maternal health dissertation topics

• Research article
• Open access
• Published: 05 February 2015

A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda

• Primus Che Chi 1 , 2 ,
• Patience Bulage 3 ,
• Henrik Urdal 1 &
• Johanne Sundby 2  

BMC Pregnancy and Childbirth volume  15 , Article number:  18 ( 2015 ) Cite this article

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Armed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women’s uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict.

This is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women’s utilisation of a range of MSRHS vis-à-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data.

A complex and inter-related set of factors affect women’s utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women’s utilisation of these services mainly through impeding women’s health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women’s fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers.

Conclusions

Improving women’s uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.

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Although the 2013 UN Millennium Development Goals (MDGs) progress report shows that many regions of the world have made progress on the fifth goal of improving maternal health, the region of sub-Saharan Africa (SSA) is still lagging behind, and will not be able to meet the agreed targets of ‘reducing by three quarters, between 1990 and 2015, the maternal mortality ratio’ and ‘achieving, by 2015, universal access to reproductive health’ [ 1 ]. Within SSA, countries in or emerging from armed conflicts are among the hardest hit. The deteriorating impact of armed conflict on maternal health is well acknowledged, and tends to linger even after the end of the conflict [ 2 - 4 ]. Armed conflicts are associated with higher total fertility and maternal mortality rates [ 5 ]. A 2010 review [ 6 ] of maternal mortality in 181 countries spanning 1980–2008 revealed that in 2008, 50% of all maternal deaths occurred in only six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo); all of which have experienced recent armed conflict. For over a decade, the 10 countries ranked lowest on the Save the Children’s ‘State of the World’s Mothers Index’ have been conflict and post-conflict states [ 7 ]. Similarly, the 10 countries ranked lowest in the UN Human Development Index for the last decade are either in conflict or emerging from conflict. In this regard, armed conflict has been described as an important contributor to the social determinants of health [ 8 - 10 ] and a driver of health inequity [ 11 ]. Armed conflicts tend to limit access to maternal, sexual and reproductive health services (MSRHS) due to high levels of insecurity and high opportunity costs of accessing such services.

The uptake of MSRHS is closely associated with improvements in maternal health. For instance, quality antenatal care (ANC) should optimally reduce the risk of poor pregnancy outcomes, and a caesarean section can be obtained only when a woman seeks care at a health facility. To enhance women’s utilisation of these health services in post-conflict societies, an important step will be to explore the factors that may hinder and facilitate their uptake of services in these contexts. While much work has been done on the determinants of maternal health utilisation [ 12 - 16 ] including demographic, socio-economic, cultural, and health related factors, a general conclusion appears to be that the importance and impact of the factors varies from one setting to another. With health systems in conflict and post-conflict countries faced with challenges such as damaged infrastructure, limited human resources, weak stewardship and a proliferation of non-governmental organisations without proper coordination, this results in the delivery of disrupted and fragmented health services [ 17 ]. Hence, the utilisation of MSRHS is likely to be affected.

Burundi and Uganda are among the countries in Sub-Saharan Africa that are not poised to meet the fifth MDG goal of improving maternal health. They have both experienced brutal civil wars that claimed tens of thousands [ 18 ] of lives and displaced millions of people. Burundi experienced an ethnic conflict from 1993–2005 that led to the displacement of approximately 1.2 million people [ 19 ]. Although the country has been experiencing some gradual improvements in general population health, the population life expectancy stands at 53.9 years, with one of the highest maternal mortality ratios (800 deaths per 100,000 live births) and total fertility rates (6.1) in the world (UN World Fertility Patterns 2013; UN MDG indicator monitoring database). The Northern region of Uganda is recovering from over 20 years of armed conflict between the Lord’s Resistance Army and the Ugandan Government that resulted in the disruption of health services, massive population displacement and erosion of traditional and family structures [ 20 ]. The number of people displaced by the conflict was estimated at 2 million [ 17 , 20 ]. With a total fertility rate of 6.3, the Northern region ranks the highest in the country, with a median age at first birth of 17.8 years [ 21 ]. Uganda has a life expectancy of 59 years and maternal mortality ratio of 310 per 100,000 live births (UN World Fertility Patterns 2013; UN MDG indicator monitoring database), and the corresponding data for the Northern region might be worse.

The health system in Burundi is organized as a pyramid structure with three levels, comprising the central, intermediate and peripheral levels. The central level involves the Office of the Minister with its associated directorates, departments, programmes and related services, and it is responsible for formulating sector policy, strategic planning, coordination, mobilization and allocation of resources and oversight-evaluation. The intermediate level is comprised of 17 provincial health bureaus, in charge of coordinating all health activities of the province, supporting the health districts and ensuring proper collaboration between sectors. The peripheral level is responsible for the delivery of healthcare, and as of 2010 it was comprised of 45 health districts, including 63 hospitals and 735 health centres (423 public, 105 approved religious facilities and 207 private facilities) distributed throughout the 129 cities in the country [ 22 ]. All health centres are expected to offer a minimum package of services, including treatment and prevention consultation services, laboratory, pharmacy, health promotion and health education services, as well as in-patient observation. However, a recent survey found that 45% of health centres were unable to provide the complete recommended minimum package due to lack of personnel, infrastructure, equipment or medication [ 22 ]. For example, the survey reported that the physician-to-resident, and midwife-to-woman of child bearing age ratios are 1 per 19,231 (WHO recommended ratio is 1 per 10,000) and 1 per 123,312 (WHO recommended ratio is 1 per 5,000), respectively. Furthermore, a 2010 national survey of emergency obstetric and neonatal care (EmONC) facilities found that only five health centres were offering the recommended basic EmONC services, while 17 hospitals could provide comprehensive EmONC services – with the latter having a poor geographical distribution nationally [ 22 ]. These are recurrent challenges that appear to be happening against the backdrop of low government expenditure on health, as shown in Table  1 . The current health situation in Burundi is described as precarious, with a fragile health system characterized by a high burden of communicable and non-communicable diseases, particularly affecting pregnant women and children [ 23 ]. According to the 2009 statistics, the diseases that were the primary causes of morbidity and mortality were malaria, acute respiratory infections, diarrheic diseases, malnutrition, HIV/AIDS and tuberculosis [ 22 ]. Following the end of the armed conflict in 2007, Burundi has been gradually restructuring the health system, with the introduction of the district health system to implement primary health care, coupled with the implementation of a performance-based financing (PBF) programme [ 24 ]. Furthermore, the government has introduced a free health care policy for pregnant women and children under 5, and a health insurance scheme for the informal sector. With these reforms in place, it is estimated that about 50% of the population (mainly pregnant women and under-fives) have universal access to health care [ 23 ]. The reforms have equally led to an increase in the use of health services, better quality of treatment, and a greater number of health personnel in rural areas [ 23 ].

Uganda equally operates on the district health system model, with the decentralization of health service delivery to the health district and health sub-district levels. The delivery of healthcare is done by both public and private actors, with the government owning 2,242 health centres and 59 hospitals, compared to 613 health facilities and 46 hospitals run by private not-for-profit actors (PNFP), and 269 health centres and 8 hospitals run by private health practitioners as of 2010 [ 25 ]. A major proportion of the PNFP providers are faith-based religious organizations, including the Uganda Catholic, Protestant, Orthodox and Muslim Medical Bureaus. A minimum package of health services is provided at all levels of health care in both the public and private sectors. Since 2001, user fees have been abolished in all public health facilities, but utilisation of health services has been hampered by poor infrastructure, lack of medicines and other health supplies, shortage of health workers, and low salaries [ 25 ]. Furthermore, concerns around long waiting times, unofficial fees in public facilities, and poor attitudes among health workers have also limited the utilisation of health services [ 26 ]. The disease burden in the country is dominated by communicable diseases, with maternal and perinatal health conditions contributing to the high mortality [ 27 ]. While Uganda is experiencing a shortage of health workers (as highlighted in Table  1 ), following a recent government recruitment exercise, overall staffing levels at higher level health centres such as Health Centres IV and III has improved from 57% in 2012 to approximately 70% in 2013 [ 27 ].

Some key reproductive health indicators in Burundi and Uganda are displayed in Figure  1 . While ANC coverage for at least one visit in both countries is quite satisfactory, the other health indicators such as contraceptive uptake, unmet need for family planning and ANC coverage for at least four visits are disappointing and require some improvement.

Reproductive health outlook for Burundi and Uganda. Source of data: UN MDG indicators monitoring database ( http://mdgs.un.org/unsd/mdg/data.aspx ). SBA: Skilled birth attendance; CPR: Current contraceptive use among married women 15–49 years old, any method; ANC 1: Antenatal care coverage, at least one visit; ANC 4: Antenatal care coverage, at least four visits; FP: Family planning.

This study aims to explore the determinants of women’s utilisation of MSRHS in the post-conflict settings of Northern Uganda and Burundi and how exposure to armed conflict may affect these factors. Our main research question was ‘ what are the factors that encourage and discourage women’s uptake of maternal and reproductive health services and how does exposure to armed conflict affect these factors? ’ Through this study, we seek to contribute to the broader literature on determinants of maternal health and health-seeking behaviour in conflict and post-conflict settings.

Study settings

The study was undertaken in two provinces in Burundi (Bujumbura Marie and Ngozi) and a district in Northern Uganda (Gulu). In Burundi, participants were recruited from the cities of Bujumbura and Ngozi and the rural and semi-urban communes of Ruhororo in Ngozi Province and Kinama in Bujumbura Mairie province respectively. In Gulu district, the participants were recruited from the rural sub-counties of Koro, Bobi and Bungatira, and the municipality of Gulu, which comprises of four sub-counties. Maps of the study areas are found in Additional file 1 .

Data collection method

This is a qualitative study based on in-depth interviews (IDIs) and focus group discussions (FGDs). Interviews and FGDs were conducted in the local languages (Kirundi in Burundi and Luo in Northern Uganda), French or English (where applicable). All English interviews and FGDs were carried out by the principal investigator (PCC), while those in the local languages and French were conducted by trained local research assistants. The fieldwork took place from June until September 2013.

Study participants

Study participants were recruited from staff members of local and international NGOs and local health providers (LHPs) working in the domain of maternal, sexual, and reproductive health (MSRH). The second group of participants consists of women of reproductive age, living in rural and semi-urban areas. Since we are interested in also capturing the effect the conflict had on MSRHS, NGOs and health providers invited to participate in the study had developed, supported and/or provided MSRHS during the conflict or shortly after the conflict. Similarly, the women we invited to participate in the study had sought or attempted to seek for such services as well during such periods.

Issues discussed

The interviews and FGDs focused specifically on the general state of MSRH in Burundi and Northern Uganda, aimed at describing the general state of maternal health and understanding the factors affecting women’s utilisation of basic MSRHS, taking into consideration the possible effects of the recent conflict. The detailed guides for the interviews and FGDs for each of the participant categories can be found in Additional file 2 . A sample of some of the questions posed to participants during the interviews and FGDs include:

What factors do you think affects women’s utilisation of health services during pregnancy and childbirth? (explore possible factors such as quality of care/treatment provided by health provider, costs for services, travel distance, lack of knowledge on when to seek care etc).

Have these factors changed over time? (probe to inquire how?).

Do you have any ideas how the past conflict might have affected this? (probe to inquire how was the use before and after etc).

Ethical considerations

Ethics approval for the study was obtained from the Regional Committee for Medical and Health Research Ethics, South-East (Norway); le Comité National d’Ethique pour la Protection des êtres Humains Participant à la Recherche Biomédicale et Comportementale (Burundi); and Gulu University Institutional Review Committee (Uganda). We also received permission from local administrative and health authorities. All participants/informants gave their informed consent before participating in the study, and their anonymity, privacy and confidentiality was respected. Written or oral consent was acceptable and approved by the relevant ethics committees.

Data management and analysis

All interviews and FGDs were audio-recorded and later transcribed and translated into English (where applicable). English transcripts were imported into the QRS Nvivo (QSR International, 2012). Considering the multidisciplinary nature of the research team and that the data were mainly made up of semi-structured interview transcripts, the framework method [ 28 ] was used to manage and analyze the data. Three team members open-coded the transcripts on Nvivo and Microsoft® Word. Microsoft® Word was used for coding and analysis by one of the co-authors who did not have access to Nvivo. The codes were descriptions or labels of specific ideas identified as the transcripts were read. Two team members reviewed the codes that were developed, and the inter-coder reliability was high. Inter-related or similar codes were then clustered into different categories, and the categories were subsequently grouped into specific themes. The themes were inductively and deductively developed. Inductive means that they were anticipated from the design of the interview and FGD guides and consciously explored in the interviews and FGDs. Deductive means that they were not anticipated during the design, but rather identified during the review of the transcripts. There was a constant interplay between data collection, analysis and theme development, with new and dominant ideas that emerged in earlier interviews and FGDs being explored deeper in subsequent and later interviews and discussions. The themes were also developed taking into consideration the main factors affecting women’s utilisation of maternal health services proposed by Wild et al.’s [ 29 ] multilayered explanatory model (i.e. individual, social, cultural, political and health system factors).

A detailed description of the methods is provided in Additional file 1 .

Characteristics of study participants

As shown in Table  2 , we had 63 interviews and 8 FGDs across the study settings in Burundi and Northern Uganda. A total of 115 individuals participated in the study: 46 women of reproductive age (‘women’), 32 ‘LHPs’ and 37 NGO staff. The LHPs included those working at the facility (LHP) and senior administrative officials working at the local ministry of health (LHP-Policy maker). Within the NGO category we had three sub-categories of respondents: NGO, NGO-Health providers (NGOs that also provide health services) and NGO-Policy makers (mainly UN-based NGOs).

In the following paragraphs we present the participants’ perceived current status of MSRH and level of utilisation of MSRHS, and the determinants of women’s utilisation of these services vis-à-vis the possible effects of exposure to conflict. The individual determining factors were quantified by obtaining the percentage of participants within each of the categories that mentioned a specific factor during an interview or FGD.

Current status of maternal and reproductive health

Over two-thirds of the LHP and NGO respondents in both Northern Uganda and Burundi felt that the general status of MSRH is poor, but has been improving in the aftermath of the conflict. They mentioned positive evolution of some MSRH indicators such as maternal mortality, skilled attendance at birth and contraceptive uptake coupled with the initiation of some specialized services like cervical cancer screening as key pointers to improvements in maternal health.

“ During the time of the war maternal mortality was very high in this region. But currently it is between 300 and 400 per 100 000. But around that time it was around 600 to 700… ” NGO, FGD – Gulu, Northern Uganda “[In Ngozi Province] in 2005, the percentage of women who deliver at the health facility was 40 percent but now it is about 70 percent. The uptake of family planning in 2005 was 10 percent but now it is around 25 percent. ” LHP-Policy maker, IDI – Ngozi, Burundi

The positive observations made by the LHP and NGO respondents were also affirmed by the women, most of whom felt that the number of pregnant women from their communities attending ANC and delivering at the health facility had been increasing since the conflict ended. The increasing uptake of these services was largely associated with improved physical safety, an increase in the number of health facilities that has reduced the distance people have to travel to seek care, and an ongoing government health policy of free healthcare for all in government health facilities (for Uganda), and free healthcare for pregnant women and children under five years (for Burundi).

“ With the president’s law ( free health care for pregnant women and children under five ), things have evolved in a positive way. Death rate for pregnant women has reduced considerably…Today a death of a pregnant woman is considered as an accident. ” Woman, IDI – Kinama, Burundi “ In the past it was very difficult to reach the hospital but now services are closer…If you compare the time that one would take to reach the hospital in the past, you will find that it is better now ” Woman, IDI – Bungatira, Northern Uganda

Determinants of women’s utilisation of MSRHS and the effect of conflict exposure

A combination of complex and inter-related factors affecting the utilisation of MSRHS by women were identified across the study sites. A number of these factors were associated with exposure to past conflict. Using the Wild et al. [ 29 ] multilayered person-centred exploratory model on the utilisation of maternal health services we grouped the factors into the following themes: individual, socio-cultural, and political/health system levels. Table S2 (Additional file 3 ) shows the main factors identified by the different categories of participants across the study sites. The perspectives of the LHP and NGO categories of respondents were highly similar, hence these were merged. The determinants were largely presented as ‘push’ (barrier) or ‘pull’ (facilitating) factors and included both supply and demand side factors. The factors identified are presented vis-à-vis the various participant categories.

Individual level

The most common individual level factor that encouraged women across the study sites to utilise MSRHS like family planning was the difficulty with catering for existing children. This factor was raised by over 80% of the women. This is because following the end of the conflict there has been a very strong cultural desire to replace family members lost during the conflict. The demand for family planning services was also facilitated by desire for women to recuperate after child birth, prevailing pressure on the existing limited land resources, and high incidence of land disputes following relocation of families back to their communities from internally displaced persons (IDP) camps as the insurgency ended. This has limited the quantity of food that can be cultivated.

“ In general, the living conditions are very difficult. You cannot give birth to too many children when you do not have something to give them. Nowadays, there is not enough space for those children. These are some of the reasons why women seek for family planning services ” Woman, IDI – Koro, Northern Uganda

Previous experience with or fear of a complicated or abnormal delivery and the development of an obstetric danger sign (as well as the severity of the manifestation of the sign) were also important individual level facilitating factors (76%). Most of these decisions tended to have been undertaken with the backdrop of little or no help with household chores for many of these women.

In Burundi, the desire to ensure that the newborn was registered and granted a birth certificate which gave free access to healthcare under the new targeted healthcare policy was a very strong ‘pull’ factor (90%) for facility delivery.

“ The reason why women are motivated to visit the health facility when pregnant is because they are afraid of delivering at home. When you deliver at home, your baby is not registered .” Women, FGD - Ruhororo, Burundi

Normally, the birth notification document that is required to make a birth certificate is provided at the facility after delivery, hence women who do not deliver at the facility often struggle to have a birth certificate issued for their newborn. Other ‘pull’ factors that emerged included the desire to know their HIV status and to learn about the evolution of the pregnancy.

One main barrier identified across the sites, and especially in Northern Uganda, included past unpleasant experiences or fear of such experiences at the hands of health providers at the health facility, discouraging some women from seeking services (60%). With extensive impoverishment among the rural women who were temporarily displaced from their communities during the conflict, many of them felt despised, looked down upon, and poorly received by health personnel when visiting the health facility. Also, 43% of the women cited past experience of severe side effects of contraceptives, such as heavy bleeding and increase in weight, as a barrier to the uptake of modern contraceptives. In Burundi, approximately 20% of the women reported that some women were discouraged from seeking maternal health services for fear of being diagnosed with HIV infection. A few respondents mentioned the lack of ‘good clothes’ to wear as a barrier to facility delivery. Some who could not afford ‘good’ clothes preferred to deliver at home, especially within urban and semi-urban areas.

