The Impact of Health Education Programs for Pregnant Women on Reducing Maternal and Infant Mortality

(1)

The Impact of Health Education Programs for Pregnant Women on the Reduction of Maternal and Infant Mortality

Nurhidayati¹*, Yayuk Sri Rahayu², Dewi Rubi Fitriani³, Ni Nyoman Murti⁴ & Grace Carol Sipasulta⁵

1Universitas Almuslim, Indonesia

Article Information ABSTRACT

Received: Month 00, 0000 y Revised: Month 00, 0000 y Online: Month 00, 0000 y

Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) remain significant global health challenges, particularly in developing countries. These rates persist due to disparities in socioeconomic status, education, and healthcare access. A key factor contributing to high MMR and IMR is the lack of knowledge among pregnant women about the importance of prenatal care.

Health education is crucial in increasing awareness of pregnancy, childbirth, and infant care, helping women make better health decisions for themselves and their babies. Proper pregnancy checkups are vital for optimizing the first 1,000 days of life and can identify risks such as anemia, malnutrition, hypertension, and infections, allowing timely interventions to prevent complications. However, implementing health education programs faces challenges like limited resources, insufficient healthcare personnel, and restricted access to healthcare, especially in remote areas. Cultural, social, and economic factors also influence pregnant women's participation in these programs. Studies show that health education, particularly through media like videos, has improved pregnant women’s knowledge and attitudes. Prenatal education has also been shown to reduce anxiety, improve mental health, and lead to better birth outcomes.

Despite these successes, gaps remain, necessitating further research into effective and culturally appropriate strategies. This review aims to assess the effect of health education on maternal and infant death rates, providing evidence to inform policies and improve healthcare for mothers and babies. The findings will support the development of more effective health programs to reduce mortality and enhance overall maternal and infant health.

Keywords

Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), Health Education, Prenatal Care, Healthcare Access, Socioeconomic Factors

(2)

Keywords: Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR), Health Education, Prenatal Care, Healthcare Access, Socioeconomic Factors

INTRODUCTION

The Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) remain critical global health challenges that require significant attention. These indicators are essential for evaluating the quality of healthcare services in a country. Despite numerous efforts, maternal and infant mortality rates remain high in certain regions, particularly in developing countries. This situation reflects disparities in access to and the quality of adequate healthcare services for pregnant women and infants.

One contributing factor to high MMR and IMR is the lack of knowledge and awareness among pregnant women regarding the importance of proper prenatal care. Health education plays a crucial role in increasing pregnant women’s understanding of various aspects of pregnancy, childbirth, and infant care. With sufficient knowledge, pregnant women can make better health-related decisions for themselves and their babies.

Standardized antenatal care is a key step in optimizing the first 1,000 days of life. Proper prenatal care can identify high-risk conditions such as anemia, malnutrition, hypertension, and infections. Appropriate interventions can then be provided to prevent complications that may threaten the lives of both mother and baby.

However, the implementation of health education programs for pregnant women still faces several challenges. Limited resources, a shortage of trained healthcare professionals, and restricted access to healthcare facilities remain major obstacles, particularly in remote areas. Additionally, socio-cultural and economic factors can influence the participation of pregnant women in health education programs.

Several previous studies have demonstrated the effectiveness of health education in improving knowledge and behavior among pregnant women. Research on the impact of breast care education through video media on the knowledge and attitudes of third-trimester pregnant women in the working area of UPTD Puskesmas Mengwi II found that video-based health education significantly influenced knowledge and attitudes. Health education has also been proven effective in increasing pregnant women’s knowledge about preventing low birth weight (LBW).

Moreover, prenatal health education accompanied by 3D video has been shown to effectively reduce anxiety levels in primigravida pregnant women. Anxiety during pregnancy can negatively affect labor processes and infant health. Therefore, comprehensive and effective health education is crucial in preparing pregnant women for childbirth with confidence.

Although these studies have significantly contributed to understanding the impact of health education on pregnant women, gaps still need to be addressed.

Further research is required to identify the most effective health education strategies tailored to the needs of pregnant women from diverse socio-cultural and economic backgrounds. Additionally, studies should evaluate the long-term impact of health education programs on maternal and infant health.

This journal aims to bridge these gaps by conducting a comprehensive study on the impact of health education programs for pregnant women in reducing maternal and

(3)

infant mortality rates. The study will evaluate the impact of health education programs on maternal and infant health indicators, such as maternal mortality rates, infant mortality rates, and pregnancy and childbirth complications.

Through this study, strong scientific evidence is expected to highlight the importance of health education programs in improving maternal and infant health. The findings of this study can serve as a basis for developing more effective and efficient health policies and programs aimed at reducing maternal and infant mortality.

Additionally, this research is expected to contribute new knowledge to the field of maternal and child health.

Thus, this journal is anticipated to provide significant benefits to society, particularly for pregnant women and infants, as well as to policymakers and healthcare practitioners in their efforts to improve maternal and child healthcare services.

