Women's perspectives on health service integration for multi-morbidity in pregnancy, childbirth, and postpartum in a high-burden setting.
BACKGROUND: Maternal and infant health outcomes in low- and middle-income countries (LMICs) remain below global targets. Greater integration of health services within routine antenatal care and infant immunization is a priority but has had variable success when implemented. We aimed to understand coexisting health needs for integrated services among women and infants and elevate women's views on health service delivery and planning. METHODS: We conducted a longitudinal study of 699 pregnant women and their infants in Papua New Guinea from first antenatal visit to 1 year postpartum. We collected clinical and laboratory data on health at five time points and assessed women's experience of and preferences for integrated care. FINDINGS: Pregnant and postpartum women and infants had a high prevalence of multiple health issues identified by clinical reporting or screening tests, including anemia, malaria, and reproductive tract infections in women and stunting, anemia, and infections in infants. Many needs coexisted, requiring an integrated approach. Women expressed broadly positive attitudes toward integrating services, prioritizing infant illness care, growth monitoring, vaccination information, maternal illness care, family planning, and maternal or infant nutrition. Women suggested more services for infants than themselves or other family members. Their health priorities changed over time from pregnancy into the postpartum period. CONCLUSIONS: Antenatal and postpartum services in LMICs will have more impact if they identify and respond to the full spectrum of coexisting health issues affecting women and infants and better incorporate women's health needs and preferences into health service planning and delivery. FUNDING: Details are provided in the acknowledgments section.
Christopher J Morgan, Michelle J L Scoullar, Pele U Melepia et al.