“ The things that discourage some are…lack of good clothes to wear in order to go to the hospital or health centre without being laughed at; lack of clothes for the newborn; and ashamed of being laughed at if they do not have something to eat whereas other patients have relatives to bring them good food .” Woman, IDI - Kinama, Burundi

The educational level was also mentioned (24%) as an individual level determinant for women’s utilisation of MSRHS, with more educated women being more likely to seek these services. Lack of safety was identified as an important barrier to education during the conflict. Some respondents (41%) also felt that the high burden of domestic chores that some women have to undertake, ranging from cooking, cleaning, and farming, may discourage the use of facility-based health care.

“… I think that it is because of the too much work that women have at home that stops them from going to the hospital. ” Woman, IDI – Bobi, Northern Uganda

LHPs and NGOs

Most of the individual level factors that the LHP and NGO respondents felt affected women’s utilisation of MSRHS were largely similar to those mentioned by the women themselves across the study settings. In Northern Uganda, the main facilitators mentioned only by LHPs and NGOs included availability of contraceptive methods that could be concealed from the male partners/husband (such as implants) (60%); and a deep sense of trust that their privacy and confidentially would be respected by the health providers (50%) – especially for HIV positive women, and for those secretly requesting family planning and post-abortion care services. The corresponding facilitators for Burundi included HIV positive women’s desire to protect their unborn child from HIV infection (70%); and realization of the importance of family planning – including personal positive experiences with contraceptive use (65%); improving knowledge; and understanding the evolution of their pregnancy. The barriers were similar across the participant categories in Northern Uganda, and many respondents (74%) in this participant category felt that the poor health-seeking behaviour of some women was due to the conflict-engendered low literacy levels among the population.

Barriers mentioned only by LHPs and NGOs in Burundi were ignorance of the importance of these services, lack of money for transport and medication, in some areas confidence in traditional birth attendants to undertake home deliveries, and personal religious convictions.

Socio-cultural level

The most common socio-cultural factors raised across the study sites were poverty (85%), community- and male-partner perceptions about modern contraceptives (80%), and the ease of reaching the health facility (70%), including the distance to the facility and the nature of the road network. These were to some extent associated with the conflict, as huge segments of the population, especially in rural areas, are still struggling to rebuild their livelihoods destroyed by the conflict. Infrastructure, including roads, schools and health facilities, was generally disrupted during the conflict. With respect to contraceptive uptake, rumours and myths about modern contraceptives, fear of side effects, and male-partner opposition to uptake were perceived as important barriers.

“ There are some women who do not believe the contraceptive methods because they think that these methods will prevent them from reproducing in the future ” Woman, IDI – Kinama, Burundi “ Some say that family planning [modern contraceptive] is going to kill their eggs…While others think family planning can make one produce children without a head. ” Woman, IDI – Koro, Northern Uganda

While the main barriers to the uptake of modern family planning methods in Northern Uganda were linked to strong male-partner opposition and fears of possible side effects, in Burundi concerns about male-partner opposition were less common.

The main facilitator for utilisation of family planning services was pressure on limited resources (60%), including land on which cultivation is done. This was considered a growing problem in some of the sites as the incidence of land disputes was reported to have sharply increased, especially following the return of displaced populations.

Factors that were raised only by women in Northern Uganda included the perception of women on contraceptives as ‘men’ or ‘without womanhood’, discouraging some from seeking such services; male-partner opposition to spousal uptake of HIV voluntary counselling and testing (VCT) services for fear of being diagnosed with HIV; and fear of undergoing a caesarean section.

Most of the socio-cultural level factors mentioned by the women were also emphasised by the LHPs and NGO respondents. Factors that were only mentioned by the LHPs and NGOs in Northern Uganda included a great respect for and availability of traditional birth attendants (TBAs) to undertake deliveries in some rural areas (40%); and a cultural perception of pregnancy as a normal condition that may discourage some women from seeking ANC and facility delivery services (50%). In some settings, pregnant women who regularly attended ANC sessions were perceived as ‘ not strong enough ’.

“ People think that when you are pregnant it is a normal condition and you do not have to go to the health facility. They feel that when you go there you are a coward .” NGO-health provider, IDI – Gulu, Northern Uganda

Respondents to some extent associated the great respect for TBAs to the conflict, as skilled birth attendance was almost non-existent for huge segments of the population during conflict, and TBAs were regarded as heroines within some communities.

Other sociocultural factors were the perception among some men that women on contraceptives are stubborn (difficult to control) and sexually promiscuous (25%); a desire to replace family members lost during the war (85%); and the cultural desire for large family size (77%). These factors also accounted for the often mentioned male-partner opposition to contraceptive use by their spouses. The strong position of the Catholic Church against the use of modern contraceptives was reported to be a key barrier (70%) for the uptake of family services in both Burundi and Northern Uganda, as more than 60% of the population are Catholics. The strong negative impact of the Catholic Church on the uptake of modern family planning services observed among these categories of respondents was not mentioned as a major concern among the women respondents.

In Burundi, a few respondents (26%) identified the cultural practice of concealing a pregnancy for the first trimester as a major barrier to early ANC service uptake. This is a practice that is not only limited to uneducated women in rural areas, but also common among educated women in the cities.

The occasional financial costs incurred by women at the level of the facility also discouraged some women from seeking services, while the improved security situation has been an important pull factor.

Political and health system level

Most of the women (95%) in both Burundi and Northern Uganda felt that the most important political and health system level pull factor for uptake of MSRHS is the universal and selective healthcare policy for Uganda and Burundi respectively that facilitates access to services through the removal of user fees. All respondents in Burundi were generally more appreciative of the health system, especially the manner in which they are received and treated at the level of the health facility, compared to their counterparts from Northern Uganda. As such, most respondents from Burundi felt that no barriers existed at the level of the political and health system domain.

“ Women are well treated and whenever you go [to the health facility] when you are pregnant, they receive you and they treat you well .” Woman, IDI – Ruhororo, Burundi “W e know that there are nurses at the health centres and hospitals who are ready on a daily basis to receive a woman who is coming to bear a child. They are always ready to help that woman. We thank the government for this. They do not discriminate in receiving patients. ” Woman, FGD – Kinama, Burundi

On the other hand, over half of the women respondents from Northern Uganda felt that although the cost of basic health care is free, some health providers tend to extort money from them. A number of women narrated incidents at the health facility where health providers requested unauthorised financial tips following the delivery of a service.

“ Sometimes you can go [to the health facility] and you are told by the nurses to give them some money for the help they have given to you … ” Woman, IDI – Bobi, Northern Uganda “ When I went to give birth, the nurse told me that ‘since you have given birth well I want you to give me something but don’t tell the in-charge (supervisor)’. Then I removed 5,000 Shillings and gave her .” Woman, IDI – Bungatira, Northern Uganda

Furthermore, the provision of some services such as family planning, ANC, and VCT through mobile outreach clinics and village health teams in the case of Northern Uganda, and TBAs and community health workers in the case of Burundi was also a strong pull factor for the demand for these MSRHS. Of all the women respondents, especially in Northern Uganda, 40% reported that they are drawn to attending ANC services and undertake delivery at a health facility because of material incentives provided along with the services, such as bed nets and delivery kits.

“ Some women go to the health facilities because another woman has gotten that incentive and you hear them saying that ‘if my friend has gotten this there, then I have to also give birth from the hospital in order to get mine’ .” Woman, FGD – Koro, Northern Uganda

A common barrier discouraging some women from seeking facility services was that the attitude of some health providers was occasionally perceived as abusive and degrading to the clients (57%), at times because of their perceived state of poverty. This perceived barrier was, however, very uncommon in Burundi.

“ Some women fear those nurses because they like harassing women when they go to seek for services and some can even abuse you ” Woman, IDI – Bobi, Northern Uganda

Specifically in Burundi, most women (90%) felt that the construction of more health facilities, hence reducing the travel distance, and the recruitment of more health personnel were other facilitators, especially in rural areas. In Northern Uganda, the common barriers raised were the irregular presence and frequent absence of personnel at some facilities (60%), especially in the rural areas, and the policy of insisting that pregnant women must be accompanied by the male partner during some ANC consultations if they are to receive prompt service delivery (63%).

“ If the child the woman is carrying does not have a father, it discourages the woman from going for ANC visits because some facilities require you to come with your husband. ” Woman, IDI – Bungatira, Northern Uganda

A number of women felt that tying prompt ANC service delivery to being accompanied by the male partner unfairly treated women without partners, and women whose partners refused to accompany them or were unavailable for other reasons. The prevailing practice of insisting on male partner involvement was also associated with the reluctance of some women to seek other MSRHS, such as family planning and VCT. In many situations women that were unaccompanied by their spouse were reportedly attended to much later, or even sent away unattended. This practice of prioritizing accompanied women, or even not providing some services to unaccompanied women, was a major concern among some women in Northern Uganda.

“ I would think the health personnel should improve the way they treat mothers when they go for maternal and other services available in the health unit. Not that if they do not go with their husband they should leave without services because there are men who are also very difficult to deal with and so their wives should not be dropped out from services because of their husband’s conduct. ” Woman, IDI – Bobi, Northern Uganda

The political and health system level factors that were identified by the health providers and NGOs were highly similar to those reported by the women. The common facilitating factors that emerged across the study sites included the policy of removal of user-fees (100%), the increasing level of community sensitization on health issues (90%), the prohibition of TBAs from undertaking deliveries, which had directly pushed some women to deliver at health facilities (75%), and the delivery of some services at community level.

In Burundi, the introduction of the performance-based financing (PBF) programme was highlighted as the most important facilitating factor to the delivery and uptake of MSRHS (100%). Through the PBF scheme health personnel are remunerated specifically for the quantity and quality of specific services provided in addition to their regular salary. Facilities are also better stocked with basic supplies than before, the range of services offered has increased, and more lay health workers have been trained from the community to intensify community health sensitization activities. Also, competent personnel tend to always be at the facility, TBAs have been trained and assigned a new role in health promotion and community sensitisation, and the attitude of personnel towards the clients has reportedly improved. All these have encouraged more women to seek MSRHS. On the downside, some respondents (25%) felt that the strong increase in the number of women seeking MSRHS following the introduction of the selective health care and PBF policies has not been sufficiently matched with a corresponding increase in the number of skilled personnel at the facility, nor in the quantity of medical supplies. The end result has been a decline in service quality and delays in the provision of services, which has negatively affected the demand for some services.

Some facilitating factors that were mentioned only by LHPs and NGOs in Northern Uganda are effectiveness in the integration and follow-up of clients, especially in the domains of VCT and prevention of mother-to-child transmission of HIV; professional competence of personnel with respect to safeguarding clients’ privacy and confidentiality; payment of the cost for skilled birth attendance and related services at a reputable private hospital by some local politicians; and availability of youth-focused and youth-friendly services. Moreover, the availability of free antiviral therapy coupled with the provision of nutrition support for HIV positive mothers, and the provision of some incentives (such as a delivery kit and a washing basin) for women who deliver at the facility, were also important pull factors. The main barriers mentioned only by LHPs and NGOs were poor management of pregnant teenagers and teenage mothers; the poor drug supply policy and regular stock-out of some essential supplies at the facility level; and in some areas, the poor coordination among NGOs, health facilities and the district health office affecting the pattern of service delivery.

This study has demonstrated that a complex and inter-related set of factors affect women’s utilisation of MSRHS in post-conflict settings, and that armed conflict are among them. These factors cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women’s fear of developing pregnancy-related complications, situation of women empowerment and support at the community and household levels, removal of user-fees, proximity to the health facility, and attitudes of health providers. The main negative effects on family planning service uptake related to the exposure to conflict were associated with a generally low level of appreciation of the importance of some services, due to low educational attainment partly as a result of the conflict. Another effect has been a strong cultural desire for a large family size, especially among men, partly as a response to the loss of family members during the conflict. Furthermore, the disruption of infrastructural development such as roads and health facilities during the conflict, means that proximity to functional health facilities for many rural dwellers remains a considerable problem in some areas. While related studies have been undertaken in Uganda, largely employing a quantitative design, we are not aware of any such studies undertaken in Burundi.

Our findings are consistent with those of other researchers in related settings. Previous studies in Northern Uganda have identified lack of finance, of information, and of decision-making powers as key challenges to access to health care services for women [ 30 ]. Also, the abusive and unwelcoming attitude of some health providers towards women, financial demands by some health providers, and uncooperative husbands, have been reported in other regions of Uganda as important barriers to the uptake of family planning, ANC visits, and other health services by women [ 31 ]. A systematic review of access to and utilisation of health services for the poor in Uganda [ 32 ] identified distance to service points, perceived quality of care, and availability of drugs as key determinants. In addition the review concluded that perceived lack of skilled staff in public facilities, late referrals, health worker attitudes, costs of care, and lack of knowledge were important barriers to service utilisation. Although many women appreciate the importance of ANC visits and facility delivery, when they cannot find someone to take care of their families, (especially their children) while they are away at the facility, they opt not to go, as was observed in post-conflict Sierra Leone [ 33 ]. In post-conflict Timor-Leste, women’s choice of delivery in a health facility has been linked to previous perinatal deaths or complications, such as prolonged or painful labour, bleeding, or referral in a past pregnancy, as well as the parity status, with primiparous women more likely to deliver at the facility [ 29 ]. In post-conflict Liberia, Lori et al. [ 34 ] reported that there was a strong sense of secrecy around pregnancy and childbirth, similar to our observation in Burundi, and distrust of the health care system among a proportion of the population, factors that in our study were associated with late attendance of ANC consultations and possibly with home deliveries among some women. Secrecy around such issues might be linked to concerns about witchcraft, in particular that an enemy may bewitch the unborn child or prolong its delivery. Similar views were expressed by some of our study participants. During the 2006 conflict in Lebanon, Kabakian-Khasholian et al. [ 35 ] equally observed that the key determinants for seeking maternal care were the availability of health services and experiences of complications. In some conflict settings, the choice of place of delivery is affected by the availability of appropriate clothing to wear to the facility, and the preference of key decision makers in the family, such as mothers-in-law and husbands [ 36 ].

In the aftermath of the internal conflict in Timor-Leste in 2006, the country was plagued with similar challenges to those we observed in Burundi and Northern Uganda, and one key response employed by the authorities was the institution of a maternity waiting camp for pregnant women [ 37 ]. At one of the facilities we visited in Northern Uganda, such a home was recently introduced especially to deal with pre-identified clients in rural remote areas with the risk of an abnormal delivery. Although this practice seems to be uncommon in our study settings it might be an important intervention to extend to other major health facilities. Accommodating the women and their companions may be a particularly important intervention for those who have to travel over a long distance to come to the facility.

Both Uganda and Burundi have waived user fees for maternal health related services; Uganda introduced a universal healthcare policy in March 2001, while Burundi introduced a selective healthcare policy for women giving birth and children under 5 years in May 2006. This policy seems to be the most important determinant of women’s uptake of MSRHS in our study settings, highlighting the importance of financial barriers in determining the demand for health services. A study in rural Burkina Faso showed that substantial reductions in user fees for ANC and skilled attendance at birth improved equity in access to these services across socio-economic groups, but did not ensure that all women benefited from the services [ 38 ]. These observations highlight the importance of also focusing on policies aimed at addressing other barriers. For instance, the current strategy of community provision of some MSRHS such as contraceptives, ANC, and postnatal care through mobile outreaches and local community structures, including traditional birth attendants, community health workers and village health teams, is a welcome model for delivering services, and needs to be strengthened. Furthermore, the level of engagement of the health system and other key community structures with males in the community on the importance of utilisation of MSRHS, including contraceptive uptake, also has to be intensified. Men might not have been appropriately engaged on these issues, and their knowledge of the services may be erroneous, which possibly accounts for the level of resistance that has been observed among some men vis-à-vis the uptake of MSRHS. Health providers might therefore have to coin their messages more efficiently to enhance male partner support for the utilisation of maternal and child health services. For example, a study of Northern Uganda concluded that the introduction of community and health facility capacity strengthening interventions such as training of health workers, provision of medical supplies including delivery kits, and community mobilization using village health teams, dance, drama and “male partner access clubs”, led to improvements in first ANC visit attendance, in VCT service uptake for attendants of first ANC visits, in facility delivery, and in VCT service uptake by couples [ 39 ]. While the current free healthcare policy for pregnant women and children under five has had a positive influence on the number of women going for ANC and facility delivery, other associated expenses such as transportation to the health facility, food to eat, clothes for the baby and the mother, and care for the other children at home when the mother is away continue to prevent some women from utilising ANC and facility-based delivery services. Similar observations in Timor-Leste are reported by Wild et al. [ 29 ]. In war-torn Afghanistan, Hadi et al. found that with appropriate conditions in place, many women and families will continue to seek facility-based delivery [ 40 ]. These conditions include providing free services and transport facilities at night, incentives to health providers, maintaining privacy in the delivery room, and the quality of services.

In many settings where stimulating demand for health services has largely been sought through the removal of user fees, but where proper planning and coordination has been lacking, other challenges on the supply side have arisen [ 41 , 42 ]. This happened in Burundi in May 2006 following the sudden abolition by the president of all user fees for children under five, and for women giving birth in all public health centres and hospitals. This was closely followed by a reduction in financial flows to the facilities, resulting in frequent drug stock-outs, reduced quality of the services, and disruption of the referral system [ 42 ]. These are similar challenges to those that we observed across the sites, although these challenges were more acute in the case of Northern Uganda. In Burundi, the nationwide introduction of the PBF programme in April 2010 to complement the earlier introduced free health care policy for children under five and pregnant women, seems to have mitigated some of the challenges that were observed following the introduction of the free healthcare policy. This has led to a generally more positive perception of the health system among women in Burundi compared to the women in Northern Uganda, as we observed in our study. The PBF scheme is a supply-side results-based financing programme which involves a ‘fee-for-service–conditional-on-quality of care’ mechanism that rewards hospitals and health facilities with monthly payments determined by service utilisation levels and performance on quality measures [ 43 ]. In the absence of a similar and well-coordinated personnel remuneration system like the PBF, health personnel in Northern Uganda may be more demoralized, less enthusiastic in the delivery of basic health services, and more prone to request unofficial payments from clients. The initial challenges faced by Burundi in the wake of the introduction of the selective healthcare policy, and nowadays in Northern Uganda, where a universal healthcare policy is in place, points to the importance of careful planning, implementation and coordination of such policies. However, failure to do so may seriously compromise the quality of services, as was observed across the study sites, and especially those in Northern Uganda. While the positive impact of the PBF programme on the utilisation and quality of maternal and child health services was widely reported by participants in Burundi, a few participants equally acknowledged that challenges with respect to staff burn-out and service quality as a result of the increasing demand for services remain. Although a number of post-conflict countries in Africa including Burundi and Rwanda have rolled-out nationwide PBF schemes as a means of improving health worker performance and as a tool for health sector reform, Ireland et al. have questioned the validity of PBF as a tool for health sector reform. They argue that the “debate surrounding PBF is biased by insufficient and unsubstantiated evidence that does not adequately take account of context nor disentangle the various elements of the PBF package” [ 44 ] (p. 695).