METHODS

This study is a systematic review that collects and synthesizes research related to the impact of health education programs for pregnant women on reducing maternal and infant mortality. The keywords used in the literature search are "The Impact of Health Education Program for Pregnant Women on the Reduction of Maternal and Infant Mortality Rates." Literature sources were obtained from online databases, including PubMed, Elsevier, Google Scholar, and ScienceDirect.

To determine relevant articles, researchers applied inclusion and exclusion criteria.

The inclusion criteria included:

1. Scientific articles in English or Indonesian.

2. Articles published in journals with at least Sinta 4 accreditation.

3. Fully accessible articles (Full Text).

4. Articles discussing the impact of health education programs for pregnant women on maternal and infant mortality.

The exclusion criteria included:

1. Articles that do not provide Full Text.

2. Articles that are not case studies.

3. Duplicate articles.

RESULTS

Based on the review of identified scientific articles, seven articles were selected as literature for this study. These articles discuss the impact of health education programs for pregnant women on reducing maternal and infant mortality. The detailed findings from each article are presented in Table 1 below.

N o

Researc h Title

Authors Journal Review Results

1 The effect of maternal educatio n on infant

Girmay Tsegay Kiross, Catherine Chojenta , Daniel Barker, Tenaw Yimer Tiruye, Deborah Loxton

PLoS ONE 14(7):

e0220076.

https://doi.org/10.1371/j ournal. pone.0220076

The study results indicate that education is closely related to maternal and infant mortality rates. Mothers with

(4)

mortality in

Ethiopia:

A

systemati c review and metaanal ysis

(2019) primary education

have a 28% lower

chance of

experiencing infant mortality compared to illiterate mothers (OR: 0.72; 95% CI = 0.66–0.78).

Meanwhile, mothers

who attain

secondary or higher education have a 45% lower chance of experiencing infant mortality compared to illiterate mothers (OR: 0.55; 95% CI = 0.47–0.64).

2 The

effectiven ess of prenatal and postnatal home visits by paramedi cal

professio nals and women's group meetings in

improvin g

maternal and child health outcomes in low and

middle- income countries

M. Gupta, A. Ban sal, V. Chakrapan i,

N. Jaiswal, T. Kira n (2022)

Royal Society For Publik Health

increases

significantly when mothers receive competent medical

care during

pregnancy,

childbirth, and the postpartum period.

Reducing the

maternal mortality rate (MMR) to less than 70 per 100,000 live births is a current target of the Sustainable

Development Goals (SDGs). Women worldwide die during childbirth or within the first 24 hours after giving birth, with low- and middle-income

countries (LMICs) accounting for more than 99% of these deaths. More than

(5)

: a systemati c review and

meta- analysis

800 women

worldwide die during childbirth or within the first 24 hours after giving birth, with low- and middle-income

countries (LMICs) accounting for more than 99% of these deaths.

3 A

systemati c review of the effective ness of antenatal care program mes to reduce infant mortality and its major causes in socially disadvant aged and vulnerabl e women

Jennifer Hollowell,

Jennifer J

Kurinczuk, Laura Oakley, Peter Brocklehurst, Ron Gray (2009)

National Perinatal Epidemiology Unit, University of Oxford

In contrast to the conventional model of antenatal care, we found that the

evidence was

insufficient and of low quality to conclude that interventions that utilize alternative models of planning

or providing

antenatal care can reduce infant mortality or preterm birth (PTB) in vulnerable or disadvantaged

populations.model of antenatal care, we found that the

evidence was

insufficient and of low quality to conclude that interventions that utilize alternative models of planning

or providing

antenatal care can reduce infant mortality or preterm birth (PTB) in vulnerable or

(6)

disadvantaged populations.

4 Racial Dispariti es in Maternal and Infant Health:

Current Status and Efforts to Address Them

Latoya Hill, Alisha Rao, Samantha Artiga, and Usha Ranji

(2024)

The independent source for health policy research, polling, and news.

Significant Racial Disparities in Maternal and Infant Health Persist

Maternal and infant health disparities reflect broader social and economic injustices.

Efforts to improve maternal and infant health and reduce disparities include:

• Expanding access to healthcare

services and

insurance,

• Providing more diverse services to support maternal and infant health,

• Diversifying the healthcare

workforce, and

• Enhancing data collection and

reporting on

maternal and infant health.

5 Intervent ions to Reduce Maternal and Newborn Morbidit y and Mortality

A Metin

Gülmezoglu, Ther

esa A

Lawrie, Natasha Hezelgrave, Olufe

mi T

Oladapo, João Paulo

Souza, Marijke Gielen, Joy E Lawn, Rajiv

Bahl, Fernando

National Library Of Medicine

Some regions, particularly Sub- Saharan Africa, still have high fertility rates, maternal mortality, and under-five child mortality,

emphasizing the importance of integrated

Reproductive,

(7)

Althabe, Daniela Colaci, and G Justus Hofmeyr.

(2016)

Maternal, Newborn, and Child Health (RMNCH)

interventions.

