Key factors to improve maternal and child health in Sindh province, Pakistan

Summary This thesis was conducted to find out which factors influence health service utilization, a key component of improving maternal, newborn, and child health (MNCH), so that policy makers can set priorities and focus the limited resources that are available on what is important. The thesis focuses on antenatal care (ANC), facility-based birth, breastfeeding, and child immunization. Studies for the thesis used data from the 2013 and 2014 MNCH Program Indicator Surveys that were conducted to provide data on key indicators required to monitor the implementation of MNCH and family planning/reproductive health interventions in Sindh and Punjab provinces in Pakistan. Four findings emerged from the studies. First, health information dissemination from a skilled health professional is important for health service utilization. Second, community-level peer counselors play an important role in advocating for use of health facilities by individuals, families, and the community. Third, MNCH policy and strategic plans need to focus interventions, including information campaigns, on target population groups, such as parents in low educational and socio-economic classes and parents of children in specific age groups. Fourth, to increase health service utilization, healthcare workers need to be trained to be effective health and behavior change communicators. Our findings point to two key factors for healthy behavior change: increased opportunities for women to learn about pregnancy and child healthcare and the encouragement from the skilled health professionals