Based on our findings and those of previous studies [ 12 - 16 ], the determinants seem to be largely the same in post-conflict and non-conflict settings except for the fact that the barriers in post-conflict settings tend to be more widespread and exacerbated . We demonstrate that exposure to armed conflict affected women’s utilisation of MSRHS mainly through low educational attainment for both men and women translating into ignorance of the importance of health services and into high levels of impoverishment. Another commonly observed effect was the strong desire, especially among men, to replace lost family members, resulting in their general opposition to modern contraceptives. Working in the opposite direction, great pressure on limited land for cultivation coupled with reported increased incidence of land disputes as conflict-displaced populations return to their communities, appear to encourage some women to consider modern family planning services for birth control.

Our findings also highlight some similarities and differences in the perceived determinants of women’s uptake of MSRHS between and within the categories of participants and study settings. For example, almost all factors identified by the women were also highlighted by the LHP and NGO respondents. This is not particularly surprising, as the latter serve within the communities where these women reside, and have a generally good knowledge of the socio-cultural context of these women. Also, a number of the NGOs and local health providers have local community projects within our study areas that may further improve their level of engagement with the women in those communities. This possible practice of engagement of health personnel with local communities is worth encouraging and supporting as it may improve the delivery of services, thus providing better client satisfaction. However, while the LHP and NGO respondents across the study sites perceived the Catholic Church as having a very strong negative effect on the uptake of modern contraceptives, this was not a concern among the women respondents. The major barriers for the women were opposition from their male partner and the fear of possible side effects. The non-mention of a strong religious influence on modern contraceptives uptake by the women might reflect the fact that the religious values that some women hold may not necessarily be in keeping with the official teachings of their religion, or that their local cultural values may have a much stronger impact on their belief systems. Alternatively, the women might simply not want to apportion blame on their religion as a sign of respect. It is also important to note that the issue of seeking facility delivery in Burundi was strongly associated with the desire to obtain a birth certificate for the child. This highlights the importance that women in rural Burundi place on the free healthcare policy, as the birth certificate of the child might be required at times in public facilities before services are provided free of charge. The issue of limited land that has served as a facilitator to family planning uptake was raised only by the women, across the study sites. This might reflect the reality these women go through on a daily basis to raise their children and put food on the table for their families. Since the women were largely based in rural areas, with farming as their main occupation, they might have personally experienced the challenges of having a large family living off a limited piece of land, and how such pressure affects household- and community cohesion. This may explain why some women disregard personal risk and seek for concealable modern contraceptives against the backdrop of male-partner- and cultural opposition. The other concerns raised about the uptake of modern contraceptives are not unique to our study. A study in Ghana found that a third of women considered modern contraceptives as unsafe, 20% reported opposition from their male partner as a barrier to uptake, and 65% of users reported at least one side-effect [ 45 ]. Therefore, in order to improve the uptake and continual usage of modern contraceptives in these areas, these concerns have to be addressed.

The challenges of delivering health care and rebuilding health systems in conflict and post-conflict settings have been well acknowledged. The major challenges are the lack of security; acute shortage of skilled health professionals due to migration to safer areas; lack of infrastructure and medical supplies and drugs; obstruction of access to health facilities by warring parties; security forces harassing, arresting and prosecuting health providers; poor coordination among government, health care providers and humanitarian organizations; and assaults on patients within hospitals, among others [ 46 - 50 ]. These challenges make the health system non-functional, resulting in limited availability of, limited access to, and poor quality of health services. As such, rebuilding health systems must take into consideration the prevailing challenges to ensure efficient use of limited resources and provide maximum impact. In this regard, experts have recommended that health system strengthening programmes in such settings should put more emphasis in the short-term on the provision of primary health care services, using existing human resources for health, community structures, NGOs and mobile outreach clinics [ 51 ]. Programmes such as the renovation and construction of health facilities and the development of human resources for healthcare are more likely to succeed in the medium- and long term. This happens to be the approach that both governments have eventually embarked on, although in the earlier post-conflict years in Northern Uganda so many resources were channeled into the construction of health facilities, especially in rural areas, that to date many remain non-functional due to acute shortage of human and material resources. A more stepwise approach, rather than thinning out the limited resources over a large area without much progress taking place, could have been more effective. Furthermore, governments of post-conflict settings along with their development partners must carefully design the core elements of the health system to provide reliable essential health while ensuring that it addresses issues around equity, government accountability to citizens, and governments’ capacity to manage important social programs [ 47 ].

Limitations

A limitation of the study was that the women participants were mainly staying within the catchment areas of some local health centre or had regular weekly access to basic healthcare services through mobile outreach clinics. We were unable to recruit women participants in much disadvantaged remote areas that were not regularly served with basic health services. As such, the perspectives of that group of women are not well captured in our study.

In post-conflict settings, a vast and complex set of factors affect women’s utilisation of MSRHS ranging from the individual, socio-cultural, political to health system levels. The main determinants include the removal of financial barriers to access; level of household, community and facility support for women; proximity to health services; and community perceptions of some services. Exposure to conflict generally exacerbated the barriers to women’s uptake of services, mainly through low educational attainment and stronger cultural desire for increased fertility to replace family members lost to the conflict. To improve women’s uptake of MSRHS in such settings, robust health system strengthening programmes addressing the barriers across the individual, socio-cultural and political spheres are needed. While addressing financial barriers to access is important, attention should also be paid to non-financial barriers. The goal should be developing an equitable and sustainable health system.

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Acknowledgements

We are grateful to all the participants who took time off to participate in the study. Ms. Foglabenchi Lily Haritu assisted with coding the transcripts. We thank our local collaborators across all the study sites for logistic and administrative support. We thank the reviewers, Kate Teela and Maree Porter, and the editor for their comments. This fieldwork received funding from Folke Bernadotte Academy, Sweden and the Institute of Health and Society, University of Oslo, Norway. The entire work has been supported by: the EU 7th Framework Marie Curie ITN ‘Training and Mobility Network for the Economic Analysis of Conflict’ – TAMNEAC (Grant agreement 263905), the Research Council of Norway – Project 230861 ‘Armed Conflict and Maternal Health in Sub-Saharan Africa’, and the Peace Research Institute Oslo (PRIO).

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PCC: Participated in the conception and design, data collection and analysis, and drafting and revising the first manuscript; PB: participated in data analysis, and drafting and reviewing the manuscript; HU: participated in the conception and design, data interpretation, and reviewing the manuscript; JS: participated in the conception and design, data interpretation, and reviewing the manuscript. All authors participated sufficiently in the work to take public responsibility for appropriate portions of the content. All authors reviewed and approved the final manuscript.

Additional files

Additional file 1:.

Methods. This is a detailed description of the materials and methods used for undertaking the study. It includes a description of the study settings and participants, data collection, management and analysis methods, collaborative partnership, recruitment of participants and ethical considerations.

Additional file 2:

Data Collection Tool: Interview and Focus Group Discussion Guides. This is a detailed description of the interview and focus group discussion guides for the various categories of research participants. The guides are for the entire study from which this paper is one of the outcomes.

Additional file 3: Table S2.

Factors affecting women’s utilisation of Maternal, Sexual and Reproductive Health Services (MSRHS) in post-conflict Burundi and Northern Uganda. This is a summary of the factors affecting women’s utilisation of maternal, sexual and reproductive health services in Burundi and Northern Uganda as perceived by women of reproductive age, local health providers and staff of NGOs working in the domain of maternal and reproductive health. The factors are further classified into individual level factors, socio-cultural level factors and political and health system level factors.

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Chi, P.C., Bulage, P., Urdal, H. et al. A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC Pregnancy Childbirth 15 , 18 (2015). https://doi.org/10.1186/s12884-015-0449-8

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Received : 06 August 2014

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DOI : https://doi.org/10.1186/s12884-015-0449-8

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El-Shal, Amira. "The effects of health sector reform interventions in Egypt on family planning and maternal and child health." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/18120/.

Forero, Ilenia Anneth. "The Water Culture Beliefs of Embera Communities and Maternal and Child Health in the Republic of Panama." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4673.

Alarcón-Guevara, Samuel, Joshua Peñafiel-Sam, Sergio Chang-Cabanillas, and Reneé Pereyra-Elías. "Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015." Blackwell Publishing Ltd, 2021. http://hdl.handle.net/10757/655820.

Yugbaré, Belemsaga Danielle, Anne Goujon, Aristide Bado, Seni Kouanda, Els Duysburgh, Marleen Temmerman, and Olivier Degomme. "Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study." BMC, 2018. http://epub.wu.ac.at/6734/1/document.pdf.

Buccini, Gabriela dos Santos. "Determinantes do uso da chupeta e mamadeira em crianças menores de um ano nas capitais brasileiras e Distrito Federal." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/6/6138/tde-05092012-111455/.

Pinheiro, Leonor Ramos. "Uso de manobras de reanimação neonatal e internação em unidade de cuidado intensivo entre recém-nascidos de termo: análise secundária dos dados do estudo Nascer no Brasil." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-10072017-142957/.

Silva, Aline Gaudard e. "As repercussões da violência entre parceiros íntimos na utilização de serviços de saúde nos primeiros seis meses de vida." Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=3549.

Gemma, Marina. "Fatores associados à integridade perineal e à episiotomia no parto normal: estudo transversal." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/6/6136/tde-25052016-125737/.

Aihara, Yoko Sirikul Isaranurug. "Effect of maternal and child health handbook on maternal and child health promoting belief and action /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737949.pdf.

Smith, Emily Rose. "Maternal and Child Health, Nutrition, and Hiv." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32644541.

Bodas, Mandar V. "Three Essays on Maternal and Child Health." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5543.

Nickelson, Joyce E. "A modified obesity proneness model in the prediction of weight status among high school students." [Tampa, Fla] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002410.

Nicolais, Christina J. "Maternal Health and Child Behaviors as Risk Factors for Child Injury." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3381.

Hagan, Teresa. "Under-utilisation of maternal and child health care." Thesis, Sheffield Hallam University, 1988. http://shura.shu.ac.uk/3084/.

Wood, David L. "Child Poverty and Its Impact on Child Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5178.

M'soka, Namakau C. S. "Beliefs of women receiving maternal and child health services at Chawama Clinic in Lusaka, Zambia regarding pregnancy and child birth." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/509.

Leiferman, Jennifer Ann. "The effect of maternal depressive symptomatology on maternal behaviors associated with child health /." Digital version accessible at:, 2000. http://wwwlib.umi.com/cr/utexas/main.

Carreon-Bailey, Rebecca Socorro. "Influences of maternal parenting behaviors: Maternal mental health, attachment history and eduction." CSUSB ScholarWorks, 2006. https://scholarworks.lib.csusb.edu/etd-project/2989.

Percy, Ray. "Maternal verbal communication and the treatment of children with anxiety disorders in the context of maternal anxiety disorder." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/370404/.

O'Keefe, Maree Frances. "Maternal perspectives of child health consultations by medical students." Title page, contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09pho4121.pdf.

Moucheraud, Corrina. "Evaluation of Strategies and Outcomes in Maternal and Child Health." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121157.

Gonzalez, Citlalli R. "Maternal Behavioral Determinants and Child Dietary Quality in Latino Families." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10784465.

The purpose of this study was to conduct a secondary analysis to examine the association between the change from baseline to follow-up in Latino mothers’ self-reported nutrition knowledge, self-efficacy, intentions, food label use, and role modeling from baseline to follow-up with their reports of children’s dietary intake measured at follow-up. Data were obtained from from Sanos y Fuertes, a culturally-tailored community-based nutrition education intervention. The participants were Latino mothers and their children ages 2 to 8 years old. A dietary quality scoring system was created using food frequency data. To account for reported frequencies, five set points were created to define criteria for high dietary quality. Logistic regression tests were conducted for the five set points. The change in nutrition knowledge ( p = .019) and role modeling ( p = .034) of the mothers significantly predicted probability of higher child dietary quality at follow-up. Findings suggest the need for interventions that focus on increasing parental dietary knowledge while emphasizing the importance of role modeling. Further research is needed to explore cultural-related dietary differences between Latinos and non-Latinos.

Kanu, Alhassan Fouard. "Health System Access to Maternal and Child Health Services in Sierra Leone." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7394.

Moonesar, Immanuel Azaad. "The Role of UAE Health Professionals in Maternal and Child Health Policy." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1649.

Clements, Andrea D., A. L. Acuff, Wallace E. Jr Dixon, and C. Snyder. "Maternal and Child Temperament and Parenting Style." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/4936.

Winstanley, Alice. "Maternal and infant contributions to development following premature deliveries." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/47366/.

Nasrullah, Muazzam [Verfasser]. "Child marriage and its impact on maternal and child health in Pakistan / Muazzam Nasrullah." Bielefeld : Universitätsbibliothek Bielefeld, 2015. http://d-nb.info/1077605277/34.

Lydon-Rochelle, Mona Theresa. "Method of delivery and risk of subsequent adverse maternal health outcomes /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/7286.

Fertuck, Deborah. "Children with chronic physical disorder : maternal characteristics and child outcomes." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56618.

Tauheed, Jannah. "Arsenic, Lead and Manganese as Risk Factors for Child and Maternal Neurotoxicity." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27201739.

Plant, Dominic. "When one childhood meets another : maternal child maltreatment and offspring child psychopathology." Thesis, Canterbury Christ Church University, 2016. http://create.canterbury.ac.uk/15001/.

Kachimanga, Chiyembekezo. "Improving utilization of maternal health related services: the impact of a community health worker pilot programme in Neno Malawi." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29240.

Prado, Daniela Siqueira. "Práticas obstétricas e influência do tipo de parto em resultados neonatais e maternos em Sergipe." Pós-Graduação em Ciências da Saúde, 2018. http://ri.ufs.br/jspui/handle/riufs/8552.

Panjsheri, Saiqa. "Child health: mother knows best the association between child malnutrition and maternal education in Nepal /." CONNECT TO ELECTRONIC THESIS, 2007. http://hdl.handle.net/1961/6769.

Singogo, Irene Miti. "Perinatal deaths in Lusaka, Zambia : mothers’ experiences and perceptions of care." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6015.

Hood, Robert Baltasar. "Hepatitis C virus and maternal and child health in the United States." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1587213372856517.

Carvalho, Natalie. "Health Impacts and Economic Evaluations of Maternal and Child Health Programs in Developing Countries." Thesis, Harvard University, 2012. http://dissertations.umi.com/gsas.harvard:10264.

Jaffer, Khadija. "Child safety in day care centres within the Western Cape." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/27004.

Dow-Fleisner, Sarah Jeanne. "Defying the odds: Child health and wellbeing in the context of maternal depression." Thesis, Boston College, 2017. http://hdl.handle.net/2345/bc-ir:107610.

Minden, Maureen Marguerite. "Discrepancy between maternal health policy and practice : The case of maternal child health workers at sub-health posts in a rural district in Nepal." Thesis, University of London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536773.

Moser, Michele R., T. Clark, and Andres Pumariega. "Mental Health Disparities in Child Welfare." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/4973.

Stephenson, Robert Brian. "The impact of rural-urban migration on child survival in India." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313189.

Sinha, Aakanksha. "India’s Child Malnutrition Paradox: Role of Maternal Autonomy & Health Related Awareness." Thesis, Boston College, 2016. http://hdl.handle.net/2345/bc-ir:105064.

Zhang, Yuzheng, and 张誉铮. "Monitoring the impact of maternal health interventions on child mortality in Philippines." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206949.

Sandiford, Peter. "The impact of maternal literacy on child survival during Nicaragua's health transition." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266223.

Mbabazi, Muniirah. "Exploring the efficacy of maternal, child health and nutrition interventions in Uganda." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/48215/.

Kuo, Alice, David L. Wood, James H. Duffee, and J. M. Pasco. "Poverty and Child Health in the United States." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5138.

Evans, Subhadra. "The interface of maternal and child psychological and physical health: What maternal chronic pain means for children's functioning." Thesis, University of Canterbury. Psychology, 2004. http://hdl.handle.net/10092/4513.

Brind'Amour, Katherine. "Maternal and Child Health Home Visiting Evaluations Using Large, Pre-Existing Data Sets." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468965739.

Mukasa, Bakali. "Maternal and Child Health Access Disparities Among Recent African Immigrants in the United States." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2297.

PhD, Maternal and Child Health

Advance the health and well-being of women, children and their families

The Ph.D. program in family science provides a research-oriented approach to the discovery and application of knowledge about families, family theory, research methodology, family policy, family programs and ethnic families.

• Request Info

Perfect for...

• Students looking for a unique program focused on the entirety of the family system and family health policy.
• Students looking for a program with an emphasis on low-income and minority populations.

Career Paths

• Academic and research positions in colleges and universities
• High level administrative or research positions in city/county/state/national health and human service agencies
• Leadership positions in nongovernmental and advocacy organizations.
• Positions in hospitals, HMO and health insurers

Program Overview

The maternal and child health doctoral program provides interdisciplinary training in research, theory, policy and practice relevant to health and well-being as well as services for women, children, and their families. Graduate students learn about health disparities, the life course perspective, mental health, obesity, childhood injury, family and health policy, adoption, domestic and child abuse, family support, epidemiology, and research methods.  Students graduate with the skills and knowledge for professional work in educational, governmental, and clinical settings. 

Visit the Department of Family Science site.

For more information, see the Family Science flyer.

Upon graduating with a PhD in Maternal and Child Health, students will be able to:

• Describe the independent and interdependent determinants of health, disease, and disparities; including individual, familial, social, cultural, racial/ethnic, medical and environmental factors.
• Design a study to test hypotheses on an MCH issue. Review literature, select appropriate design, data, methodology and methods, analyze data, draw appropriate conclusions, and summarize findings for publication.
• Identify, analyze, and evaluate U.S. health care policy, program, and data surveillance systems.
• Synthesize and translate MCH knowledge into understandable information to advance health literacy.
• Formulate advocacy strategies to implement MCH policy while balancing interests of diverse stakeholders.

The MCH Ph.D. curriculum requires 57 graduate credit hours beyond the master’s degree public health core (15 credits), including maternal and child health core courses (20 credits), research methods courses (16 credits), electives (6 credits), research internship (3 credits), and dissertation credits (12 credits). Please consult with your advisor and the Director of Graduate Studies as individual study plans may differ. Students in the Ph.D. program advance to candidacy after completing required coursework and passing a written qualifying examination. After advancement to candidacy, students must complete a dissertation proposal and oral defense, followed by the doctoral dissertation and oral dissertation defense. 

