The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern. / Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.

Thesis (M.S.)--University of Missouri-Columbia, 2003. / Typescript. Includes bibliographical references (leaves 73-87). Also available on the Internet.

Thesis (M.S.)--University of Missouri-Columbia, 2003. / Typescript. Includes bibliographical references (leaves 73-87). Also available on the Internet.

Thesis (M.S.C.E.) / OBJECTIVES: Half of all U. S. pregnancies are unintended, and of these, about 6 out of 10 are carried to term. These are known as “unintended births,” and they are at elevated risk for adverse social, economic and health outcomes. The goal of this study was to examine, using the latest data from the National Survey of Family Growth (2006-2010), whether women with unintended births were more likely than their counterparts to use effective postpartum contraception. METHODS: In this retrospective cohort study of U.S. women ages 15-44, all births within three years of the study interview were classified as intended or unintended, and the method and timing of postpartum contraception were ascertained. Our primary outcome was time to initiation of a highly effective postpartum contraceptive method during the first postpartum year. Highly effective contraception was defined as a method with less than one pregnancy per 100 woman-years of typical use. Secondary outcomes included time to initiation of any contraceptive use over the first postpartum year, and postpartum contraceptive non-use. RESULTS: Complete data was available for 2,691 births. Young, black, undereducated, unmarried, and poor women, as well as those who paid for their delivery with Medicaid were more likely than their counterparts to have unintended births (p<0.0001). After adjustment for confounders, women with unintended births were 1.4 (95% CI: 1.2-1.6) times as likely to use highly effective postpartum contraception compared to women with intended births. During the first month postpartum, women with unintended pregnancies were 0.8 times as likely to use no contraceptive method as women with intended births (95% CI 0.7-0.9, p=0.0046); there were no differences between groups for the rest of the first postpartum year. Married women, white women, women with college degrees, and women with who were giving birth for the first time were somewhat more likely than others to initiate effective contraception after an unwanted pregnancy. CONCLUSION: A relatively small difference in time to initiation of highly effective postpartum contraception, along with an almost 1 in 5 prevalence of postpartum contraceptive nonuse for the entire first postpartum year, indicates that women in this study sample are not well-prepared to prevent recurrence of unintended birth. These results add to the body of data supporting effective postpartum contraception as a public health priority.

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Unintended pregnancy (UP) is increasing among Latinos in the United States. Unintended pregnancy contributes to many negative consequences for infants, mothers and families. Concurrently, various factors affect Latino couples’ sexual relationship power, communication and decision making about family planning, including sexual relationship power, relationship commitment, dyadic adjustment, individual background, and cultural characteristics. Previous research has not focused on understanding the factors that affect Latino couples’ sexual relationship power, communication and sexual decision making from each partner’s perspective. The purpose of this study was to examine the association between sexual relationship power, communication, and sexual decision making from each partner’s perspective in relationship to family planning. In a cross-sectional design, recruited were a convenience sample of 40 Latino couples whose female partners in their second/third trimester from prenatal care clinics. Almost half of the participants were Mexican (males: 48%; females: 43%). The mean ages were 28 years (males, SD:5.67) and 26.5 years old (females, SD 4.81). Sample characteristics and partner responses were compared and contrasted. Machismo, perceived relationship commitment, relationship satisfaction and perceived decision making significantly contributed to the variance in sexual relationship power among women (F(8,26) = 6.776, p < 0.001). Increasing sexual relationship power through Latina empowerment and mutual decision making has the potential to build sustainable relationships. Relationship commitment, relationship satisfactions as well as cultural values (machismo and marianismo) were also the significant predictors for most of the study key variables. Decision making conversations among couples should optimally begin before the initiation of sexual activity and continue throughout the couples’ active sexual relationship. Couples communication facilitates making known each other’s will and thoughts and helps to promote healthy reproductive and sexual lives. Findings will contribute to developing targeted interventions to decrease UP while increasing quality of life for Latino families.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2008. / LICL has E-Thesis 0043 ; please contact computer services.

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