TY - JOUR
T1 - Interventions to improve enablers and/or overcome barriers to seeking care during pregnancy, birthing and postnatal period for women living with vulnerabilities in high-income countries
T2 - A systematic review and meta-analysis
AU - Bowden, Emily R.
AU - Chang, Anne B.
AU - McCallum, Gabrielle B.
N1 - Funding Information:
ABC is funded by a NHMRC practitioner fellowship (grant 1058213).
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/6
Y1 - 2023/6
N2 - Objective: To reduce maternal morbidity and mortality, World Health Organization recommendations include: commencing pregnancy care before 12-weeks’, at least eight antenatal and four postnatal visits, and attendance of skilled care at birthing. While lower adherence to the recommendation predominates in low- and middle-income countries, it also occurs in some settings in high-income countries. Globally, various strategies are used to optimise maternity care, in line with these recommendations. This systemic review aimed to determine if enhanced care improves maternal care-seeking, thus improving clinical outcomes for women and babies living with vulnerabilities, in high-income countries. Design, setting and participants: We searched the Cochrane Central Registers of Controlled Trials and Cochrane Pregnancy and Childbirth, MEDLINE, CINAHL, Proquest Dissertation and Thesis and reference lists of relevant articles. The latest search was performed June 20, 2022. Randomised controlled trials, non-randomised intervention trials and cohort studies comparing effects of interventions designed to increase utilisation of maternal health services with routine care, for women at increased risk of maternal mortality and severe maternal morbidity in high-income countries were included. Two authors selected, extracted, assessed and analysed data. Additional information was sought from study authors. This systematic review and meta-analysis was registered with PROSPERO(CRD42021256811). Findings: Nine studies with 5,729 participants were included. Interventions to enhance care significantly increased utilisation of health services, increasing attendance at antenatal classes (Odds Ratio[OR]=15·23, 95%Confidence Interval[CI] 10·73–21·61, p<0·0001) and postnatal visits by 6–8 weeks (OR=2·66, 95%CI 1·94–3·64, p<0·0001), compared to routine care. Infants in the intervention groups were significantly less likely to be: born preterm (OR=0·68, 95%CI 0·56–0·82, p<0·0001); low birthweight (OR=0·78, 95%CI 0·64–0·95, p = 0·01) or; require neonatal intensive care (OR=0·80, 95%CI 0·66–0·96, p = 0·02). Conclusions and Implications for practice: Among women living with vulnerabilities in high-income countries, interventions to enhance care increases utilisation of maternal health services and improves outcomes.
AB - Objective: To reduce maternal morbidity and mortality, World Health Organization recommendations include: commencing pregnancy care before 12-weeks’, at least eight antenatal and four postnatal visits, and attendance of skilled care at birthing. While lower adherence to the recommendation predominates in low- and middle-income countries, it also occurs in some settings in high-income countries. Globally, various strategies are used to optimise maternity care, in line with these recommendations. This systemic review aimed to determine if enhanced care improves maternal care-seeking, thus improving clinical outcomes for women and babies living with vulnerabilities, in high-income countries. Design, setting and participants: We searched the Cochrane Central Registers of Controlled Trials and Cochrane Pregnancy and Childbirth, MEDLINE, CINAHL, Proquest Dissertation and Thesis and reference lists of relevant articles. The latest search was performed June 20, 2022. Randomised controlled trials, non-randomised intervention trials and cohort studies comparing effects of interventions designed to increase utilisation of maternal health services with routine care, for women at increased risk of maternal mortality and severe maternal morbidity in high-income countries were included. Two authors selected, extracted, assessed and analysed data. Additional information was sought from study authors. This systematic review and meta-analysis was registered with PROSPERO(CRD42021256811). Findings: Nine studies with 5,729 participants were included. Interventions to enhance care significantly increased utilisation of health services, increasing attendance at antenatal classes (Odds Ratio[OR]=15·23, 95%Confidence Interval[CI] 10·73–21·61, p<0·0001) and postnatal visits by 6–8 weeks (OR=2·66, 95%CI 1·94–3·64, p<0·0001), compared to routine care. Infants in the intervention groups were significantly less likely to be: born preterm (OR=0·68, 95%CI 0·56–0·82, p<0·0001); low birthweight (OR=0·78, 95%CI 0·64–0·95, p = 0·01) or; require neonatal intensive care (OR=0·80, 95%CI 0·66–0·96, p = 0·02). Conclusions and Implications for practice: Among women living with vulnerabilities in high-income countries, interventions to enhance care increases utilisation of maternal health services and improves outcomes.
KW - High-income countries
KW - Maternal health services
KW - Pregnancy
KW - Utilisation
KW - Vulnerable women
UR - http://www.scopus.com/inward/record.url?scp=85151837890&partnerID=8YFLogxK
U2 - 10.1016/j.midw.2023.103674
DO - 10.1016/j.midw.2023.103674
M3 - Review article
AN - SCOPUS:85151837890
SN - 0266-6138
VL - 121
SP - 1
EP - 10
JO - Midwifery
JF - Midwifery
M1 - 103674
ER -