母子健康におけるパートナーの役割

タイトル: Partner Dynamics at Maternal and New born Continuum of Care Enrollment among a Panel of Six Weeks Postpartum Women in Ethiopia, Community based Longitudinal Study; A multinomial Logistics Regression Analysis

概要: IntroductionIn this era of SDG countries relatively achieving maternal and newborn health geographic coverage are moving to a new paradigm called completion of maternal and new born care continuum (MN- CoC). Measuring the influence of significant others: partner/or husband and community engagement are considered as pivotal and one of the pillar strategies to achieve of completion of MN-CoC. Unfortunately, there is a lack of policy framework for partner and/or husband involvement in pregnancy, childbirth and postnatal care and when exists there is a gap in policy and practice in developing countries context. Articulating and endorsing such policy is likely to promote husband and/or partner encouragement and support during at the enrollment to maternal and newborn care continuum (MN-CoC). Hence, quantifying the level of MN-CoC partner dynamics on antenatal care visit and/or discussion about where to deliver the index child at and identifying its correlates among a panel of six weeks postpartum women provides evidence for the policy articulation endeavor by the Federal Health Ministry of the Federal Democratic Republic of Ethiopian and developmental partners working on reproductive and maternal and newborn health care. MethodsCommunity based nationally representative longitudinal data collected from a panel of pregnant and six weeks postpartum women were further analyzed. A total of 2,207 six weeks postpartum women who were married and/or living a partner were included in this analysis which was adequate to yield an unbiased estimates for MN-CoC partner dynamics. Multinomial logistics regression was run to identify correlates of partner Dynamics. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Statistical significance was declared at p-value of 0.05. ResultsThe proportion of partner and/or husband dynamics on MN-CoC of among six weeks postpartum women who reported that their partner and/or husband encouraged them to go to clinic for ANC and discussed with them about place of delivery for the index child was nearly 2/3 (64.67%; 62.21%, 67.04%).Besides, nearly one in 5 of them reported that their husband and/or partner did not encourage (18.2%; 16.64%, 20.33) and encouraged either of the first two MN-CoC two domains (17.08%, 15.25%, 19.10%). The region women residing, being in a polygamy marriage, contraceptive ever use history, attainment secondary/higher education and index child delivery place were found to contribute for the variation in MN-CoC partner dynamics. The finding calls up on regionally sensitive activities and efforts with public-private partnership in service provision and targeting women with polygamy which in turn empower women to control over their fertility through increasing higher education enrollment, and diversifying access to contraceptive commodities are hoped to improve MN-CoC partner dynamics thereby enabling women in completing maternal and new born care continuum. Such endeavors and interventions are hoped to facilitate the ministry and other developmental partners comprehensive efforts to address the MN-CoC partner and/or partner dynamics in terms of policy articulation, advocacy, implementation, evaluation and revising it to fit its purpose and attain the desired targets. Author Plain English SummaryO_ST_ABSPurpose of Conducting the StudyC_ST_ABSIn every community, pregnancy and childbirth are expected to be joyful and positive experiences for the mother, the newborn and as well as for the families, however, neonatal, infant and maternal mortality is unacceptably high in low and middle income countries including Ethiopia. It is experienced not as the joyful event it should be, but as a dangerous and frightening time in their lives. In order to address such considerable problem, in the SDG era the focus of policy articulation, program concentration and research undertaking in maternal and newborn health care has shown a paradigm shift of measuring the completion of maternal, newborn care continuum (MN-CoC) by streamlining resources that were invested independently on each care continuum domains. Besides, WHO recommended completion of the three main domains of the maternal and newborn care continuum as pivotal strategy to improved maternal and new born health outcomes. Accordingly, partner encouragement, support and accompany during antenatal care, childbirth and postnatal care is one of the proposed strategy for pregnant women to be enrolled, retained and complete the maternal and new born care continuum including in sought care in the extended six postpartum period in particular and the inter pregnancy period in general. This is based on the evidence pool on the influence of significant others surrounding the women, notably; the community where they are residing and their partner and/or husband on health service use is considerably high. Determining the level of partner dynamics on the MN-CoC domains and identify its correlates is critical to track the progress of the proposed strategy. Nationally representative data collected from a panel of pregnant and six weeks the six post-partum women were used. Added Value of the StudyNearly 1 in 5 panel of women by their six week postpartum reported that they did not received any encouragement on the two first domains MN-CoC during their index pregnancy. Regional variation was observed in the level of partner dynamics at maternal and newborn care continuum enrollment domains (MN- CoC) and the variation was also explained by contraceptive ever use history as well. Women in polygamy marriage were less encouraged to go to clinic for ANC and lower opportunity to discuss where to deliver the index child with their partner and/or husband. . Implication of the StudyThe Federal Democratic Republic of Ethiopian Health Ministry and developmental partners need to articulate and endorse male involvement policy with region specific integrated public private strategies which improve women autonomy to control over their fertility and women higher education enrollment with a focus on women with polygamy so as to increase partner dynamics on MN-CoC. Partner encouragement on the first two domains of is key to enroll and retain pregnant women within the MN- CoC. There is a need to strengthen postpartum family planning counseling and diversifying the provision. Similarly women in polygamy needs attention. The need for installing preconception care in the health system to be provided in and around pregnancy and child birth; particularly the inter pregnancy preconception care package.