• The PhD Student Handbook
• PhD Degree Requirements
• Graduate Student Ombudsman
• Graduate Assistantship Policies
• Department of Family Science Graduate Student Advising and Mentoring Policy

Department of Family Science

Dr. Tanner Kilpatrick Director of Graduate Studies [email protected]

Insights in Maternal Health: 2022

Policy Brief 04 January 2023 Policy measures to expand home visiting programs in the postpartum period Binh Phung 1,202 views 0 citations

Original Research 17 November 2022 Unmet need for contraception and its associated factors among adolescent and young women in Guinea: A multilevel analysis of the 2018 Demographic and Health Surveys Sidikiba Sidibé ,  5 more  and  Seni Kouanda 1,205 views 0 citations

Original Research 10 November 2022 Health professionals' perspectives on clinical challenges in managing hypertensive disorders of pregnancy and recommendations for improving care: A multi-center qualitative study Kwame Adu-Bonsaffoh ,  2 more  and  Joyce L. Browne 1,599 views 4 citations

Loading... Original Research 29 March 2022 Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighborhood in Delhi, India Bireshwar Sinha ,  8 more  and  Nita Bhandari 2,083 views 11 citations

Home » Blog » Dissertation » Topics » Health Sciences » 99 Obstetrics and Gynecology Dissertation Topics | Research Ideas

99 Obstetrics and Gynecology Dissertation Topics | Research Ideas

By Liam Dec 15, 2023 in Health Sciences , Obstetrics and Gynecology | No Comments

Are you a student embarking on your journey in the field of Obstetrics and Gynecology, searching for that perfect dissertation topics to pave the way for your undergraduate, master’s, or doctoral thesis? Look no further! In this comprehensive guide, we’ll explore a diverse range of Obstetrics and Gynecology dissertation topics that will not only captivate […]

Are you a student embarking on your journey in the field of Obstetrics and Gynecology, searching for that perfect dissertation topics to pave the way for your undergraduate, master’s, or doctoral thesis? Look no further! In this comprehensive guide, we’ll explore a diverse range of Obstetrics and Gynecology dissertation topics that will not only captivate your interest but also contribute to the advancement of this vital field of medicine. Whether you’re at the inception of your academic career or pursuing advanced research, we’ve got you covered with intriguing topics to fuel your dissertation journey.

Obstetrics and Gynecology, often referred to as “OB-GYN,” is a specialized medical discipline that encompasses two essential branches of women’s healthcare. Obstetrics focuses on the care of pregnant women, ensuring their well-being during pregnancy, childbirth, and the postpartum period. Gynaecology, on the other hand, deals with the diagnosis and treatment of various reproductive and gynaecological disorders in women. Together, these fields play a crucial role in safeguarding women’s health across the lifespan.

In conclusion, the world of Obstetrics and Gynecology offers a multitude of compelling research avenues for students at all academic levels. These dissertation topics encompass the breadth and depth of women’s healthcare, from pregnancy and childbirth to gynaecological health concerns. As you embark on your dissertation journey, remember that your research in Obstetrics and Gynecology has the potential to make a profound impact on the lives of women worldwide. So, choose a topic that resonates with your passion and dedication, and let your academic exploration begin!

Download Obstetrics and Gynecology Dissertation Sample

A list of Obstetrics and Gynecology Dissertation Topics:

Examining the maternal and neonatal outcomes of in vitro fertilization (IVF) pregnancies.

Analyzing the impact of socioeconomic factors on maternal and neonatal outcomes in the UK.

Exploring the experiences of transgender individuals in accessing reproductive healthcare.

Evaluating the safety and efficacy of vaginal birth after cesarean (VBAC).

Analyzing the historical trends in the management of gestational diabetes mellitus.

Assessing the prevalence of sexually transmitted infections among pregnant women.

Investigating the use of mindfulness-based interventions in reducing labor pain.

Exploring the factors influencing women’s decisions regarding contraceptive methods.

Exploring the experiences of women with endometriosis in healthcare settings.

Investigating the influence of cultural factors on contraceptive choices among women in the UK.

Assessing the changing landscape of contraception options for women over the years.

Investigating the impact of maternal obesity on fetal development and birth outcomes.

Evaluating the role of genetics in recurrent pregnancy loss.

Investigating the progress and challenges in achieving gender equity in the field of Obstetrics and Gynecology.

Nutrition and dietetics in obstetrics and gynaecology: Optimizing maternal health through nutritional support.

Examining the historical and current trends in maternal and infant nutrition practices.

Investigating the influence of COVID-19 on contraceptive choices and family planning.

Evaluating the psychosocial support needs of women with gestational diabetes.

Investigating the impact of maternal thyroid disorders on fetal development.

Examining the barriers to accessing abortion services in different regions.

Investigating the association between gestational hypertension and cardiovascular health.

Examining the effects of maternal smoking on infant neurodevelopment.

Investigating the role of cultural competence in healthcare providers’ interactions with diverse patient populations.

Investigating the role of diet and nutrition in polycystic ovary syndrome (PCOS).

Examining the effectiveness of post-COVID-19 mental health support programs for new mothers in the UK.

Examining the effects of maternal anaemia on birth outcomes.

Investigating the attitudes and experiences of healthcare providers towards obstetric care in the UK.

Examining the impact of maternal gestational weight gain on child obesity risk.

Evaluating the effectiveness of group prenatal care models.

Analyzing the psychological and emotional aspects of infertility treatment.

Assessing the long-term psychological effects of COVID-19 on pregnant women and new mothers.

Investigating the implications of COVID-19 vaccination during pregnancy on maternal and fetal health.

Evaluating the effectiveness of comprehensive sex education programs in schools.

Analyzing the historical perspectives on women’s reproductive rights and autonomy.

Examining the relationship between endometriosis and infertility.

Analyzing the prevalence and risk factors of postpartum depression among new mothers.

Assessing the evolving role of midwives in maternal care and advocacy.

Investigating disparities in access to reproductive healthcare among different socioeconomic groups.

Exploring the psychosocial factors influencing maternal-fetal attachment.

Investigating the effects of maternal smoking on fetal lung development.

Assessing the utilization of telehealth services in maternity care in the United Kingdom.

Evaluating the role of midwives in improving maternal healthcare in underserved areas of the UK.

Otolaryngology and obstetrics: Addressing voice and airway concerns in pregnant women.

Analyzing the association between maternal alcohol consumption and birth defects.

Examining the advancements in minimally invasive surgical techniques in gynecology.

Investigating the impact of intimate partner violence on maternal and fetal health.

Exploring the experiences of women from diverse backgrounds in accessing gynaecological healthcare in the UK.

Investigating the role of midwives in improving maternal and neonatal outcomes.

Investigating the role of paternal involvement in breastfeeding initiation and duration.

Exploring the relationship between maternal nutrition and fetal growth restriction.

Exploring the experiences of pregnant healthcare workers on the frontlines of the COVID-19 crisis.

Analyzing the impact of infertility treatments on women’s mental health.

Exploring the use of non-invasive prenatal testing for detecting genetic abnormalities.

Assessing the use of aromatherapy in managing labour pain and anxiety.

Investigating the use of music therapy in reducing labour pain and anxiety.

Evaluating the effectiveness of perineal massage in preventing perineal tears during childbirth.

Assessing the role of microbiota in pregnancy and neonatal health.

Exploring the experiences of women with pregnancy complications in seeking healthcare.

Investigating the association between maternal dental health and adverse pregnancy outcomes.

Assessing the effectiveness of public health campaigns in promoting women’s health in the UK.

Assessing the use of mobile health apps in monitoring pregnancy progress.

School psychology in obstetrics and gynecology: Promoting mental health and well-being in pregnant and postpartum adolescents.

Analyzing the impact of Brexit on reproductive healthcare policies and access in the UK.

Evaluating the effectiveness of preconception care in improving pregnancy outcomes.

Assessing the effectiveness of telemedicine in prenatal care delivery.

Assessing the association between gestational diabetes and childhood obesity.

Assessing the use of antenatal corticosteroids in preventing preterm birth complications.

Exploring the experiences of LGBTQ+ individuals in reproductive healthcare.

Investigating the effects of maternal sleep disturbances on pregnancy outcomes.

Analyzing the impact of maternal mental health on child behavioral outcomes.

Analyzing the effects of prenatal exposure to environmental toxins on child development.

Examining the impact of assisted reproductive technologies on maternal and fetal outcomes.

Investigating the role of genetics in the understanding of gynecological disorders.

Analyzing the effects of maternal sleep position on stillbirth risk.

Assessing the impact of maternal nutrition on the epigenetics of the offspring.

Evaluating the effectiveness of breastfeeding support programs in promoting breastfeeding duration.

Evaluating the effectiveness of mindfulness-based interventions in reducing pregnancy-related anxiety.

Assessing the role of midwives in providing maternal care during the COVID-19 pandemic.

Examining the impact of maternal stress on pregnancy complications.

Analyzing the effectiveness of contraceptive counseling in preventing unintended pregnancies.

Exploring the disparities in access to maternal healthcare services during the COVID-19 pandemic.

Exploring the experiences of women with uterine fibroids in healthcare decision-making.

Investigating the use of acupuncture in managing pregnancy-related pain.

Reviewing the evolution of prenatal screening and diagnostic techniques in Obstetrics and Gynecology.

Examining the impact of maternal obesity on breastfeeding initiation and duration.

Investigating the psychosocial factors influencing teenage pregnancy and parenting.

Exploring the cultural factors influencing childbirth practices and preferences.

Investigating the impact of the COVID-19 pandemic on maternal and neonatal outcomes in Obstetrics and Gynecology.

Analyzing the utilization of telemedicine in prenatal care during and post-COVID-19.

Analyzing the role of race and ethnicity in maternal mortality rates.

Investigating the maternal and neonatal outcomes of planned home births with certified midwives.

Reviewing the impact of medical interventions on reducing maternal mortality rates.

Examining the impact of COVID-19 on maternal and neonatal healthcare policies and practices in the UK.

Evaluating the effectiveness of postpartum doula support in improving maternal well-being.

Assessing the effects of perinatal exposure to air pollution on infant health.

Evaluating the effectiveness of virtual childbirth education classes in the era of COVID-19.

Investigating the role of paternal depression in postpartum depression in mothers.

Investigating the long-term consequences of preterm birth on child development.

Analyzing the maternal and neonatal outcomes of home births versus hospital births.

There you go. Use the list of Aviation dissertation topics well and let us know if you have any comments or suggestions for topics-related blog posts for the future or want help with dissertation writing; send us an email at [email protected] .

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226 Hot Public Health Thesis Topics For Top Grades

Are you stuck trying to get the best current public health research topics for thesis and writing it? If yes, know you are not alone. A lot of students find the tasks challenging, but we are here to help. Keep reading our informative guide that demonstrates how to prepare an engaging public health paper.

We will also highlight hot 226 health policy topics for paper and other public health ideas for dissertation that you can use for top grades. Why settle for less when we can help you select the best college or university papers?

What Is Public Health?

Before looking at the top public health statistics undergraduate thesis topics or other public health research ideas, let’s start with the definition. So, what is public health?

According to the World Health Organization (WHO), public health is “the art and science of preventing diseases, helping to prolong life and promote health using organized efforts. Good examples of public health efforts include preventing outbreaks, educating the public on health choices, promoting fitness, preparing for emergencies, and avoiding the spread of infectious diseases. Public health

How To Write A Great Public Health Dissertation

If you are a graduate or masters student, one of the most comprehensive documents that you need to prepare is the dissertation. It is an expansive paper and comes at the end of your course. Remember that you need to ensure it is prepared well because a team of professors will ultimately evaluate it. So, here are the main steps that you need to follow to prepare a high quality dissertation:

Identify the topic of study Comprehensively research the topic and identify the main points to support it Develop the thesis statement for the dissertation (this thesis will ultimately be tested after gathering your data) Develop an outline for the dissertation. This guide should tell you what to write at what specific instance. Here is a sample outline: Topic of the study Introduction. Start with the thesis statement, followed by the objectives of the study. Then, the rest of the introduction should be used to set the background for the study. Literature review: Review relevant resources about the topic. Methodology: Explain the methodology that was used during the study. Is Results and analysis: Provide the results gathered during the study. Discussion and conclusion: Here, you should discuss the study results and demonstrate whether they approve or disapprove the thesis statement. If you found any gaps in the previous studies, highlight them too and call for further studies. Bibliography: This is a list of all the resources you used to prepare the paper. Write the first draft following the outline we have just listed above. Write the final copy by refining the first draft, proofreading, and editing it.

Awesome Public Health Thesis Topics

Here are the leading thesis topics in public health for top grades. You can use them as they are or tweak a little to suit your preference.

Public Health Thesis Topics In Mental Issues

• What is the role of public health in addressing mental issues in society?
• Seasonal affective disorder: A review of the disorder’s prevalence rates.
• Society should always listen to the needs of mentally ill persons.
• Eating disorders in adults: A review of the treatment strategies used for adults in the UK.
• What is the relation between climate change and emerging public health issues?
• Comparing depression prevalence rates in the UK to those of the US.
• What are the main causes of anxiety disorders in society?
• A review of the connection between HIV/AIDS and mental health issues in society.
• Running a public health facility: What is the most important equipment?
• Emerging public health issues in developing countries.
• Analyzing the psychological problems of breast cancer.
• What strategies should people use to prevent their mental health from social media dangers?
• A review of the public health benefits associated with active lifestyles.
• Stress: Why is it a major risk factor for mental health in many communities?
• What are the most common mental health issues in society today?
• Comparing the rates of depression and stress in China and the UK.
• Addressing anxiety-related disorders: Is cognitive-behavior therapy the best treatment method?
• A review of the economic burden of living with a person suffering from anxiety disorders.
• How does depression impact the quality of life?
• Comparing training of public health officers in the US to India.

Unique Research Topics In Public Health

• Surrogacy: A review of associated ethical issues.
• Prevalence of medical errors in hospitals: A review of the policies used to prevent the problem in the United States.
• Blood transfusion: What are the side effects?
• A review of doctors’ roles in promoting healthy lifestyles.
• Maintaining healthy body weight: Comparing the effectiveness of the recommended methods.
• A review of organ donation trends in Europe and Asia.
• Analyzing the ethical factors around cloning: When should it be allowed?
• The ethics of human experimentation.
• Comparing the rates of heart attacks in women to men in the United States.
• What are the main causes of heart attacks? Can it be prevented?
• Progress in diabetes studies and treatment: Is it possible to get a cure in the future?
• Biological weapons and their impacts on society: A review of the Leukemia rates in Japan.
• Pre-diabetes in children: What are the main symptoms, and how can it be addressed?

Public Health Paper Topics On COVID-19

• How will COVID-19 change life?
• What are the advantages and disadvantages of self-isolation?
• Life lessons that you learned during the COVID-19 pandemic.
• What challenges has your community faced during COVID-19 pandemic?
• School life during COVID-19 pandemic.
• A review of mass media operations during pandemic.
• What projects did you undertake during the pandemic?
• A review of projects that your community undertook during the COVID-19 pandemic.
• A closer look at the backlash against Asians in Europe at the start COVID-19 pandemic period.
• Preparing for the next pandemic: What lessons did the world learn from the COVID-19 pandemic?
• The best strategies for staying healthy during a pandemic.
• Is there anything that we could have done to prevent the COVID-19 pandemic?
• Comparing the effectiveness of Europe and American healthcare preparedness for tackling disasters.
• A review of mental health status in a community of your choice during the COVID-19 pandemic.
• A review of COVID-19 emergence theories: Which one do you think is more credible?
• Comparing the impacts of the COVID-19 pandemic to Ebola.
• Vaccines development for viral infections: What made the development of the COVID-19 vaccine possible so fast, whereas that of HIV/AIDS has taken so long?
• A review of the vaccine development process.
• Time for review: How effectively do you think your government responded to the COVID-19 pandemic?
• Rethinking public health on a global scale: Demonstrating why effective healthcare is only possible when looked at globally.

Interesting Public Health Research Topic Ideas

• What is the importance of learning public health in school?
• Identify and review a common public health issue in your community.
• The history of human health: Comparing what was considered healthy in ancient times to what is referred to as healthy today.
• Going vegan: How can it impact your health?
• Excessive weight: Is it the new threat to human civilization?
• Is bodybuilding healthy?
• Body positive: Is it a new health standard or ignorance of body issues?
• Things to consider when selecting healthy food to eat.
• Why psychological health should be part of every community in society.
• The health of newborns: What is the difference between their healthcare and that of adults?
• Emerging trends in the healthcare industry: How can the latest trends benefit society?
• Comparing depression and anxiety in two countries of your choice.
• Physical wellness must include healthy behavioral patterns and nutrition.
• A sense of belonging is paramount to personal and community health.
• What is the relationship between spirituality and public health?
• A review of stigmatization of mental health issues in a community of your choice.
• Is it possible to prevent depression?
• At what point should children start learning sex-related education?
• Comparing the two main public health issues in two cities: London and New York.
• What is the relationship between poverty and public health?

Hot Researchable Topics In Public Health

• The resurgence of measles in society: The best guidance for clinicians.
• Tackling the growing national drug problem.
• Bioterrorism preparedness for global disasters.
• A review of recent vitamin D recommendations for older adults.
• Strategies for maintaining maternal mortality at low levels across the globe.
• Efforts by Asian governments to reduce infections from using unsafe water.
• Over-the-counter drug abuse in Europe: Compare two countries of your choice.
• Health care providers’ roles in preventing bullying in society.
• Knowledge management in the UK healthcare organizations.
• The health benefits of good healthcare waste management.
• Characteristics of dental wastes in hospitals.
• Comparing the most prevalent public health issues in developed and developing nations.
• Latest trends in financing public health.
• The relevance of clinical epidemiology in public health.
• Evidence based public health.
• Epidemiological burden of HIV/AIDS in developing countries.
• Addressing cervical cancer in developing countries: Is it possible to eliminate it completely?
• Ethics in public health clinical research.
• Comparing the strategies used in teaching and motivating public health professionals in developing and developed countries.

Research Topics In Public Health For Masters

• Advertising and impacts on food choices in the community.
• The use of stem cell technologies for cancer treatment: What are the latest trends?
• Bio-printing: Is it the future of organ transplants?
• Nutrition education: How does it promote healthy diets?
• Exercising: What role does it play in promoting strength and balance in the elderly?
• Weight loss surgery: What are the key advantages and disadvantages?
• Heart disease is a major public health issue in society.
• Alternative strategies for treating depression in society: Are they effective?
• Healthcare leadership and its importance in public health.
• Legal aspects of public health care in the society.
• Mental disabilities in patients: A review of the emerging trends in the UK.
• How does the United States promote the development of public health?
• Inequalities in medicine: What impact does it have in public health?
• The most controversial issues in public health in the UK.
• What are the most preferred storage systems for medical supplies in the UK public health facilities?
• Reimagining the public health systems on the globe: Where do you see the UK health system in the next 20 years?

