Provision of antenatal care in Europe-A scientific study commissioned by European Board and College of Obstetrics and Gynaecology (EBCOG)

Prevalence and determinants of late first antenatal care initiation in western Ethiopia: findings from a multi-centered cross-sectional study

Background

Late initiation of antenatal care (ANC) continues to be a significant public health issue in sub-Saharan African countries, including Ethiopia. However, despite the high prevalence of late ANC initiation in Ethiopia, only a few studies have been conducted, particularly in developing regions, such as Bebishangul-Gumez. Therefore, this study aims to assess the prevalence of late initiation of the first ANC and associated factors among pregnant women in Western Ethiopia, 2023.

Methods

A facility-based cross-sectional study was conducted in Western Ethiopia from March 28, 2023 to April 30, 2023. We employed a systematic random sampling technique to select 427 participants. Data were collected using an electronic capture technique with open data kit (ODK), then, transported to XLS and exported to Stata version 17 software for analyses. Bivariate analysis was performed at significance level of p-value < 0.25 to select candidate variables for multivariable analysis. In the final model, factors with a p-value ≤ 0.05 were considered significantly associated with late initiation of ANC.

Results

A total of 414 pregnant women participated, yielding a response rate of 96.9%. The prevalence of late first ANC booking in this study was 56.8% (95% CI: 51.9, 61.5). Multivariable analysis revealed that being a housewives (AOR = 2.09, 95% CI 1.09, 4.01), having education status below secondary school (AOR = 3.5, 95% CI: 1.9, 6.1), having an unplanned pregnancy (AOR = 3.01, 95% CI 1.31, 6.90), lack of advise on when to start ANC (AOR = 1.74, 95% CI (1.09, 2.79), and attending ANC at hospital reduce the odds of late initiation of ANC (AOR = 0.41, 95% CI, 0.23, 0.72) were factors significantly associated with the late initiation of ANC.

Conclusion

The prevalence of late initiation of ANC was found to be high in the study area. Educational status below secondary school, unplanned pregnancy, lack of advice on when to start ANC, housewives and attending ANC at hospital were factors found to be significantly associated with the late initiation of ANC. Therefore, policies should be developed to increase support for female education, maintain women's empowerment initiatives through economic changes, expand family planning programs to decrease unplanned pregnancies, and increase awareness in the early initiation of ANC.

The first 1000 days: the price of inequalities in high and middle-income countries

The first 1000 days of human life start from conception until the child turns 2 years of age. This is a unique period in which the foundations of a child's lifelong health are built. Disadvantaged socioeconomic circumstances and limited access to health care services can globally affect a child's health outcomes and educational and vocational potential. This article discusses health inequalities over the first 1000 days of life and possible mitigation programs. Governments and politicians should promote fairer health interventions and pediatric healthcare workers should be aware of the main health determinants to advocate for more equitable and child-focused resource allocation. Therefore, the main approaches to contrast health inequalities include cooperation between governments and public health professionals, removing barriers to accessing medical care, and raising staff awareness about health determinants. Finally, pro-equality interventions should include providing services commensurate with the level of need, in adherence to the principle of social justice. IMPACT: This review aims to elicit a detailed understanding of how inequalities affect early childhood development in different socio-economic contexts, focusing on both the short and long-term consequences. The greatest impact comes precisely from providing valuable tools for both clinicians and public health practitioners to understand and read, in daily practice, the effects produced by health determinants and health inequalities.

Factors associated with low birth weight in low-income populations in the Western Balkans: insights from the multiple indicator cluster survey

Introduction

Low birth weight, defined as a birth weight below 2,500 g, represents a significant public health concern with a multifactorial risk dimension. Socio-demographic factors and individual characteristics of women and their social environment could influence low birth weight. This study aimed to analyze the association between the socio-demographic and reproductive characteristics of women living in low-income households and low birth weight in Serbia, Kosovo, and Montenegro.

Methods

This study was conducted as secondary data analysis during the Multiple Indicator Cluster Survey - Round 6 in Serbia, Kosovo, and Montenegro. The household questionnaire and the individual questionnaire for women aged 15-49 were used as standard research instruments. We analyzed 1,019 women whose households belonged to the first (poorest) or second (poor) wealth index quintiles and who had given birth to a live child within the 2 years preceding the study. A multivariate logistic regression was applied with low birth weight in newborns as the outcome variable.

