showed that the effects of mode and place of delivery on atopic outcomes were mediated by C difficile colonization. CONCLUSION: Mode and place of delivery affect the gastrointestinal microbiota composition, which subsequently influences the risk of atopic manifestations. Article Published Date : Oct 31, 2011

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. 📎

Abstract Title: Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. Abstract Source: BMJ. 2011 ;343:d7400. Epub 2011 Nov 23. PMID: 22117057 Abstract Author(s):   Abstract: OBJECTIVE: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. DESIGN: Prospective cohort study. SETTING: England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. PARTICIPANTS: 64,538 eligible women with a singleton, term (≥37 weeks gestation), and"booked"pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. MAIN OUTCOME MEASURE: A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). RESULTS: There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). CONCLUSIONS: The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes. Article Published Date : Dec 31, 2010

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. 📎

Abstract Title: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Abstract Source: CMAJ. 2009 Sep 15;181(6-7):377-83. Epub 2009 Aug 31. PMID: 19720688 Abstract Author(s): Patricia A Janssen, Lee Saxell, Lesley A Page, Michael C Klein, Robert M Liston, Shoo K Lee Article Affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. METHODS: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. RESULTS: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21-0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09-1.85). INTERPRETATION: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician. Article Published Date : Sep 15, 2009

Homebirth as systems-challenging praxis: knowledge, power, and intimacy in the birthplace. 📎

Abstract Title: Homebirth as systems-challenging praxis: knowledge, power, and intimacy in the birthplace. Abstract Source: Qual Health Res. 2008 Feb ;18(2):254-67. PMID: 18216344 Abstract Author(s): Melissa J Cheyney Article Affiliation: Department of Anthropology, Oregon State University, Corvallis, Oregon 97331, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: In this article, I examine the processes and motivations involved when women in the United States choose to circumvent the dominant obstetric care paradigm by delivering at home with a group of care providers called direct-entry midwives. Using grounded theory, participant observation, and open-ended, semistructured interviewing, I collected and analyzed homebirth narratives from a theoretical sample of women (n = 50) in two research locales. Findings interpreted from the perspective of critical medical anthropology suggest that women who choose to birth at home negotiate fears associated with the"just in case something bad happens"argument that forms the foundation for hospital birth rationales through complex individual and social processes. These involve challenging established forms of authoritative knowledge, valuing alternative and more embodied or intuitive ways of knowing, and knowledge sharing through the informed consent process. Adherence to subjugated discourses combined with lived experiences of personal power and the cultivation of intimacy in the birthplace fuel homebirth not only as a minority social movement, but also as a form of systems-challenging praxis. Article Published Date : Feb 01, 2008

Episiotomy, hospital birth and cesarean section: technology gone haywire--what is the sutured tear rate at first births supposed to be?

Abstract Title: Episiotomy, hospital birth and cesarean section: technology gone haywire--what is the sutured tear rate at first births supposed to be? Abstract Source: Midwifery Today Int Midwife. 2008(85):24-5. PMID: 18429515 Abstract Author(s): Judy Slome Cohain Article Affiliation: This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: One hundred percent of woman having a first vaginal birth from 1940-1990 had an episiotomy. It is still used for first births at a rate of 50-60% in many places. Perineal outcomes on first births are critical because the biggest risk factor for needing suturing on subsequent births is a previous episiotomy. No scientific evidence has demonstrated improved outcomes with episiotomy. This paper documents a rate of 99% intact perineums, 1% sutured perineums, in a group of 80 primipara in their early 20s at attended homebirths, average birth weight 3150 gm. Primipara women in their late-20s with 3400 gm babies experienced a 28% sutured tear rate at planned home-births. This suggests that homebirth with a motivated attendant, young age and birth weight of 3150 gm can almost always deliver vaginally without perineal damage. Episiotomy, hospital birth for healthy pregnancies and elective cesarean surgery are commonly practiced, dangerous, out-of-date medical routines unsupported by research. Article Published Date : Jan 01, 2008