Top Thesis Topics In Dental Public Health

• Common oral health issues in Ireland.
• A review of common problems of endodontically treated teeth.
• The role of good leadership skills in dental education.
• Child management techniques between male and female practitioners.
• What role does ergonomics play in dentistry?
• Dental material and bio-engineering: What are the latest trends?
• A review of the relationship between diabetes and oral health in the society.
• The role of electronic health care record systems used in public health.
• Comparing dental health issues in the developing and developed countries.
• A review of public awareness of dental health issues in a community of choice.
• How can you ensure that all the food you buy is safe and healthy?
• What strategies are used by your local health community to promote dental awareness?
• Dental health management in California: What do you think should be done differently?
• Are you satisfied with the strategies used to address dental issues?

Hot Thesis Topics Public Health

• Mandatory overtime work for medical staff: How does it impact their commitment to their job?
• Nursing shortage and its impact in public health.
• Strategies for improving public health in the EU.
• Mental health issues among asylum seekers in the United States.
• Common mental issues among veterans returning from war: A case study of the United States.
• What functions does management play in healthcare settings when handling key public health issues?
• How poor relationships between nurses and doctors can impact public health services delivery.
• Third-party players in public health and their roles.
• Financial reporting standards in public health facilities.
• What is the correlation between revenue collection in society and the quality of patient services?
• Reviewing the coordination of public health officials during disasters.
• The importance of staff training on quality of health services.
• Comparing the differences between alternative medicine and conventional medicine in addressing public health issues in society.
• Obesity: What are the main causes in child-going age?
• A review of health consequences of caffeine.
• Medical marijuana: What are the main pros and cons?
• A review of the US Farm Bill Amendments that legalized use of cannabis in the US.
• Doing sports: Is it always healthy?
• Low-fat or low-carb diet: Which one is better in addressing overweight and diabetes issues?
• Preventing communicable diseases: Evaluating the prevention strategies used in Asia.
• What is the estimated cost of treating heart problems?

Controversial Public Health Dissertation Topics

• Smoking and impacts of current efforts to address cancer in the society.
• A review of the main causes of heart attacks in society today.
• Tobacco ads: Evaluating their impacts and the relationship to the current cancer trends in the society.
• Sleep disorders: Explain why they should be considered a public health issue.
• Staffing shortage and the impacts in fighting COVID-19 pandemic in Asia.
• Analyzing risk management of treating different diseases in the community.
• COVID-19 pandemic in numbers: Comparing the infection rates in the developed and developing countries.
• Reviewing strategies used in the US public health system to achieve equity: How effective are they?
• Analyzing the main challenges in the UK medical care system.
• Rising cases of suicides in the society: What are the main causes?
• A comprehensive review of strategies used to prevent suicides in the 21st century in the US.
• Use of vaccines to prevent diseases: Do adults still need the vaccines?
• Heat-related deaths: What strategies should be adopted?
• Chronic-diseases prevention: Comparing the strategies used in developing and developed countries.
• Are we becoming too dependent on antibiotics in fighting diseases?
• Opioid crisis: Are the doctors to blame for it?
• Use of blockchain in growing accuracy of clinical trials in medicine.
• What dangers are posed by nuclear wastes in society?
• Assessing US industrial facilities compliance rates to cut down emissions.
• Using clean energy as a strategy of improving public health: What are the expectations?
• What is the healthiest country?
• Evaluating the correlation between gaming and deviant behavior among children in society.
• COVID-19 could have been prevented if WHO was more vigilant?

Public Health Research Questions

• Is the high cost of medical healthcare in the United States justified?
• What is the correlation between poverty and poor health in society?
• Should health care for homeless people be free?
• Unconventional medicine: Should it be part of the UK healthcare system?
• Should doctors be responsible for medical errors?
• Should medical officers or health facilities be allowed to promote selective medical products?
• Should all healthcare facilities in the UK be required to have translators for non-English speaking clients?
• Mental health issues associated with domestic violence: A case study of France.
• Is it a good idea to legalize euthanasia?
• What are the benefits of using surgical masks in public?
• What are the most important lessons from the different waves of the COVID-19 pandemic reported on the globe?
• Who is more responsible for the COVID-19 pandemic?
• Ebola or COVID-19 pandemic: Which is worse?
• What are the main causes of epidemics on the globe?
• Public health planning: What are the most important things to think about?
• Should governments pay the cost of rehabilitating drug addicts in society?
• Teaching children healthy lifestyles: What are the best strategies?
• What problems do people with autism face in society?
• What are the leading causes of child mortality in your community?
• Gun violence in the United States: Should it be considered a public health issue?
• What illnesses are considered foodborne?

Easy Topics In Public Health

• All workplaces should support breastfeeding.
• What are the best strategies to reduce pollution in society?
• Public health benefits of recycling waste in society.
• Reviewing the causes of poor water quality in the developing world.
• Comparing water quality standards policies in the UK and US.
• Health impacts of the rapid depletion of o-zone depletion.
• Better planning of infrastructural development is important for healthier societies: Discuss.
• The US is better prepared to handle pandemics that might arise after the COVID-19 pandemic. Discuss.
• A review of common diseases spread by vectors.
• A review of key policies installed to protect employee health.
• Legal age for consuming energy drinks should be set by the government to address the problem of diabetes.
• Smoking: Should it be banned in public?
• What are the best strategies for raising awareness in public?
• Can reducing the workload of employees in manufacturing facilities improve their health?
• Sunbathing should be restricted to prevent the risk of cancer: Discuss.
• Should abortion be banned in society?
• School-related stress: How can it be prevented?
• Should birth control be made available and free for all teenagers?
• What should be categorized as a bad health habit?
• Compare and contrast two common treatment methods for treating behavioral disorders.
• Internet addiction: What are the main dangers of internet addiction?

Other Public Health Topics For Research

• How to stay healthy and safe during a pandemic.
• Using a bicycle instead of driving is healthier.
• Common mental disorders in India.
• What is the biggest health issue among young people?
• The impact of exercising in teenagers.
• Why do teenagers experiment with drugs?
• What impact does dispositional violence have on mental disorders?
• Is telemedicine helpful in promoting better healthcare?
• Unproven alternative medicine: What are the associated risks?
• What alternatives do we have for antibiotics?
• What is the difference between private and public healthcare?
• A review of the main health issues associated with puberty.
• What is the most dangerous disease of the 21st century?
• Why are some people still afraid of vaccines?
• Experimental treatment: Why do people agree to undergo it?
• How can we improve the health of people living with chronic illnesses?
• The best strategies to make people aware of the basics of healthcare.
• A review of the growing awareness about reproductive health in the society.

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• APE and Thesis/Capstone

What is applied practice experience?

An Applied Practice Experience (APE) is a unique opportunity that enables students to apply practical skills and knowledge learned through coursework to a professional public health setting that complements the student’s interests and career goals. The APE must be supervised by a Field Supervisor and requires approval from an APE Advisor designated by the student’s academic department at RSPH. To successfully fulfill the APE requirement, students must a) complete a minimum of 200 clock hours in one or two public health agencies, institutions or communities; b) meet student-selected MPH foundational competencies and concentration competencies; c) produce at least 2 deliverables that benefit the APE agency; d) enter and track all APE-related information, deliverables and required approvals in the RSPH APE Portal; and e) registration in the student’s Department 595 course (i.e. BSHE 595, BIOS 595, etc.) is required in the student’s final semester of enrollment. See MCH Practicum Approval Form here .

Prior to the start of a student’s APE, the student must receive departmental approval, and for MCH Certificate requirements, it must be MCH-focused.

Organization : Motherhood Beyond Bars

Location : Atlanta, GA

Project Description :

• Conducted childbirth education and social support through group discussions to pregnant women at Helms Prison under the Georgia Department of Corrections
• Reviewed curriculum used for the postpartum education at Lee Arrendale State Prison

Organization : International Livestock Research Institute (ILRI).

Location : Nairobi, Kenya

• Informed the development of program activities including gender strategies and nutrition and health programming
• Worked to improve food security and reduce poverty and undernutrition through research for better and more sustainable use of livestock

Organization : Families First Health and Support Center

Location : Seabrook, NH

• Provided education and support to parents and young children ages 1-3
• Assisted the prenatal program with intake procedures and data entry for patient satisfaction surveys
• Provided education and support for patients to register for the clinic’s Patient-Centered Medical Home Guidelines online patient portal
• Assisted the nursing/primary care department with patient outreach activities.

Organization : Emory Farmworker Project

Location : Valdosta, GA; Bainbridge, GA

• Created educational tools that addressed domestic violence, screening, and available resources for the female migrant farmworker population

Organization : IMA World Health

Location : Democratic Republic of Congo (DRC)

• IMA World Health operates its Projet d’Accès aux Soins de Santé Primaire (ASSP) [ Access to Primary Health Care Project ]
• Understand community attitudes and perceptions of Movie Night health messaging and media in order to provide information on future film plots or needed modifications to be made prior to scale-up in other provinces that ASSP serves
• Movie Night consisted of videos about malaria, girls’ education, and early marriage

What is a thesis?

Thesis Projects help students develop skills in conducting research and analyzing, interpreting, and processing study findings.

Any project from a public health work experience, volunteer position, applied practice experience, or global field experience has the potential to lead to a thesis. See MCH Thesis/Capstone approval form here .

What is a capstone?

Capstone projects allow students to explore a topic of interest in depth—possibly expanding a course project or applied practice experience into new dimensions—to increase practical skills and experience, sharpen presentation skills, gain peer feedback, and increase career development. See MCH Thesis/Capstone approval form here .

Examples of theses and capstone projects

Below are some of the theses and capstone projects that students enrolled in the MCH Certificate Program have completed. A more comprehensive list can be found  here . 

Pregnancy and Perinatal Health

• The Influence of Changing Social Norms on Qatari Women’s Perceptions of Gender and Empowerment During Pregnancy
• Syphilis in Pregnancy and Associate Adverse Outcomes: Global Estimates and Analysis of Multinational Antenatal Surveillance Data

Child Health

• Body Mass Index and Waist-to-Height Ratio in Children Ages 6-17: A Comparison of the United States and India
• Examining Characteristics of Children with Spina Bifida in a Population-based Surveillance System and a Clinic-based Patient Registry

Adolescent Health

• “Now I am a mother…and I feel like a mother and I’m not a girl anymore”: Pathways to Early Motherhood among Kaqchikel Young Women in Sololá, Guatemala
• Sugars in the U.S. Diet: A Description of Consumption Patterns by Type and Purchasing Practices of Adolescent Consumers

Women’s Health

• Understanding Intimate Partner Violence, HIV, and Community Based Resources Through a Spatial Lens among Women in Atlanta, Georgia
• A Qualitative Analysis of Barriers to Legal Abortion Access Experienced by Colombian Women

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Maternal and child health news, resources and funding for global health researchers

Fogarty has a strong commitment to improving the health of children, adults, families and communities throughout the world. Several Fogarty programs currently address issues related to maternal and child health, including vaccinations, trauma, birth defects, prevention of mother-to-child transmission of HIV (PMTCT), fetal alcohol syndrome and childhood nutrition.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) leads NIH research efforts in the fields of child health and development, including pregnancy and fertility. The NIH Office of Research on Women's Health (ORWH) works in partnership across NIH to ensure that women's health research is part of the scientific framework at the NIH and throughout the scientific community.

Fogarty participated in the MAL-ED program to investigate linkages between malnutrition and intestinal infections and their effects on children in the developing world. Fogarty and NIH partners also support research to reduce household air pollution from elemental stoves for cooking or heating, which impacts women and children.

Fogarty Grants

View a full list of active and recent grant awards focusing on maternal and child healthresearch

Recent Maternal and Child Health News

• WHO and UNICEF launch free online course to address children’s environmental health WHO news, March 13, 2024
• Identifying barriers to life-saving diarrhea care NIH Research Matters , March 5, 2024
• Progress Toward Rubella and Congenital Rubella Syndrome Elimination — Worldwide, 2012–2022 Morbidity and Mortality Weekly Report , February 29, 2024
• Intervention reduces likelihood of developing postpartum anxiety and depression by more than 70% NIH news, February 26, 2024
• Progress Toward Measles Elimination — World Health Organization Eastern Mediterranean Region, 2019–2022 Morbidity and Mortality Weekly Report , February 22, 2024
• Utilization of opportunistic cervical cancer screening in Nigeria , co-authored by Fogarty Emerging Global Leader Jonah Musa Cancer Causes and Control , January 2024

NIH News and Resources

• NIH Office of Research on Women's Health (ORWH): Global Health Research
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): Office of Global Health (OGH)

Other US Government Resources

• United States Agency for International Development (USAID):  maternal and child health
• Centers for Disease Control and Prevention (CDC): maternal and infant health
• Health Resources and Services Administration (HRSA): Maternal and Child Health Bureau

Other Online Resources

• Integrated Public Use Microdata Series (IPUMS), supported in part by the NIH: Harmonized international survey data on maternal, child and reproductive health
• Kaiser Family Foundation Fact Sheet: The U.S. Government and Global Maternal, Newborn and Child Health
• Saving Lives at Birth: A Grand Challenge for Development USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, DFID and KOICA
• WHO on Maternal Health
• Global Strategy for Women's, Children's and Adolescents Health 2016-2030 , published 2015
• WHO report: Air pollution and child health: prescribing clean air , published October 2018
• Maternal Health
• Child Mortality  
• UNICEF annual State of the World's Children reports

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• Volume 6, Issue 4
• Systematic review of the concept ‘male involvement in maternal health’ by natural language processing and descriptive analysis
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• http://orcid.org/0000-0003-1427-5067 Anna Galle 1 ,
• Gaëlle Plaieser 1 ,
• Tessa Van Steenstraeten 1 ,
• Sally Griffin 2 ,
• Nafissa Bique Osman 3 ,
• Kristien Roelens 4 ,
• Olivier Degomme 1
• 1 ICRH, Department of Public Health and Primary Care , Ghent University , Gent , Belgium
• 2 International Centre for Reproductive Health - Mozambique (ICRHM) , Maputo , Mozambique
• 3 Departamento de Obstetrícia e Ginecologia , Universidade Eduardo Mondlane , Maputo , Mozambique
• 4 Department of Human Structure and Repair , Ghent University , Gent , Belgium
• Correspondence to Dr Anna Galle; anna.galle{at}ugent.be

Introduction Experts agree that male involvement in maternal health is a multifaceted concept, but a robust assessment is lacking, hampering interpretation of the literature. This systematic review aims to examine the conceptualisation of male involvement in maternal health globally and review commonly used indicators.

Methods PubMed, Embase, Scopus, Web of Science and CINAHL databases were searched for quantitative literature (between the years 2000 and 2020) containing indicators representing male involvement in maternal health, which was defined as the involvement, participation, engagement or support of men in all activities related to maternal health.

Results After full-text review, 282 studies were included in the review. Most studies were conducted in Africa (43%), followed by North America (23%), Asia (15%) and Europe (12%). Descriptive and text mining analysis showed male involvement has been conceptualised by focusing on two main aspects: psychosocial support and instrumental support for maternal health care utilisation. Differences in measurement and topics were noted according to continent with Africa focusing on HIV prevention, North America and Europe on psychosocial health and stress, and Asia on nutrition. One-third of studies used one single indicator and no common pattern of indicators could be identified. Antenatal care attendance was the most used indicator (40%), followed by financial support (17%), presence during childbirth (17%) and HIV testing (14%). Majority of studies did not collect data from men directly.

Discussion Researchers often focus on a single aspect of male involvement, resulting in a narrow set of indicators. Aspects such as communication, shared decision making and the subjective feeling of support have received little attention. We believe a broader holistic scope can broaden the potential of male involvement programmes and stimulate a gender-transformative approach. Further research is recommended to develop a robust and comprehensive set of indicators for assessing male involvement in maternal health.

• maternal health

Data availability statement

Data are available on request. Data analysed during the current study will be made available from the corresponding author on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjgh-2020-004909

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Key questions

What is already known.

Increasing male involvement (MI) in maternal health (MH) is considered to be a promising and effective intervention for improving maternal and newborn health outcomes.

MI is described as a multifaceted concept in the quantitative literature, although a multidimensional evidence-based set of indicators is lacking.

In qualitative literature MI is often described by men and women from different settings as the male partner ‘being there’, meaning giving physical and emotional support.

What are the new findings?

Conceptualisation of MI in MH in the literature is done by focusing on either the psychosocial aspects or on MH care utilisation. The attention given to one or both aspects resulted in the use of different indicators and depended on the geographical context of the study.

Overall MI was most often measured by instrumental actions such as presence at health services, financial support or providing transport. Other aspects of MI, such as communication, emotional support and shared decision making, have received little attention, especially in low-income and middle-income countries.

What do the new findings imply?

More research into other aspects of MI (such as the subjective feeling of perceived support and shared decision making) can broaden the potential of MI programmes and also reveal and minimise potential negative side effects of MI interventions.

A more holistic assessment of MI in MH, exploring different aspects of MI, could facilitate researchers to generate more robust findings, strengthening the existing evidence on MI programmes.

Since the 1994 Cairo Conference, where men’s involvement in contraception, family planning, maternal health and child health was emphasised, research has increasingly paid attention to men’s role, responsibilities and behaviour in sexual and reproductive health. 1 Evidence about the positive impact of male involvement (MI) in maternal health on maternal and child health outcomes has been widely published in the last decade 2–6 and recently WHO included active involvement of men during pregnancy, child birth and the postpartum period as an effective strategy to improve maternal as well as newborn health outcomes in their 2015 recommendations on maternal and newborn health (MNH) promotion interventions. 7

However, no common set of evidence-based indicators exists for assessing MI in maternal health, despite considerable evidence about the positive impact. Researchers seem to agree that MI is a multifaceted term but the concept itself has taken different forms according to the context and researcher’s interest. Looking through the lens of Prevention of Mother to Child Transmission (PMTCT) programmes, for example, researchers often focus primarily on male presence at antenatal care (ANC) and HIV testing 3 8–10 as the core indicators for MI, without paying attention to other aspects of involvement in maternal health. This single measurement assumes that male partner presence is always a positive action and that men who do no not attend services are inherently ‘not involved’. 11 However, it is well known that in many health systems men face multiple barriers to being present during ANC such as privacy issues, overcrowded ANC consultations, stigmatisation and strong prevailing gender norms. 12–14 Consequently, the fact that he is or not present might not correspond to his intentions of being involved or actual (supportive or unsupportive) behaviour outside the health facility. Limited research has also highlighted the negative side of male presence at ANC. 12 15 16 In some cases it might be an act of dominance and control, thereby limiting women’s ability to actively participate in the conversation during the ANC consultation. 12 All these arguments should be taken into account when measuring MI based on a single indicator.

