An examination of the factors associated with male partner attendance in antenatal care in India.

BACKGROUND: A growing body of literature indicates that including male partners in antenatal care can be instrumental to improving women's health service utilization and maternal and child health outcomes. Despite this, very few studies have documented overall trends in male partner attendance and what factors influence this involvement within the Indian context. In this study, we used nationally representative data to examine levels of male partner attendance in antenatal care and the factors associated with male partner attendance. METHODS: Data were used from the National Family Health Survey (NFHS-4) conducted in 2015-16. Weighted (probability weights) descriptive statistics were conducted to summarize the level of male partner attendance in antenatal care in India, and multivariable logistic regression models were constructed to estimate the factors associated with male partner attendance in antenatal care. RESULTS: In 2015, of the women who had attended at least one antenatal care contact during their pregnancy, about 85% reported that their male partners had accompanied them to antenatal care contacts, with variations across regions. Level of education, household wealth, knowledge of pregnancy-related issues, men's age at marriage, region, and women's level of autonomy emerged as significant predictors of male partner attendance in antenatal care. CONCLUSIONS: The results of this study highlight the multiple influences that shape male partners' attendance in antenatal care. The findings underscore the need for a multi-faceted approach to programs and interventions aimed at encouraging male partner involvement; recognizing men both as individuals, as well as being situated within the family/household and community.

Impact of contraceptive coverage policies on contraceptive use and risky sexual behavior among adolescent girls in the USA.

OBJECTIVE: This study used representative data to examine the impact of changes in contraceptive coverage policies (contraceptive insurance mandates and pharmacy access to emergency contraception) on contraceptive use and risky sexual behavior among adolescent girls. STUDY DESIGN: Using 2003-17 Youth Risk Behavior Survey data on 116 180 adolescent girls from 34 states, we conducted difference-in-differences models to examine changes in contraceptive use and unprotected sexual intercourse with the implementation of contraceptive coverage policies. We also tested interactions between age and pharmacy access to emergency contraception. RESULTS: Findings indicate that contraceptive insurance mandates and pharmacy access to emergency contraception were not associated with changes in contraceptive use or unprotected sexual intercourse among adolescent girls, although some changes were observed in specific age groups. Despite this, our results show an overall increase in reported use of birth control pills and longer-acting methods from 2003 through 2017. CONCLUSIONS: Using representative data, this study lends support to existing evidence that increased access to emergency contraception does not impact contraceptive method used or unprotected sexual intercourse among adolescent girls. The results underscore the need for expanding access to a wide range of contraceptive options for adolescents, with a focus on safer and more effective longer-acting methods.

Male partners' role in maternal health service utilization: a secondary analysis using 2015-16 National Family Health Survey (NFHS) data.

OBJECTIVE: While prior research has documented several socio-demographic and policy level determinants of maternal health service utilization, the influence of partners and family on women's decisions to use maternal health services has received limited attention. This study focuses on the role of male partners in antenatal care, and examines the association between male partner attendance at antenatal care and maternal health service utilization. DESIGN: Cross-sectional observational study. SETTING: India. PARTICIPANTS: This study utilized data from the 2015-16 National Family Health Survey (NFHS-4). Of all the ever-married women who had at least one live birth in the past five years, a total number of 144,840 respondents were included for the analysis on antenatal care utilization and 146,378 respondents were included for the analysis on institutional delivery. MEASUREMENTS: The key dependent variables used for the study were timing and frequency of antenatal care, and institutional delivery; while the primary independent variable for the study was male partner attendance in antenatal care. Weighted descriptive statistics and multivariable logistic regression models were constructed to examine the association between male partner attendance in antenatal care and maternal health service utilization, controlling for participants' sociodemographic characteristics. RESULTS: Controlling for all socio-demographic variables, the results showed that women who were accompanied by a male partner during antenatal care contacts were 18% more likely to report initiating antenatal care in the first trimester (OR= 1.18, 95% CI [1.13- 1.23]), 72% more likely to report having 4 or more antenatal care contacts (OR= 1.72, 95% CI [1.64 - 1.80]), 45% more likely to report having 8 or more antenatal care contacts during their pregnancy (OR= 1.45, CI [1.35 - 1.55]) and 40% more likely to have an institutional delivery (OR= 1.40, 95% CI [1.34 - 1.48). KEY CONCLUSIONS: Few studies have examined the role of partners and family in influencing women's maternal health service utilization. The results of this study add to the growing knowledge base in the area of male partner involvement in maternal care by demonstrating that male partner attendance in antenatal care is positively associated with maternal health service utilization. IMPLICATIONS FOR PRACTICE: These results provide support for interventions that aim at a gender transformative approach to maternal health. Engaging with male partners and educating them in antenatal care could lead to improved knowledge levels among the couple, and increased support and access to maternal health services.

Factors influencing institutional delivery and the role of accredited social health activist (ASHA): a secondary analysis of India human development survey 2012.

BACKGROUND: India has focused on incentivizing institutional delivery and introducing the ASHA worker as a key strategy to improve maternal health outcomes. We examined the determinants of institutional delivery and the role of the ASHA worker in shaping choice regarding place of delivery. METHODS: We used data from the India Human Development Survey-II conducted in 2011-12, and extracted an analytic sample of women (N = 8711) who reported having at least one child since 2005. Logistic regression was used to examine influence of socio-demographic factors, frequency of antenatal care (ANC) contacts and exposure to ASHA worker on institutional delivery. RESULTS: About 15% of the respondents had eight or more ANC contacts. The odds of having an institutional delivery were higher among those respondents who had 8 or more ANC contacts (OR = 3.39, p < 0.001, 95% CI: 2.26, 5.08), and those who had 4-7 ANC contacts (OR = 1.72, p < 0.001, 95% CI: 1.48, 1.99) as compared to those with less than 4 ANC contacts. About 26% of the respondents had any exposure to an ASHA worker. After controlling for ANC contacts, these respondents had three times the odds of institutional delivery (OR = 3.04, p < 0.001, 95% CI: 2.37, 3.89) compared to those who had no exposure to ASHA workers. Further, several sociodemographic variables were associated with institutional delivery. While age of spouse, age at marriage, level of education and urban residence were positively associated with institutional delivery; age of respondent and number of children were inversely associated with institutional delivery. CONCLUSIONS: Both frequency of ANC contacts and exposure to ASHA worker independently emerge as important determinants of institutional delivery. Furthermore, ASHA workers may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and institutional delivery.