Outcomes of planned home births with certified professional midwives: large prospective study in North America. 📎

Abstract Title: Outcomes of planned home births with certified professional midwives: large prospective study in North America. Abstract Source: BMJ. 2005 Jun 18;330(7505):1416. PMID: 15961814 Abstract Author(s): Kenneth C Johnson, Betty-Anne Daviss Article Affiliation: Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9. This email address is being protected from spambots. You need JavaScript enabled to view it.<This email address is being protected from spambots. You need JavaScript enabled to view it.></This email address is being protected from spambots. You need JavaScript enabled to view it.> Abstract: OBJECTIVE: To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. DESIGN: Prospective cohort study. SETTING: All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. PARTICIPANTS: All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. MAIN OUTCOME MEASURES: Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. RESULTS: 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. CONCLUSIONS: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. Article Published Date : Jun 18, 2005

Home-like versus conventional institutional settings for birth.

Abstract Title: Home-like versus conventional institutional settings for birth. Abstract Source: Cochrane Database Syst Rev. 2005(1):CD000012. Epub 2005 Jan 25. PMID: 15674867 Abstract Author(s): E D Hodnett, S Downe, N Edwards, D Walsh Article Affiliation: Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ontario, Canada, M5S 3H4. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Home-like birth settings have been established in or near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth. OBJECTIVES: Primary: to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward. Secondary: to determine if the effects of birth settings are influenced by staffing or organizational models or geographical location of the birth centre. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (18 May 2004) and handsearched eight journals and two published conference proceedings. SELECTION CRITERIA: All randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional birth environment to conventional hospital care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals. MAIN RESULTS: Six trials involving 8677 women were included. No trials of freestanding birth centres were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting significantly increased the likelihood of: no intrapartum analgesia/anaesthesia (four trials; n = 6703; relative risk (RR) 1.19, 95% confidence interval (CI) 1.01 to 1.40), spontaneous vaginal birth (five trials; n = 8529; RR 1.03, 95% CI 1.01 to 1.06), vaginal/perineal tears (four trials; n = 8415; RR 1.08, 95% CI 1.03 to 1.13), preference for the same setting the next time (one trial; n = 1230; RR 1.81, 95% CI 1.65 to 1.98), satisfaction with intrapartum care (one trial; n = 2844; RR 1.14, 95% CI 1.07 to 1.21), and breastfeeding initiation (two trials; n = 1431; RR 1.05, 95% CI 1.02 to 1.09) and continuation to six to eight weeks (two trials; n = 1431; RR 1.06, 95% CI 1.02 to 1.10). Allocation to a home-like setting decreased the likelihood of episiotomy (five trials; n = 8529; RR 0.85, 95% CI 0.74 to 0.99). There was a trend towards higher perinatal mortality in the home-like setting (five trials; n = 8529; RR 1.83, 95% CI 0.99 to 3.38). No firm conclusions could be drawn regarding the effects of staffing or organizational models. AUTHORS' CONCLUSIONS: When compared to conventional institutional settings, home-like settings for childbirth are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. Caregivers and clients should be vigilant for signs of complications. Article Published Date : Jan 01, 2005

Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. 📎

Abstract Title: Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. Abstract Source: CMAJ. 2002 Feb 5;166(3):315-23. PMID: 11868639 Abstract Author(s): Patricia A Janssen, Shoo K Lee, Elizabeth M Ryan, Duncan J Etches, Duncan F Farquharson, Donlim Peacock, Michael C Klein Article Affiliation: Centre for Community Health and Health Evaluation Research, BC Research Institute for Children's and Women's Health, Vancouver. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: The choice to give birth at home with a regulated midwife in attendance became available to expectant women in British Columbia in 1998. The purpose of this study was to evaluate the safety of home birth by comparing perinatal outcomes for planned home births attended by regulated midwives with those for planned hospital births. METHODS: We compared the outcomes of 862 planned home births attended by midwives with those of planned hospital births attended by either midwives (n = 571) or physicians (n = 743). Comparison subjects who were similar in their obstetric risk status were selected from hospitals in which the midwives who were conducting the home births had hospital privileges. Our study population included all home births that occurred between Jan. 1, 1998, and Dec. 31, 1999. RESULTS: Women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician. After adjustment for maternal age, lone parent status, income quintile, use of any versus no substances and parity, women in the home birth group were less likely to have epidural analgesia (odds ratio 0.20, 95% confidence interval [CI] 0.14-0.27), be induced, have their labours augmented with oxytocin or prostaglandins, or have an episiotomy. Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences. The adjusted odds ratio for cesarean section in the home birth group compared with physician-attended hospital births was 0.3 (95% CI 0.22-0.43). Rates of perinatal mortality, 5-minute Apgar scores, meconium aspiration syndrome or need for transfer to a different hospital for specialized newborn care were very similar for the home birth group and for births in hospital attended by a physician. The adjusted odds ratio for Apgar scores lower than 7 at 5 minutes in the home birth group compared with physician-attended hospital births was 0.84 (95% CI 0.32-2.19). INTERPRETATION: There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife. The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted. Article Published Date : Feb 05, 2002

Home birth in New Zealand 1973-93: incidence and mortality.

Abstract Title: Home birth in New Zealand 1973-93: incidence and mortality. Abstract Source: N Z Med J. 1997 Mar 28 ;110(1040):87-9. PMID: 9137308 Abstract Author(s): G Gulbransen, J Hilton, L McKay, A Cox Article Affiliation: Auckland Home Birth Association. Abstract: AIMS: To determine for the period 1973-93, national and regional (1991 and 1992 only) incidence of home birth in New Zealand, with home birth defined as home being the intended place of birth at the onset of labour, to calculate perinatal and maternal mortality rates for home birth, and to categorise the cause of perinatal death. METHODS: Data sheets for 9776 planned home births were analysed. These had been collected by the Home Birth Associations of New Zealand/Aotearoa. National perinatal data and data from National Women's Hospital, Auckland were used for comparison. Trend analysis was performed by Poisson regression allowing for overdispersion. RESULTS: Planned home birth made up 2% of the total births in 1993, up from 0.04% in 1973. The home birth perinatal mortality rate for this period was 2.97 per 1000 total births, with no change over time. This was not significantly different from the rate for a selected low risk group at National Women's Hospital. Lethal anomalies caused 31% of the perinatal deaths. There was one maternal death (maternal mortality rate: 1.02 per 10,000 total births). There were significant differences in the rate of home birth in separate area health board regions for 1991 and 1992. CONCLUSION: Home birth was a safe and increasingly popular: though minor, option for New Zealand women from 1973-93. Article Published Date : Mar 27, 1997

Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study.

Abstract Title: Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. Abstract Source: J Nurse Midwifery. 1995 Nov-Dec;40(6):483-92. PMID: 8568573 Abstract Author(s): R E Anderson, P A Murphy Abstract: This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNMs) from 1987 to 1991. A retrospective survey was used to obtain information about the outcomes of intended home birth, including hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery home birth practices). It is estimated that 60-70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000, including known third-trimester fetal demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality rate for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartum transfer rate for those intending home birth at the onset of labor was 8%. Most responding nurse-midwives used standard risk-assessment criteria, only delivered low-risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women. Article Published Date : Oct 31, 1995
Therapeutic Actions Home Birth

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Metabolic Syndrome in Very Low Birth Weight Young Adults and Controls: The New Zealand 1986 VLBW Study.