Looking at the qualitative literature there seems to exist some consensus regarding the meaning of MI globally, with slightly different accents according to the context. A study in rural South Africa showed that MI was understood as giving instrumental support to female partners through financial help, helping with physical tasks and providing emotional support. 17 In Mozambique, MI was seen as ‘taking care of the family’ in various ways such as providing financial support, making the decisions and showing love towards the partner. 12 In two Arabic countries, MI was described as being accessible, present and available in addition to being supportive and encouraging. 18 Studies from the USA found that MI meant ‘being there’, both emotionally and physically, by doing household chores or listening attentively to the woman’s concerns. 19 20 African-American parents in the USA summarised MI as being present, accessible, available, understanding, willing to learn about the pregnancy process and eager to provide emotional, physical and financial support. 21 Despite the common construct of ‘being there’, often meaning supporting financially, emotionally and being physically present, this has not yet been translated into a set of robust quantitative indicators for measuring MI. Nevertheless more recently studies have started to construct composites or a collection of indicators for measuring MI, instead of focusing on a single item. 22 23 Furthermore, factors such as financial support, birth preparedness, decision making and participation in household chores have been included as MI indicators. Some studies also included reports of the male partner himself, often resulting in contradicting findings between men and women. 24

Despite the growing number of studies in the field of MI in maternal health, no consensus exists regarding the number and content of indicators for assessing MI in maternal health, although several authors have argued that evidence based indicators are necessary for improving the quality of the available evidence. 3 16 25 With this review, we want to explore to what extent the research community has assessed different dimensions of MI in maternal health and which patterns we can identify in the selection of indicators globally. Only by looking at MI through a broader lens can potential implications of MI interventions on different outcomes such as gender equality, psychosocial health (PSH) and couples birth preparedness be explored and improved.

The primary aim of this systematic review is to examine the conceptualisation of MI in maternal health in the quantitative literature of the last 20 years. As secondary objective we want to critically review and discuss commonly used indicators.

Protocol and registration

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement of 2015 guidelines. The protocol was submitted on the 22 February to International prospective register of systematic reviews (PROSPERO) and published online on the 10 July 2020 under registration number CRD42020169078. Due to the COVID-19 crisis, the PROSPERO register was prioritising submissions related to COVID-19, causing a delay in the registration.

Eligibility criteria

The systematic review included all types of quantitative studies involving indicators or variables representing MI in maternal health published in the last 20 years. MI was defined as the participation, engagement or support of men in all activities related to maternal health. Maternal health was defined according to WHO as the period from conception until 6 weeks after childbirth, thus covering pregnancy, childbirth and the postpartum period.

A search strategy was developed by AG with inputs from OD. This search was refined with the help of the librarian of Ghent University. The systematic review involved a literature search of the PubMed, Embase, Scopus, Web of Science and CINAHL databases for peer-reviewed journal articles. Iterative modifications to the original search strategies were conducted, to assure that the observed variations in terminology were adequately reflected in both the index terms and the text-based queries for each database. A final search was conducted on the first of May 2020. Grey literature was identified through the WHO Reproductive Health Library and using Google with relevant keywords. The search strategy for PubMed can be found in online additional file 1 . The outputs of the search were exported to Mendeley desktop V.1.16.1, and duplicates were removed. Subsequently, the titles and abstracts of the studies were imported into Rayyan. Two rounds of screening were applied, first, by title and abstract, followed by full text. Two reviewers independently screened and appraised all eligible articles using preset criteria, and in case of disagreement consensus was reached through discussion. Exclusion criteria were: using only qualitative methodology, systematic review studies, conference abstracts, data collection only in the postpartum period (without any assessment during pregnancy or childbirth), articles without any measurement of the role of the partner, non-English language articles, and studies limited to testing of the male partner for HIV or other sexually transmitted infections without mentioning male support, involvement, engagement or participation. While originally also qualitative studies with a clear conceptualisation of MI were included, it was decided to exclude all qualitative studies for this particular review during the first screening phase because they required a different approach of data extraction and analysis.

Supplemental material

In the second stage of screening, full texts were obtained for the screened abstracts. If the article was unavailable through an online search, the article reach system of Ghent University was used to obtain the articles or the authors were contacted to request the full text publication. The same criteria were applied for inclusion and exclusion as in the first stage of screening together with a quality appraisal.

Quality assessment

Papers selected for retrieval in the second stage were assessed by two independent reviewers for methodological validity prior to inclusion in the review, using standardised critical appraisal instruments from the Joanna Briggs Institute (including the checklist for analytical cross sectional studies, cohort studies, prevalence studies, quasi-experimental studies, randomised controlled trials, case–control studies and systematic reviews). Studies with a score below 50% were excluded, because they often lacked essential information for this review. A relatively low threshold was used for inclusion because we wanted to examine the concept of MI used by the wider scientific community on a global scale, rather than limiting our results to a few high-quality studies.

Data extraction and analysis

A pretested data extraction framework in Microsoft Excel was used to extract and chart data from the reviewed articles. The standard data extraction table included authors, publication year, topic of study, the exact term used for describing MI in the study, study design, geographical location of study, definition of MI (if given), indicators used for measuring MI, data sources and quality assessment. Only indicators used in more than five of the included studies were retrieved for the results section and studies referring to a scale of more than 10 items (always psychosocial scales) were categorised as ‘psychosocial scale measurement (>10 items)’. Data extraction of every article was done by a team of three researchers. AG screened all articles and GP and TVS independently each screened 50% of the articles. Disagreement (<10%) was resolved by discussion or consultation with one of the supervisors (OD) if needed. Topic allocation was done by an overall thematic analysis of the article, more specifically by reflecting on which particular aspect of maternal health the study was focusing. The topics were inductively created and discussed until agreement was reached among the three reviewers responsible for data extraction. After an initial phase of renaming and discussing the topics, eventually all articles were given one of the following four ‘core topics’: PMTCT, PSH, abortion and MNH. Articles were categorised as PMTCT if they focused on care for women living with or at risk of HIV (to maintain their health and prevent transmission to their babies), including studies focusing on male HIV testing and prevention. PSH categorised studies focused on social and emotional aspects of male partners’ role in maternal health, mainly consisting of articles regarding perinatal depression and stress. Studies categorised as abortion focused on women considering or having experienced an induced or spontaneous abortion. The topic MNH included all studies focusing on MI in MNH, excluding the previous categories (PMTCT, PSH or abortion). The data of the data extraction sheet were cleaned and subsequently analysed using descriptive statistics (more specifically frequencies) and examining associations by inferential statistics. Fisher’s exact test was used for assessing differences in the main topic according to terminology and according to continent. In addition, CIs were calculated for visualising differences in proportions in the in use of indicators according to terminology.

For visualisation and confirmatory analysis of the data from the included articles, text mining by R with the tidytext package was used for natural language processing, 26 and both the ggplot package in R and matplotlib package in Python for the graphs. The decision to conduct these analysis was taken after the final screening phase, motivated by the high number of included articles and the nature of the data (including different underlying topics and patterns). First a test set of 20% of the data was used for writing the text mining scripts, which were refined once the full dataset was entered. The statistic ‘term frequency-inverse document frequency’ (tf-idf) in combination with n-grams was calculated for assessing the importance and structure of certain word combinations within the collection of articles (referred to as ‘corpus’). A word’s tf-idf represents the frequency of a term adjusted for how rarely it is used. The statistic tf-idf is intended to assess how important a word is to a subset of documents in a collection of documents or corpus. 26

Lastly, latent Dirichlet allocation (LDA) was used for Topic modelling, which is a commonly used algorithm for topic modelling in text mining, aiming at discovering a given number of topics within a set of documents (=the so-called ‘corpus’). 26 An LDA algorithm automatically generates keywords per topic and their weight (or ‘importance’). 27 Keywords can correspond to more than one topic, but generally with different weights (the keyword will be more or less important in one topic compared with another). This is an advantage of topic modelling as opposed to ‘hard clustering’ methods: topics used in natural language could have some overlap in terms of words. 26 An essential step of the LDA algorithm is assigning each word in each article to a topic. As a consequence, each document is composed of multiple topics but typically only one of the topics is dominant. 27 The more words in a document are assigned to a particular topic, generally, the more weight (also called ‘gamma probabilities’) will go on that document-topic classification. 26 As such, it is possible to determine to which topic every document corresponds dominantly. LDA modelling was used in our study to identify meaningful topics within the complete set of included articles and subsequently allocate every article to one of the generated topics.

Electronic database searches identified 5277 titles and abstracts, with a further 7 identified through the grey literature search. After removal of duplicates, 3975 articles were screened by title and abstract, resulting in 569 potential articles to be included. After reviewing the full text of these articles, 282 unique studies were included in the systematic review. A flow chart regarding the inclusion of articles can be found as an additional file ( online additional file 2 ).

Characteristics of included studies

Of all included studies, most studies were conducted in Africa (43%), followed by North America (23%), Asia (15%) and Europe (12%) (see table 1 ). The majority of studies collected data from women only (58%), while 20% collected data from both men and women and around 16% collected data from men only. Registry data were used in 6% of studies and mostly referred to hospital files indicating the presence of men during ANC. Terms used to assess the role of the male partner were: involvement, support, engagement, participation, attendance and presence. Most studies used a cross-sectional design (58%), followed by a longitudinal design (23%). Only around 6% of the studies used a randomised controlled trial design. One in 10 studies did not give a clear definition of the indicator used for assessing MI (or one of the similar terms listed earlier). While 35% of studies used a single indicator for assessing MI, most studies (63%) used a combination of indicators for measuring MI. Two-fifths (40%) of studies used ANC attendance as one of their indicators for assessing MI and one in six studies used financial support or transport (17%) and presence during delivery (17%). Around 14% of studies used the indicator HIV testing. All indicators that were used to assess MI can be found in table 1 . Core topics of the studies were PSH (32%), MNH (48%), PMTCT (18%) and abortion (3%). All categories within table 1 were mutually exclusive except for the used indicators.

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Characteristics of the included studies

Terminology used for describing the role of the male partner

Studies using the term ‘male attendance’, ‘male participation’ or ‘male engagement’ to describe the role of the male partner did not significantly differ from studies using the term ‘MI’ in the use of the most common indicators (ANC attendance, financial support or transport, presence at delivery, HIV testing, psychosocial scale measurement and communication about ANC). Results of the Fisher’s exact test per indicator can be found in online additional file 3 . We consider these terms as synonyms for the remaining results section.

Studies using ‘male presence’ to describe the role of the male partner always used presence at delivery as their only indicator and differed significantly (p=0.034) in the use of indicators from studies using the term MI.

Studies using the term ‘male support’ to describe the role of the male partner showed a significant difference (p<0.001) in the use of indicators compared with the term ‘MI’. Studies referring to the role of the partner as ‘partner support’ used more often complex psychosocial scales (>10 items) such as the Tilburg Pregnancy Distress Scale 28 or Social Support Effectiveness Questionnaire. 29

A comparison between the use of indicators for the terms using involvement/engagement/attendance or participation versus support with the respective confidence intervals can be found in figure 1 . Studies using the term ‘male presence’ were excluded from this specific analysis because they always used presence at delivery as single indicator for MI, resulting in 276 included studies (n=276).

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Use of indicators according to the term involvement (engagement/attendance/participation) versus support (n=276). ANC, antenatal care.

The use of different indicators for assessing the role of the male partner

Among all studies using the term MI/engagement/attendance or participation, a wide range of indicators was used, often assessed in different ways. We found studies aiming for an in-depth comprehensive assessment of MI through the use of extended surveys for both men and women, combining different indicators (≥3) for assessing MI (n=26). These studies (see reference list in online additional file 4 ) were not limited to a certain region or topic, indicating researchers have tried to assess MI in a multidimensional way all over the world. Several authors refer to previously developed scales or indexes, such as the MI index of Byamugisha et al , 23 but almost all studies eventually create their own unique composite. We also found studies assessing MI very simply by using service registry data retrospectively and defining MI as having the father’s name written on the birth certificate (n=7). In conclusion, no common set of indicators could be identified for measuring MI/engagement/attendance or participation.

ANC attendance as a single indicator (n=26) was common in studies in low-income countries (LICs), with majority of studies deriving from Africa, Asia and South America and only two studies from North America. On the other hand, presence at delivery was used as an indicator in all continents, suggesting it is a more ‘universal’ indicator. Financial support, which was used in all continents except in South America, was also used frequently globally as an MI indicator. HIV testing was a typical indicator in African countries and the use of psychosocial scales was more common in North American and European studies.

We were also able to identify some patterns when we examined which studies used less common indicators and why. Studies defining MI by having a father/partner registered on birth certificates (n=9) were most often conducted in North America (six out of nine studies), using big datasets and focusing on neonatal health outcomes. Studies focusing on knowledge of danger signs (n=12) were typically derived from LICs (11 out of 12 studies) and focused on maternal health outcomes (11 out of 12 studies). Studies using condom use (or communication about condom use) as an indicator of MI always derived from an African country and focused in the majority of cases on PMTCT (8 out of 12 studies).

The relationship between terminology, continent of the study and topic

A scatter plot showing the relationship between the continent of the study, the topic of the study and the terminology can be found figure 2 . A significant difference was found in the term used in the study according to continent (p<0.001) and topic (p<0.001). Studies using the term ‘support’ were more often conducted in Europe, North America, Australia and Asia, while the term ‘involvement’ was most often used in Africa and South America. All continents had studies using both terms.

Jittered scatterplot showing the relationship between the manually classified topic, continent and terminology of the different studies included in the review (n=282). MNH, maternal and newborn health; PMTCT, prevention mother to child transmission; PSH, psychosocial health.

Looking at the main topic of the study (manually given during data extraction), we also found a significant difference according to continent (p<0.001). The topic ‘PMTCT’ was most prevalent in Africa while the topic ‘PSH’ was common for studies from Europe and Australia (see figure 2 ).

In line with the indicators used for measuring male support (which mostly used psychosocial scales), studies using the term ‘support’ also more often had as their main topic ‘PSH’ (p<0.001) (see figure 2 ).

Text mining: highly used words according to continent

Pairs of two consecutive words, referred to as ‘bigrams’, were examined by text mining using the tidypackage. The tf-idf statistic was calculated for the bigrams in the corpus. Subsequently the top 15 words were ranked per continent. The continents Australia and South America were deleted during the process because of their low number of articles, 11 and 7 respectively. In figure 3 , the top 15 words per continent are represented in a word cloud, with font size reflecting the tf-idf value, showing the different content of the articles according to continent. The word cloud shows that in Asia MI studies were characterised by a focus on nutrition (reflected by the words ‘maternal nutrition’, ‘healthy moms’, ‘disordered eating’ and ‘added sugar’). In Africa, institutional delivery (reflected by the words ‘skilled delivery’, ‘supervised delivery’ and ‘delivery site’) seem important, as well as PMTCT and birth preparedness. In North America, the words ‘relationship stress’, 'intimate partner violence' (IPV) and 'postpartum depression' (PPD) show that the literature mainly focuses on PSH and the couple relationship. ‘Abortion’ and ‘adolescents’ were more prominent words in the literature in North America compared with other continents.

Word cloud visualising the top 15 bigrams per continent, based on their tf-idf value. tf-idf, term frequency-inverse document frequency.

Latent topic allocation by text mining

Lastly, we conducted a latent Dirichlet topic allocation by setting k=2, to create a two-topic LDA model. A larger number of topics (ie, a larger k) resulted in an unclear pattern of words, which were difficult to interpret. Setting k=2 we could find two meaningful topics in the corpus. First the algorithm identified two topics (topic 0 and topic 1) in the corpus and subsequently we calculated the probability that a word corresponded to topic 0 and to topic 1 (the weights) and similarly the probability that a complete document (or article) belonged to topic 0 and topic 1.

Figure 4 is a grouped bar plot of the top 20 unique key words that are most common within each topic (with the respective word count on the left y-axis and weights on the right y-axis). Especially words with a high weight and low frequency tend to characterise the content of a topic. The top keywords clearly show the two different meanings of the two topics that were extracted from the articles. The most common words in topic 0 include ‘HIV’, ‘PMTCT’ and ‘test’, suggesting that this topic represents the topic of HIV prevention, but also more broadly ANC attendance (by words such as attendance, visit, clinic). The most meaningful words in topic 1 include ‘depression’, ‘stress’, ‘psychological’ and ‘anxiety’, which suggests it may represent studies around PSH. Furthermore topic 1 includes the word ‘father’, while topic 0 only includes the word ‘male’. This might indicate that studies in the field of PSH have a longer follow-up and more often include the period after birth, when the male partner has become a father. Only unique words were included in the graph for clarity, top key words among both topics included ‘women’, ‘pregnant’, ‘maternal’ and ‘child’.

Grouped barplot visualising the top 20 unique keywords per topic with their respective weights and word counts.

The relationship between the computer-driven topic allocation, manually classified topics and continent of the studies

As a confirmatory analysis, we explored how well our unsupervised learning did at distinguishing the different topics in the documents. We would expect that studies that were manually given the topic PMTCT would be found to be mostly (or entirely) part of LDA topic 0 (HIV prevention and ANC attendance) and that studies given the topic ‘PSH’ would correspond to LDA topic 1 (PSH).

We visualised the relationship between the LDA Topics, manual topics, and continents by a scatter plot (see figure 5 ) and calculated the associations between LDA topics and manual topics with a cross-tabulation. The latter demonstrated that the topic PMTCT highly corresponds to LDA topic 0 (HIV prevention and ANC attendance), with 92% (46/50) of the PMTCT studies being classified as LDA topic 0. The topic PSH strongly corresponded to LDA topic 1 (PSH) with 92% (83/90) of the PSH studies classified as topic 1. For the topic ‘abortion’, we saw a higher correspondence with topic 1 (75%; 6/8) (PSH) and lower correspondence with topic 0 (25%; 2/8). The manual topic MNH seemed to correspond to LDA topic 0 (61%; 82/134) and 1 (39%;52/134). In the scatter plot (see figure 5 ), we noted a remarkable difference between LDA topic and manual topic correspondence according to continent, whereby MNH seem to correspond to topic 0 in Africa (HIV prevention and ANC attendance) but to topic 1 in North America (PSH). This indicates that while several studies in North America received the label ‘MNH’ during our manual data extraction, the natural language of studies in North America clearly differs from those conducted in Africa, resulting in another LDA topic (related to PSH).

The relationship between the manual topics, LDA topics and continent of the included studies (n=282). LDA, latent Dirichlet allocation; MNH, maternal and newborn health; PMTCT, prevention mother to child transmission; PSH, psychosocial health.