Results

The univariate regression analysis showed that women with low birth weight newborns were significantly more likely to live in settlements mainly inhabited by Roma, reside in urban areas, marry or enter a union before age 18, have lower education levels, experience higher illiteracy rates, and receive antenatal care not provided by a medical doctor compared to women whose newborns weighed 2.5 kg or more. A multivariate logistic regression model with a low birth weight of newborns as an outcome variable showed the association between women's illiteracy (OR: 1.741; 95% CI: 1.060-2.859) and antenatal care not provided by a medical doctor (OR: 2.735; 95% CI: 1.229-6.087).

Discussion

Illiteracy and limited access to medical doctor services during pregnancy were factors that increased the likelihood of low birth weight in newborns born to women living in low-income households in the selected Western Balkans populations. The cross-sectional design of this study does not allow the establishment of causal relationships among variables, but it can provide important evidence for future prevention strategies. Interventions are needed to enhance the education of women and to improve access to antenatal care across Serbia, Kosovo, and Montenegro.

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study

BACKGROUND

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression.

METHODS

The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed.

RESULTS

Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS.

CONCLUSIONS

Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among Italian and Immigrant Pregnant Women: A Multicenter Survey

Objectives: To compare the utilization of prenatal services between immigrant and Italian women during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted at 3 maternity care centers in Italy. Results: We included 1,312 women, 1,198 (91.3%) were Italian and 114 (8.7%) were immigrants. A significantly higher proportion of Italians underwent 8 or more prenatal care visits (64.4% vs. 54.4%, p = 0.03) and more immigrants than Italians attended their appointments at hospital settings (45% vs. 18%, p < 0.001). Regarding prenatal course, Italians were more likely than immigrants to attend a non-hospital setting or an online class (49.6% and 30.2% vs. 34.9% and 11.6%, p = 0.008). A higher influenza vaccine uptake among immigrants compared with Italians was observed (39.5% vs. 19.8%, p < 0.001). Among women not receiving certain prenatal services, immigrants were more likely to state COVID-19 pandemic was the main reason for non-compliance. Conclusion: Immigrant pregnant women were more likely to receive prenatal services at a hospital setting than their Italian counterparts. Among women who did not comply with prenatal services, immigrants were more likely to cite the pandemic as their main reason.

The several faces of the medicalization of birth. Italy and its peculiarities

Background

Medical-scientific advances in maternal care gradually improved the health of mothers and new-borns. However, this has contributed to increasing levels of medicalization, defined as the overuse of medical interventions even in low-risk pregnancies and childbirths. In Italy pregnancy and birth still appear to be rather medicalized than in the rest of Europe. Moreover, the uneven distribution of these practice over the territory appears to be evident. The purpose of this article is to both highlight and explain the Italian peculiarity in terms of high medicalization of childbirth and its territorial variability.

Theoretical framework

The extensive literature on medicalization of childbirth was systematized by some scholars who use childbirth as a case study to distinguish four meanings of medicalization, by classifying them into two generations of theories. Alongside this literature several studies attempted to interpret differences in maternity model of care showing the important role played by path dependence.

Results

In the European scenario, Italy stands out for its high percentage of cesarean sections, but also for its excessive recourse to antenatal visits during pregnancy and the application of interventions during labor and vaginal births. Going into regional detail, however, Italian situation appears rather uneven: relevant differences emerge in relation to medicalization of both pregnancy and birth.

Discussion

The article explores the possibility that areas whit different sociocultural, economic, political and institutional background may have introjected different meanings of medicalization, thus reproducing different maternity models of care. In fact, the simultaneous presence, in Italy, of four different meanings of medicalization seems to be rooted. Even with some similar traits, different conditions and situations emerge in different geographical areas, leading to the prevalence of one meaning rather than another and resulting on different outcomes in terms of medicalization.

Conclusion

The data presented in this article seem to deny the existence of a national maternity model of care and. On the contrary, they confirm the idea that medicalization is not necessarily linked to the different health conditions of mothers in different geographical areas and that a path dependent variable is able to explain it.