Related Articles Metabolic Syndrome in Very Low Birth Weight Young Adults and Controls: The New Zealand 1986 VLBW Study. J Pediatr. 2018 Dec 10;: Authors: Darlow BA, Martin J, Horwood LJ Abstract OBJECTIVE: To assess the physical well-being and components of the metabolic syndrome in a national cohort of very low birth weight (VLBW) young adults and same age controls. STUDY DESIGN: The New Zealand VLBW Study cohort prospectively included all infants with birth weight <1500 g born in 1986, with 338 (82%) surviving to discharge home. Height and weight were measured at age 7-8 years. The VLBW cohort (n = 229; 71% alive) and term-born controls (n = 100) aged 27-29 years were clinically assessed in a single center over 2 days, including assessment for components of the metabolic syndrome. RESULTS: Compared with controls, both male and female VLBW adults were significantly shorter (P < .001), but only females were lighter (P < .001) and had lower mean body mass index (P = .044), fat mass, and body fat percentage. Males, but not females, had significantly higher systolic blood pressure (P = .028), but there were no significant differences in other components of the metabolic syndrome. There was no difference in the prevalence of the metabolic syndrome in VLBW adults compared with controls (males, 22.2% vs 11.1%; P = .15: females, 12.8% vs 13.1%; P = .95). Examining the VLBW cohort with logistic regression, male sex, gestational age <28 weeks, Māori/Pacific Island ethnicity, and body mass index >90th percentile at age 7-8 years were significant predictors for the metabolic syndrome at age 27-29 years, with ORs of 2-4. CONCLUSIONS: Systolic blood pressure in males was the only component of the metabolic syndrome that was significantly elevated in VLBW adults compared with controls. Extreme prematurity (<28 weeks) and body mass index >90th percentile at age 7-8 years were significant predictors of the metabolic syndrome at age 27-29 years. TRIAL REGISTRATION: Registered at the Australian Clinical Trials Registry: ACTRN12612000995875. PMID: 30545563 [PubMed - as supplied by publisher]

Examining trends in inequality in the use of reproductive health care services in Ghana and Nigeria.

Related Articles Examining trends in inequality in the use of reproductive health care services in Ghana and Nigeria. BMC Pregnancy Childbirth. 2018 Dec 13;18(1):492 Authors: Ogundele OJ, Pavlova M, Groot W Abstract BACKGROUND: Equitable use of reproductive health care services is of critical importance since it may affect women's and children's health. Policies to reduce inequality in access to reproductive health care services are often general and frequently benefit the richer population. This is known as the inverse equity situation. We analyzed the magnitude and trends in wealth-related inequalities in the use of family planning, antenatal and delivery care services in Ghana and Nigeria. We also investigate horizontal inequalities in the determinants of reproductive health care service use over the years. METHODS: We use data from Ghana's (2003, 2008 and 2014) and Nigeria's (2003, 2008 and 2013) Demographic and Health Surveys. We use concentration curves and concentration indices to measure the magnitude of socioeconomic-related inequalities and horizontal inequality in the use of reproductive health care services. RESULTS: Exposure to family planning information via mass media, antenatal care at private facilities are more often used by women in wealthier households. Health worker's assistance during pregnancy outside a facility, antenatal care at government facilities, childbirth at home are more prevalent among women in poor households in both Ghana and Nigeria. Caesarean section is unequally spread to the disadvantage of women in poorer households in Ghana and Nigeria. In Nigeria, women in wealthier households have considerably more unmet needs for family planning than in Ghana. Country inequality was persistent over time and women in poorer households in Nigeria experienced changes that are more inequitable over the years. CONCLUSION: We observe horizontal inequalities among women who use reproductive health care. These inequalities did not reduce substantially over the years. The gains made in reducing inequality in use of reproductive health care services are short-lived and erode over time, usually before the poorest population group can benefit. To reduce inequality in reproductive health care use, interventions should not only be pro-poor oriented, but they should also be sustainable and user-centered. PMID: 30545328 [PubMed - in process]
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