The broad range of studies in the scientific literature examining and assessing MI have formed the evidence base for promoting MI as a promising strategy for improving MNH outcomes. 2 30 31 With this systematic review, we aimed to examine the conceptualisation of MI in maternal health in the quantitative literature of the last 20 years and critically review and discuss commonly used indicators. Both manual and computer-driven topic allocation showed us that studies in the field of MI in maternal health are mostly conducted to examine PSH on the one hand and maternal health care utilisation (especially ANC attendance, PMTCT services and institutional childbirth) on the other hand.

Despite the consensus that MI is a multifaceted concept, majority of studies seem to focus on only one particular aspect of the concept, resulting in a simplified measurement of MI in maternal health. The latter was illustrated by the high number of studies relying on a single indicator. Furthermore, there was no common set of indicators among studies using a combination of different indicators, almost every study had its own unique composite. Obviously, the measurement of MI depends on the context, but a critical reflection of the measurement is needed for a correct interpretation of the results. This is especially important as the lack of agreement in indicators leads to the risk that researchers only report the most significant variable. In some studies, included in the review, we found that MI was described and defined as a multidimensional concept in the introduction and methods but that in the results section only one indicator was used as ‘the MI indicator’. As a consequence, results might be biased by selecting and reporting only the most significant indicator.

Almost half of the studies focused on presence at ANC or HIV testing and consequently the benefits for mothers and their newborns will mainly be oriented towards the prevention of HIV transmission. This coincides with the implementation of instrumental MI policies in several countries, aiming at improving male attendance at ANC by refusing to attend women without a partner present or giving priority to couples in the waiting line. 12 15 32 33 The negative side effects of introducing such policies for improving male attendance at ANC have started to emerge (such as increased gender inequality, stigmatisation of single women and lower ANC attendance of women 12 34 ), nevertheless they have not led to the elimination of such programmes. This might be related to the strong influence of HIV programmes and donors, where programme success is defined by the proportion of men being tested during pregnancy. 35 In many communities, men attending antenatal healthcare services are perceived as being HIV positive, 36 because historically HIV counselling and testing was the main reason for inviting men in several African countries. 35 Future MI programmes should try to shift away from the focus on HIV testing and break the circle of stigmatisation that has been associated with these programmes.

Certain aspects of MI such as communication, decision making and ‘feeling supported’ were rarely included as MI indicators (10.64%, 8.51% and 6.38%, respectively) in the studies included in our review, while both quantitative and qualitative research have shown that these aspects of men’s involvement play an important role in maternal health care access, utilisation and outcomes. 37–42 The narrow focus on specific actions of men (such as financial support and ANC attendance) without taking into other aspects (such as couple dynamics and gender equality) clearly entails a risk of missing essential information and underreporting negative consequences. The need for greater incorporation of gender-transformative conceptual approaches into MI interventions, with effective measures, was already emphasised by Comrie-Thomson et al. 13 Another recent systematic review reported that worldwide only a minority of the interventions aiming at engaging men and boys in sexual reproductive health and rights (SRHR) includes a gender transformative approach. 43 The authors warn that engaging men and boys in SRHR without explicit attention to gender inequalities can be harmful, particularly when it comes to undermining women’s rights and autonomy. Within the field of MI in maternal health, a number of studies has shown that interventions could unintentionally lead to increased domination of decision-making about pregnancy, nutrition and infant care by men, putting pressure on women to adopt certain beliefs and practices. 4 , 44 , 45 Also subtle negative effects of MI programmes should be considered, in some cases male presence at ANC might negatively affect women’s ability to speak openly and disclose sensitive issues such as IPV. 46 47 Only by aiming for a comprehensive assessment of MI programmes (collecting both quantitative and qualitative data) can these issues be identified and addressed in future MI interventions. More data regarding empowerment of women, gender equality and perceived support (from both men and women) can contribute to designing effective interventions with a gender transformative approach. 13 48 Especially investments in programmes that promote gender equality at an early age (among children, adolescents and young adults) can lead to a lifetime of improved health and well-being, 49 including better maternal health outcomes.

Another interesting finding in our review was that the benefits of MI for the father himself are hardly explored and almost never assessed in interventions. Most studies did not collect data directly from men and even fewer studies assessed the potential benefits of MI for the father himself or mutual perceived support. Furthermore very little is known about men’s specific needs during the transition to parenthood. 50 51 Father involvement is almost always used as an instrumental approach to improve maternal health, although the added value for the father himself (eg, the perceived health benefits by improving his own access to healthcare services) were already highlighted during the Cairo conference in 1995. 52 Emphasising the positive effect for the father himself and investing in his specific needs during the transition to parenthood could be explored as an intervention strategy, 53 54 whereby the health benefits might go beyond his participation in maternal health care services.

Looking at geographical context, several differences were noted by focusing on the most unique and common terms using text mining. In studies deriving from Asia words related to nutrition were more important, while in studies from North America words referring to IPV were more typical. In studies conducted in Europe, stress and depression were important terms, while in Africa ANC attendance and HIV prevention were important. Some of these differences can be explained by the different prevalence of certain problems (such as malnutrition in India 55 and HIV in Africa 56 ), while other differences are less logical and probably influenced by funding bias and geographical sociocultural factors.

The proportion of studies about PSH and depression was lower in Africa compared with other continents. However, the literature indicates that perinatal depression is common in the African region. 57–60 Globally, perinatal depression is estimated to affect around 11% of women, and recent studies have shown that perinatal mental disorders are at least as prevalent in Africa as in other regions. 61–64 Furthermore, research has demonstrated that HIV positive women have increased risk of perinatal depression. A systematic review found a prevalence of 23.4% for antenatal depression and 22.5% for postnatal depression in HIV infected women. 65 66 The low number of studies on PSH in Africa in our review showed that the relationship between perinatal depression/PSH and the role of the male partner is poorly studied in Africa. While some have argued that many LICs have more pressing issues within maternal health than addressing perinatal depression (such as severe maternal morbidity and mortality), 2 other studies have shown there is reasonable evidence for the benefits and effectiveness of psychological interventions in low-income and middle-income countries (LMICs). 64 67 The low availability of mental health services in LMICs is one of the main challenges for addressing mental health problems, but some recent studies have shown that training and organising lay mental healthcare workers to address mental healthcare problems are a feasible and effective approach to combatting mental health disorders. 68 Furthermore MI and/or partner support has been shown to be a protective factor against perinatal depression globally. 6 69–71 More research into the field of MI and maternal mental health in LMICs could provide multiple health gains for the male partner, mother and child.

A very low number of studies in our review derived from South America compared with Africa, indicating MI in maternal health care seem understudied in that region. However, the limited literature emphasises that the current level of MI is extremely low in South America, 72 73 with strong gender norms being the most persistent barrier. 74–77 The reason why until now very few scientific studies have focused on MI in South America might be related to the lower prevalence of HIV on the continent compared with Africa. 56 Historically many MI programmes in maternal health in LMIC were implemented in order to improve the uptake of PMTCT, making it less useful (and less funded) in countries with low HIV prevalence. This also explains why the scientific literature on MI in South America is more often focused on attaining gender equality, instead of getting men to health facilities for HIV testing. 75 78

Lastly but importantly, our review demonstrated that very few studies (n=8) focused on the role of the partner during abortion care. A recent systematic regarding gender transformative interventions for engaging men and boys in SRHR reported a similar gap in the evidence, with very little interventions focusing on engaging men in access to safe abortion care. 43 However, the important role of the partner in decision making and access to abortion services cannot be ignored. 79 80 A systematic review from 2016 showed that women contemplating abortion frequently involve their male partner in the decision and rely on him to help with logistics, finances and emotional support before and after the abortion; furthermore, MI was positively associated with women’s well‐being. 80 Despite his important role, young men’s experiences of unintended pregnancy and their pregnancy decision making are hardly studied within the scientific literature, 81 although essential for offering adequate counselling and services for men and women regarding sexual and reproductive health. Given that 121 million unintended pregnancies occur each year with 61% ending in an abortion, more research regarding the role of the male partner in abortion care and pregnancy decisions is highly needed for improving not only maternal health, but also broader SRHR outcomes. 43 79 81 In conclusion, we believe the evidence base on MI in maternal health, and its related indicators, needs to be improved in the future in terms of regional representation, study robustness and a broader holistic scope.

Limitations

This review has certain limitations. We only included quantitative studies and used qualitative literature only for interpretation of the results. By focusing only on quantitative literature and selecting the ‘hard core indicators’ we, as researchers, also conduct a reductionist analysis of MI, ignoring that certain instrumental actions might mean a lot for women and their partners in terms of involvement and support. A similar in-depth systematic review regarding the qualitative meaning of MI, comparing findings from different regions, would complement our findings. Furthermore, a broader review also including the role of the partner in planning a pregnancy (before conception) and/or family planning decisions could strengthen the existing evidence regarding MI in reproductive health.

Another bias in this study might be related to the principal investigator’s (AG) background. A researcher’s background and position often affects what they choose to investigate, the angle of investigation, the methods judged most adequate for this purpose, the findings considered most appropriate, and the framing and communication of conclusions. 82 AG has mainly conducted research in Mozambique, which might lead to a higher interest in the findings most relevant to this context (eg, the relationship between HIV programmes and MI). However, by involving coauthors in all stages of the research process we tried to minimise this bias. Finally, we restricted our search to a selected number of databases and only included English literature, which means certain studies will have been missed.

The concept of MI in maternal health is considered to be multifaceted within the literature but the assessment of the concept differs globally. We found two main streams of conceptualisation within the literature: a focus on psychosocial support on the on hand and focus on instrumental support for maternal health care utilisation (such as PMTCT services, ANC attendance and institutional childbirth) on the other hand. While both aspects are considered as core elements of male partner’s (potential) role in maternal health, majority of studies seem to focus on only one of both aspects. In line with these findings the concept of in maternal health it is often measured by a simplified and narrow set of indicators and several essential elements such as communication between the couple regarding maternal health care issues, shared decision making, participation in household tasks and the subjective feeling of being supported by the male partner have received little attention. Until now, very few MI programmes seem to incorporate a gender-transformative approach with adequate measures. In addition, our review identified a gap in the literature regarding the role of the male partner in abortion decisions and access to abortion services. Further research, involving experts and pilot testing, is recommended to develop a robust set of valid and feasible indicators for assessing MI in maternal health globally in a more comprehensive way.

Acknowledgments

We would like to thank the librarian of Ghent University, Miss Nele Pauwels, for organising training on conducting a systematic review and further personal assistance in developing the search strategy. Furthermore, we would like to thank the colleagues of ICRH-Belgium for their continuous support and encouragement during the study.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2
• Data supplement 3
• Data supplement 4

Handling editor Seye Abimbola

Contributors AG conceptualised the study and lead the process of reviewing the literature. GP and TVS screened articles and contributed to data extraction. AG conducted all analysis under supervision of OD. All authors contributed to the development of the manuscript and read and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding AG is funded by a VLADOC PhD scholarship from the Flemish Inter-University Council (VLIR-UOS Belgium).

Disclaimer The funder had no role in the study design, data collection, analysis, interpretation of data or in writing the manuscript. Researchers are independent from funders and all authors had full access to all data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Health education strategies targeting maternal and child health

Álex moreira herval.

b Department of Social and Preventive Dentistry, School of Dentistry. Federal University of Minas Gerais, Belo Horizonte, Minas Gerais State, Brazil.

Danielle Peruzzo Dumont Oliveira

a Undergraduate Student, School of Dentistry, Federal University of Minas Gerais

Viviane Elisângela Gomes

Andrea maria duarte vargas, background:.

Health education during pregnancy is important to improve maternal and children outcomes. However, the strategies must be specifically designed for each context and demographic characteristics. Our objective was identify health education strategies targeting pregnant women with the intention of improving results of pregnancy at an urban level.

We conducted a scoping review of the literature to answer the question: “what health education strategies targeting pregnant women were reported by primary healthcare teams or the community promoting health in pregnancy, childbirth, postpartum and childhood?” Potential eligible studies were selected using PubMed, Web of Science, LILACS and SciELO by 2 reviewers.

From a total of 3105 articles, 23 were deemed eligible. We identified 9 educational methodologies focusing on different outcomes of pregnancy, birth or maternal wellbeing.

Conclusions:

It is important that health education strategies continue after childbirth, independent of the strategy. All the strategies presented in this review are suitable for transfer with a moderate chance of success of implementation or improvement of current education methodologies. Further research is required on health education, including a higher number of patients.

1. Introduction

The provision of health education during pregnancy has been shown to be an important aspect of prenatal care. This approach has been associated with a broad variety of maternal and child outcomes including reduced prematurity and low birth weight, and increased rates of initiation and continuation of breastfeeding. [ 1 – 4 ]

Considering the potential outcomes of health education schemes targeting pregnant women, health teams must strive to incorporate and perform educational activities to prepare pregnant women for childbirth and the postpartum period. [ 3 ] However, it is crucial to understand that there are multiple contexts, and pregnant women represent multiple demographic groups. The strategies must be specifically designed to provide the desired outcomes for different target groups. [ 5 ]

The Policy Transfer Framework can help health teams to implement or improve educational activities. Policy makers, as well as health teams, must evaluate the local, regional and national characteristics of both the area where educational strategy was initially developed, and to where it will be transferred. The desired degree of transfer (copying, emulation, mixture or inspiration) must be assessed along with possible constraints on the transfer process (past-implemented policies; institutional feasibility and economic, ideological, technologic, bureaucratic and cultural contexts). Although the Policy Transfer Framework is often used to analyze policies that have already been transferred, it can help to assess variables that may influence the incorporation and development of strategies. [ 6 ]

The aim of this scoping review was to identify the educational strategies aimed toward pregnant women with the focus of improving results during pregnancy, birth, postpartum and childhood. The review was designed to help urban primary healthcare (PHC) teams in the process of policy transfer including the implantation, implementation and improvement of pregnancy health education schemes.

The methodology of a scoping review was selected because it is an appropriate approach to provide information to policy makers where a full systematic review is needed. Ethical approval was not required, because the study was a literature review and there was no contact with patients.

A scoping review retains important characteristics of a systematic review, such as systematization, transparency and reproducibility, at the same time identifying the nature and extent of the scientific evidence relating to a theme. [ 7 , 8 ] Considering the similarities between scoping and systematic reviews, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist wherever possible during our investigations.

We used the protocol described by Peters et al [ 9 ] to carry out a scoping review. The protocol consists of 4 distinct stages:

• 1. identification of the scoping review question,
• 2. development of the inclusion criteria,
• 3. definition of the search strategy, and
• 4. summarizing the results.

2.1. Scoping review question

The research question was constructed using the elements of Population, Concept and Context (PCC), as suggested by the protocol. [ 9 ] The studied population was pregnant women, the concept was health education strategies and the context were the urban community or PHC teams. Therefore, we developed the following research question: “What health education strategies targeting pregnant women were reported by PHC teams or the community to promote health in pregnancy, childbirth, postpartum, and childhood?”

2.2. Eligibility criteria

Studies were included if they met the following criteria:

• 1. the reported methodologies were developed to promote health education,
• 2. the health education methodologies targeted pregnant women,
• 3. the health education methodologies were developed at community level or by PHC teams,
• 4. the studies should be written in English, Spanish, or Portuguese,
• 5. the methodologies of the evaluation of health education were reported and
• 6. the health education methodologies were developed at an urban level.

The urban level was selected because rural populations have different characteristics from urban ones and present other outcomes. Rural populations often require a higher number of educational actions and we believe they should be analyzed separately.

2.3. Search strategy

The electronic databases PubMed, Web of Science, LILACS and SciELO were searched to identify potentially eligible reports. The Medical Subject Headings (MeSH) was used to select the search descriptors. The Boolean operators “AND” and “OR” were used to enhance the search strategy through several combinations. Based on the PCC elements, the follow search phrase was constructed: (“Pregnant Women” OR “Pregnancy” OR “Antenatal”) AND (“Health Education” OR “Primary Prevention” OR “Health Promotion” OR “Prenatal Education”) AND (“Program Development” OR “Program Evaluation” OR Intervention OR Project OR Program OR Strategy) AND (“Maternal-Child Health Centers” OR “Family Health” OR “Primary Health Care” OR “Community Health Centers” OR “Prenatal Care"). We did not determine the beginning of the search period. The identification of studies was performed in May, 2017.

The electronic search strategy returned a total of 3151 records. These records were exported using EndNoteX7 and duplicates were deleted, initiating by software and completed with manual identification. The studies were selected for 2 reviewers ( [blinding]; Cohen kappa of 0.775, indicating substantial inter-rater reliability) that analyzed, in duplicate, all the titles and abstracts of the studies in the first moment, and after reviewers read complete papers. Disagreements were resolved by discussion and final inter-rater agreement was 100%.

2.4. Charting the results

Data were charted to identify themes and key issues from each study. In line with Peters et al, [ 9 ] the following data were collected: author(s), year of publication, country of origin, aims of the study, study population, research design, details of health education intervention (frequency, intervals between meeting, person or group responsible to promote health education) and outcomes. The 2 reviewer extracted data from reports in duplicate.

In total, 3003 papers were excluded by title and abstract reading, leaving 148 papers for full text review. The authors [blinding] independently read the full text papers. The final search output was 23 papers (Fig. ​ (Fig.1). 1 ). Thus, the present review analyzed the health education strategies directed toward pregnant women that were identified in 23 published reports. However, there are likely to be methodologies beyond the published literature, in the form of unpublished strategies used by PHC teams. It is important to remember that there may be strategies that are not included in this paper due to the inclusion criteria.

PRISMA flow diagram showing the literature search and selection of studies.

The specific interventions, populations and outcomes that were measured differed between studies (Table ​ (Table1). 1 ). The strategies reported were organized initially according to the methodology design. We identified nine educational methodologies: community-based, [ 10 – 16 ] lecture- or class-based, [ 17 – 21 ] school-based, [ 22 ] home-based, [ 23 ] and group-based approaches; [ 24 – 26 ] as well as games, [ 27 ] mobile health (mHealth), [ 28 ] website information [ 29 ] and individual education. [ 30 ] The included studies were either targeted at pregnant women living in nonspecific areas or directed to specific populations (adolescents, first time mothers, mothers of single babies, low income groups, mothers living in disadvantaged or vulnerable communities or ethnic minorities). Seventeen out of the 23 studies were conducted in high-income countries. [ 10 , 12 , 14 , 16 , 17 , 19 , 20 – 25 , 27 – 29 , 31 , 32 ] The only 6 studies that were not from high-income countries were carried out on mothers from Brazil [ 26 ] (upper-middle income), Turkey [ 11 , 15 , 30 ] (upper-middle income), Egypt [ 13 ] (lower-middle income) and Iran [ 18 ] (upper-middle income).

Location, target population, and design of the reports included in this study.

We observed wide range of outcomes which we organized into seven topics: breastfeeding, beliefs and behaviors, knowledge, school outcomes, gestational outcomes, mother outcomes, and baby outcomes (Table ​ (Table2). 2 ). Similarly, a wide variety of educational characteristics was found between the strategies (frequency, number and duration for each strategy). Regarding the educator (person or people responsible for the development of health education activities), it was observed that activities were mostly planned with health professionals and paraprofessionals (or non-professionals) in mind, indicating that progressive inclusion of persons or groups from the community is occurring where health education is being developed. The characteristics of health education ranged from one-time interventions to monthly engagements, with a maximum of 11 actions in the course of one program. [ 26 ] Only 8 studies reported the duration of the health education program. [ 11 , 16 – 18 , 20 , 21 , 25 , 30 ]

Characteristics and main results of the educational activities from the reports included in this study.

Improved breastfeeding outcomes were observed where health educational strategies were conducted by nurses [ 11 , 19 , 27 ] or nutritionists. [ 32 ] Higher school results were observed among volunteers who were trained to deliver the programs. [ 10 , 14 ] The number of reports relating to the other outcomes that we studied (baby, mother, gestational, knowledge and beliefs and behaviors) was too few to draw conclusion about their relation to health education.

Twelve themes were identified amongst health education strategies: breastfeeding, nutrition, birth, childcare, family planning, physical activity, maternal health, anxiety, social support, drug abuse, oral health, and baby development. The topics mostly addressed in the articles included in the present study, regardless of the methodology used, were breast feeding, nutrition, and birth.

4. Discussion

This scoping review identified 23 articles which reported and assessed health education strategies targeted towards pregnant women. The articles described different methods with diverse characteristics and maternal/child health outcomes.

Education activities that start during the antenatal period and continue postpartum appeared to be more effective than methods which focused on education during pregnancy only. [ 3 ] This review highlighted that educational activities which continued after birth [ 14 , 15 , 21 ] were associated with better outcomes in terms of breastfeeding continuation at 6 months, appropriate health behaviors, improved knowledge of health care and school continuation. Only 1 included article did not report improved outcomes with the continuation of health education activities into postpartum. [ 24 ] The educational strategy reported by Hoddinott et al [ 24 ] was designed using a group-based methodology and delivered via 10 weekly meetings conducted by health professionals.

A systematic review by Lumbiganon et al [ 4 ] indicates that there is insufficient evidence to conclude which is the most effective method of education to improve breast feeding outcomes. Therefore, health education initiatives designed to increase such outcomes (initiation or continuation of exclusive breastfeeding) could be designed using different strategies, as presented by Burkhalter and Marin, [ 19 ] Zimmerman, [ 32 ] Rosen et al, [ 21 ] Turan and Say, [ 11 ] MacArthur et al, [ 12 ] Hoddinott et al [ 24 ] or Volpe and Bear. [ 27 ] It is important to consider the different results of initiation and continuation of exclusive breastfeed presented, including negative results in some cases.

One of the health education strategies that reported negative results for the initiation of breastfeeding was that designed by MacArthur et al. [ 12 ] They used trained peer support workers to perform 2 sessions between 24 and 28 weeks gestation. The rates of initiation of breastfeeding did not increase following this strategy when the peer supporter had contact once or twice with the pregnant women. [ 33 ] Therefore, the negative outcome observed by MacArthur et al [ 12 ] may not indicate the inadequacy of community-based methodologies, rather that such strategies require increased contact with mothers.

A lower number of health education activities seems to limit the potential positive results, [ 33 ] although this cannot be generalized and so the number of activities must be planned according to the intended outcomes and particular educator that is involved. For example, the strategy proposed by Burkhalter and Marin [ 19 ] which included 4 monthly meetings was not sufficient to increase birth weights; while the methodology of Chang et al, [ 17 ] comprised of 4 weekly meetings, produced improvements in the mothers’ feelings of self-efficacy.

The systematic review developed by Silva et al [ 3 ] indicated that health education strategies conducted by group-based or home-based methodologies and guided by professionals or non-professionals have contributed to reduced prematurity, reduced low birth weights and increased prevalence of exclusive breastfeeding. Three of the studies included in this review described group-based strategies. [ 24 – 26 ] Two of them observed negative results on the rate of breastfeeding [ 24 ] and knowledge or self-efficacy, [ 25 ] but 1 showed improved results regarding oral health. [ 25 ] The third study evaluated group-based methodologies using a qualitative approach and showed that this was effective in increasing feelings of self-confidence, security and calm among the women. [ 26 ] Only one study that discussed a home-based strategy was included. This methodology was designed to use trained professionals to carry out 6 visits [ 23 ] and was seen to be associated with improved obstetric outcomes. Although the results of this strategy were different to those indicated by Silva et al, [ 3 ] it reinforces the benefits of home-based approaches.

The systematic reviews published by McFadden et al, [ 34 ] Balogun et al [ 35 ] and Silva et al [ 3 ] did not find that health education programs developed to be delivered by either healthcare professionals or healthcare non-professionals differed in their impact on breastfeeding or obstetric outcomes. In the present review, the reports of Jones and Mondy, [ 10 ] Turan and Say, [ 11 ] MacArthur et al, [ 12 ] Brasington et al, [ 13 ] Barnet et al, [ 14 ] Coskun and Karakaya, [ 15 ] Little et al, [ 16 ] Adams et al [ 25 ] and Guo et al [ 31 ] used non-professionals to promote health education, and the majority observed good outcomes, reinforcing the importance of including community members or peers in educational processes.

Community-based strategies were reported by Jones and Mondy, [ 10 ] Turan and Say, [ 11 ] MacArthur et al, [ 12 ] Brasington et al, [ 13 ] Barnet et al, [ 14 ] Coskun and Karakaya [ 15 ] and Little et al. [ 16 ] Although we found this methodology to be the most frequently implemented strategy, some outcomes—such as breastfeeding—showed no evidence of improvement with this approach. [ 35 ] However, this observation should not discourage policy makers from using community-based methodologies, as more studies and systematic reviews are necessary to draw firm conclusions about the effectiveness of this strategy.

Traditional methods of health education—lectures and classes—were evaluated by Burkhalter and Marin, [ 19 ] Chang et al, [ 17 ] Kaste et al, [ 20 ] Rosen et al [ 21 ] and Bahri et al. [ 18 ] In general, these reports showed good results for increase ingrates of exclusive breastfeeding and knowledge; improving oral health, beliefs and behaviors in the short-term and increased continuation of schooling and self-efficacy of mothers. However, lectures have been criticized for their low effectiveness and the lack of participant interaction. [ 36 ] Furthermore, more pro-active methodologies have the potential to adapt to different educational needs, both for mothers looking for more information and for those requiring other resources. [ 37 ]

A limitation of this scoping review was that a significant proportion of the studies included were developed in high-income countries. Links between the design of the intervention and the observed results should therefore be carefully analyzed by policy makers from low- and middle-income regions and populations, prior to their implementation in the region.

Few of the studies that we found reported the educational characteristics (frequency, number of actions and duration), which could impede the policy transfer process and limited the analysis that was able to be carried out in the present review. These details are crucial in order to increase maternal and child outcomes, which are likely to be influenced by the intensity of the interventions. [ 33 ] Thus, it is important that researchers be careful to make publish their work, providing the characteristics of health education strategies meticulously.

5. Conclusions

This review was designed to identify health education strategies that can improve maternal and child outcomes. The articles included revealed that different methods were associated with specific characteristics of pregnant women and gestational, obstetric and child outcomes. Possibly the most important result was the finding that the continuation of health education strategies after child birth contributed to improved maternal and child outcomes, particularly in regard to breastfeeding.

Specific studies correlating health education strategies during pregnancy to the improvement of maternal and child health were not developed by or found in this scoping review. Thus, research on health education is still required, including a higher number of patients. Reviews similar to the one presented in this study should be developed in rural populations, which present different characteristics from urban ones.

Considering the aspects involved in the Policy Transfer Framework (characteristics of where the educational strategy was developed and where it will be transferred, intended degree of transfer and possible constraints on the transfer process), we conclude that all of the strategies analyzed in this review are suitable for transfer. Thus, there is a wide range of health education methodologies, and policy makers can use them according to the outcomes desired.

Author contributions

Conceptualization: Álex Moreira Herval, Danielle Peruzzo Dumont Oliveira, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Data curation: Álex Moreira Herval, Danielle Peruzzo Dumont Oliveira.

Formal analysis: Álex Moreira Herval, Danielle Peruzzo Dumont Oliveira, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Funding acquisition: Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Investigation: Álex Moreira Herval, Danielle Peruzzo Dumont Oliveira.

Methodology: Álex Moreira Herval, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Project administration: Álex Moreira Herval, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Resources: Danielle Peruzzo Dumont Oliveira.

Supervision: Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Writing – original draft: Álex Moreira Herval, Danielle Peruzzo Dumont Oliveira, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Writing – review & editing: Álex Moreira Herval, Viviane Elisângela Gomes, Andrea Maria Duarte Vargas.

Álex Moreira Herval orcid: 0000-0001-6649-2616.

Abbreviations: MeSH = medical subject headings, PCC = population, concept, and context, PHC = primary healthcare, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

This study was funded by Foundation for Research Support of Minas Gerais, Government of Minas Gerais, Brazil. The funding body had no role in the design or conduct of the review, or in the writing of the paper.

We are greatfull to Foudation for Research Support of Minas Gerais for the PhD scholarship and to Universidade Federal de Minas Gerais for the support for publication fees.

The authors have no conflicts of interest.

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Child Health Nursing Dissertation Topics

Published by Owen Ingram at January 3rd, 2023 , Revised On August 16, 2023

Keeping your child healthy and growing starts at birth. Nurses who specialise in child health can help and educate parents about safety, hygiene, and nutrition requirements for children to prevent common childhood illnesses. In this article, we will cover everything from the average salary to the steps to becoming a registered child health nurse.

The field of child health nursing focuses on the care of children from infancy through adolescence. Child health nurses are registered nurses with a midwifery degree and additional training in child health.

Hospitals, clinics, and private practices employ child health nurses worldwide.

Children’s health nurses are divided into two types – those who work in schools and those who work in clinics.

• School-based nurses usually perform routine assessments, administer medication when necessary, identify signs of illness among students and refer them to school personnel for additional assessment. Such nurses use the same skills and techniques home-based nurses require in caring for hospitalised children.
• Hospital-based nurses may supervise children during routine examinations, observe outpatients’ hospitalisations, make rounds with new admissions, and teach patients about self-care.

As a child health nurse, you play a vital role in the lives of young children by providing care and support during some of the most vulnerable times in a child’s life. You also work to prevent illness and promote wellness among children.

In addition to clinical care, you may also have administrative duties such as creating nutritional and diet plans for children with solid research.

Important Note: Along with free dissertation topics and dissertation outline services , ResearchProspect also provide top-notch dissertation writing services at the best price to ease the excessive study load.

• Evidence-based Practice Nursing Dissertation Topics
• Adult Nursing Dissertation Topics
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• Dementia Nursing Dissertation Topics
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• Coronavirus (COVID-19) Nursing Dissertation Topics

Topic:1 Neonatal medicine

Research Aim: Specialization in the field of neonatology and its correlation with paediatric s to provide basic medical care to newborn infants.

Topic:2 General paediatrics

Research Aim: Understand the role of a general paediatrician  and the focus on child care and individual growth.

Topic:3 Nursing care of a neonate

Research Aim: Covering all about the nursing care of a neonate with deep insights into different types of neonatal and childhood illnesses.

Topic:4 Nursing management

Research Aim: The importance of nursing management for a child’s health to study common childhood illnesses.

Topic:5 Quality of life

Research Aim: Learning the fundamental prerequisite required to improve the quality of life of a pediatric patient during the early days of growth.

Topic:6 Obesity in infants

Research Aim: Creating the seriousness of the issue of obesity in infants and all the influencing factors that revolve around it.

Topic:7 Antibiotic resistance

Research Aim: Insights into the issue of antibiotic resistance prevention of common chronic illnesses.

Topic:8 Pediatric dermatology

Research Aim: Learning the common skin issues and their long-term consequences in infants during to genetic or external factors.

Topic:9 Pediatric ophthalmology

Research Aim: The role of pediatric ophthalmologists is to treat different serious eye problems in children up to age 5.

Topic:10 Genomic medicine

Research Aim: Study the increasing need for the genomic medicine discipline that involves clinical care for patients all across the USA.

Topic:11 Moderate to severe asthma

Research Aim: Understanding the severity of moderate to severe asthma and its associated persistent effects

Topic:12 Pediatric hospital medicine

Research Aim: Understanding the hospital setting of pediatric hospital medicine with relevance to clinicians working there to provide high-quality pedantic care to children.

Topic:13 Effect of Rare diseases on children

Research Aim: The significant effect of rare diseases on children leads to other serious pediatric emergencies which can be a threat to the lives of infants.

Topic:14 Child and Adolescent psychiatry

Research Aim: Specialization in child and adolescent psychiatry with a sound understanding of the diagnosis and treatment of common childhood issues during their early growth.

Topic:15 Mental health conditions in children

Research Aim: Different serious and mild mental health conditions are faced by children including their treatment at different levels.

Topic:16 Immunization

Research Aim: Immunization from serious illnesses like COVID, polio, and other contagious diseases that can be a threat to the health of infants

I/O Example

Child health nurses can choose from a variety of career paths. Others work in schools or hospitals. The majority of child nurses specialise in caring for newborns, while others study chronic diseases and childcare. It is a rewarding and challenging career to work as a child health nurse, no matter what path you choose. Child health nurses must be licensed RNs with a bachelor’s degree in nursing.

Children with special medical needs may require paediatric s or neonatal intensive care nurses. In particular, Neonatal child health nurses work primarily with newborn babies at risk for certain complications due to birth complications or other conditions.

The average  salary  for a child health nurse in the USA is $88,724 per year

Children, adolescents, and infants are the focus of child health nursing. For those interested in working in the healthcare industry, child health nurses represent a great career choice. Child health nursing offers the following benefits:

• You can make a difference in the lives of children.
• Child health nurses are in high demand.
• You can work in a variety of settings.
• You can specialise in a particular area of interest.
• Child health nursing offers good job security.
• You can have a flexible schedule.
• You can make a good salary.

Related Resource: Nursing dissertation Topics , Adult Nursing Topics , Critical Care Nursing Dissertation Topics , Mental Health Nursing Dissertation Topics

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Conclusion 

Those passionate about helping others and who want to help children will find child health nursing an excellent career choice. Choose a specialisation that suits your interests and goals if you are interested in a career in child health nursing.

Frequently Asked Questions

How to find child health nursing dissertation topics.

To find child health nursing dissertation topics:

• Research child health issues.
• Explore recent studies and guidelines.
• Identify gaps or challenges.
• Consider pediatric nursing practices.
• Address cultural and ethical aspects.
• Select a topic aligning with your passion and career goals.

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Student Spotlight: Glendedora Dolce

PhD student Glendedora Dolce standing with Maryland State Delegate Jennifer White Holland. Holland functions as Dolce's Health Policy Institute host.

For graduate students who are passionate about putting research and policy recommendations into action, the Johns Hopkins Health Policy Institute (HPI) is an invaluable experience. HPI Fellows are paired with Maryland state senators and delegates to perform policy-driven research and analysis, engage with stakeholders and prepare legislative materials, including policy briefs, memos, position papers, written/oral testimony, and legislation itself.  

Among the Spring 2024 HPI Fellows is Glendedora Dolce, now in her second year as a Health and Public Policy doctoral student. A former licensed public nurse (LPN), Dolce had dreams of becoming a physician, but decided to pursue a career in public health to prevent injuries, illnesses and health disparities, rather than treating them. She received her master's degree in public health from Emory University, where she became interested in child passenger safety through work at the local health department. After attaining her MPH, she worked at the U.S. Department of Transportation as a Public Health Fellow; it was there that she saw trends that would become the basis of her dissertation. “I noticed there was a higher number of car crash injuries in historically redlined communities,” she says, “so now I’m digging into who exactly is being injured in those communities and what can be done to protect their safety. Hopefully my research can inform urban planners and departments of transportation and ensure they plan with an equity lens.”   

Dolce was drawn to the Health and Public Policy PhD program by Johns Hopkins’ reputation as a leader in public health and was entirely convinced after seeing a lecture by HPM Chair Dr. Keshia Pollack Porter and attending Johns Hopkins Center for Injury Research and Policy Summer Institute. “I started looking into the department after that and saw that it really had everything I wanted. It would provide the best education and challenge me in a lot of ways.” 

Dolce’s HPI host is Delegate Jennifer White Holland, MSPH, a Bloomberg School alum who also serves as policy and community engagement director for the Horizon Foundation in Howard County. HPI applicants can select up to three lawmakers they would be interested in working with in the Maryland General Assembly, but Glendedora only listed Delegate White Holland because she felt such a strong connection to the delegate’s work. “She has a real passion for health equity and her constituents,” says Dolce, “and she’s sponsored a lot of impactful legislation.” In this year’s Maryland General Assembly session, Delegate White Holland’s bills include the Maryland Maternal Health Act, which strengthens coordination of care for mothers and mothers-to-be, and the Equal Pay for Equal Work Act, which would require employers to post salary ranges on all job listings. “At the very core, justice and equity are key themes in the bills I put forth,” says Delegate White Holland. “For the Equal Pay for Equal Work Act, women, particularly Black women and Latina women, are still at a disadvantage, trying to overcome decades of pay disparities. As I think about younger and future generations, it's important that we have access to information to bring to the negotiating table.” 

Dolce has been a vital asset in moving this legislation forward, says Delegate White Holland. “She’s truly a delight and brings a lot of real-life experience. Her unique career path, her interest in land use, transportation and planning and how she participates in issues at that intersection and their impact on public health is at her core. She has been involved in every bill that I have before me, doing research and helping to flesh out questions and answers to various issues. I remember what it was like at the graduate level, so being able to tap her has been a huge help. I also understand her life experience, as another young woman of color, embarking on a journey at Johns Hopkins University. Any way that I can help and provide those opportunities is fulfilling for our office and our district. I'm already wondering how I might keep her on staff long-term. She’s a significant value-add.” 

The firsthand experience of HPI in policymaking and politics in the legislative session is likewise a critical value-add for Dolce. “There’s a big disconnect between researchers and policymakers,” she says. “The HPI fellowship has taught me how to communicate with policymakers, thinking as the supporter and the opposer. This will be beneficial when conducting policy research.”  

Long term, Glendedora sees herself staying in Baltimore—notably the birthplace of redlining—and becoming involved in policy at the local level. “I want to bridge the gap between research and policymakers,” she says. “It would be very innovative to do both.” 

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