6 A global analysis of the determin ants of maternal health and transition s in maternal mortality

João Paulo Souza, Louise Tina Day,

Ana Clara

Rezende-Gomes,

Jun Zhang,

Rintaro Mori, Adama Baguiya, Kapila Jayaratne, Alfred Osoti, Joshua P Vogel, Oona Campbell, Kidza Y Mugerwa, Pisake

Lumbiganon, Özge Tunçalp, Jenny Cresswell, Lale Say, Allisyn Carol Moran,

Olufemi T

Oladapo (2024)

Lancet Glob Health 2024; 12: e306–16

This report

highlights that 287,000 women died from pregnancy and childbirth

complications in 2020 alone. Between 2010 and 2020, nearly 3 million maternal deaths occurred, most of

which were

preventable,

reflecting global health disparities and human rights violations.

Despite

improvements in education,

employment, and reproductive rights for women in many countries, socioeconomic

inequalities remain a major factor in maternal mortality.

7 Maternal and pregnanc y-related factors influenci ng the link

between regional deprivati

Frederick K.

Ho,a, et al.

The Lancet Regional Health - Europe 2024;47: 101075

This study analyzed data from 392,606 mother-child pairs. The results revealed that infants born to mothers

in the lowest

socioeconomic group (bottom quintile) faced the greatest risk of mortality, with a risk ratio of 2.13 (95% CI:

1.58–2.90) and an

(8)

on and infant mortality in

England:

A

retrospec tive cohort study.

absolute risk difference of 6.6 per 10,000 live births compared to those in the highest socioeconomic group (top quintile). Four key factors contributing to socioeconomic

disparities in infant

mortality were

identified:

1. Preterm birth – Proportion

Eliminated (PE):

15.25% [95% CI:

9.44–24.12%]

2. Smoking during pregnancy – PE:

13.61% [95% CI:

3.96–80.97%]

3. Maternal age under 20 at childbirth – PE: 10.52% [95%

CI: 2.93–21.35%]

4. Maternal depression – PE: 9.13% [95%

CI: 4.47–14.93%]

DISCUSSION

According to data from the WHO in 2017, the number of maternal deaths worldwide reached 817 per day. In 2019, the maternal mortality rate (MMR) was recorded at 303,000 cases, with the majority of deaths occurring in developing countries, totaling 302,000 cases (Nita Tri Putri, 2021).

Meanwhile, the United Nations International Children's Emergency Fund (UNICEF) reported in 2020 that the global infant mortality rate (IMR) reached 2.5 million cases before the age of one year (Husada & Yuniansi, 2020). Most maternal and infant deaths occur in developing countries (Nurhafni et al., 2021).

WHO also noted that the global infant mortality rate in 2016 was recorded at 40.8 million per 1,000 births. This figure decreased to 4.1 million per 1,000 births in 2017 and continued to decline to 4.0 million per 1,000 live births in 2018.

Education plays a significant role in maternal and child health. Research indicates that a mother's level of education is closely linked to infant mortality rates.

Mothers with primary education have a 28% lower risk of experiencing infant mortality compared to those who are illiterate. Meanwhile, mothers who have completed secondary or higher education have a 45% lower risk of infant mortality compared to

(9)

illiterate mothers. This suggests that education not only enhances health knowledge but also improves access to quality healthcare services.

Maternal health is closely related to child mortality rates. Providing quality healthcare services for mothers during pregnancy, childbirth, and postpartum significantly contributes to child survival. The latest target in the Sustainable Development Goals (SDGs) aims to reduce the maternal mortality rate (MMR) to less than 70 per 100,000 live births. However, globally, more than 800 women still die every day due to complications from childbirth or within the first 24 hours after delivery, with nearly all of these deaths (99%) occurring in low- and middle-income countries (LMICs).

Racial disparities in maternal and infant health remain a significant issue.

Differences in access to healthcare services and broader socio-economic conditions reflect systemic inequalities. To address these disparities, several important steps must be taken, including:

1. Expanding access to healthcare services and insurance,

2. Providing more diverse services to support maternal and infant health, 3. Diversifying the healthcare workforce to reflect a broader population,

4. Improving the collection and reporting of maternal and infant health data to support evidence-based policies.

Areas experiencing elevated birth rates, high maternal death rates, and significant child mortality under age five, particularly in Sub-Saharan Africa, underscore the critical need to enhance Reproductive, Maternal, Newborn, and Child Health (RMNCH) programs. Studies reveal that in 2020, around 287,000 women lost their lives to pregnancy and childbirth-related issues, with a majority of these deaths being preventable. The decade from 2010 to 2020 saw approximately 3 million mothers perish due to worldwide healthcare disparities and infringements on human rights.

This alarming situation emphasizes the urgent requirement for improved healthcare access, education, and resources in these regions. Addressing these challenges could significantly reduce the number of preventable deaths and improve overall health outcomes for mothers and children in vulnerable populations.

Socio-economic factors also play a crucial role in infant mortality rates. A study of 392,606 mother-child pairs found that individuals in the most marginalized socioeconomic groups had the highest infant mortality risk, with a risk ratio of 2.13 compared to the least marginalized group. Four key factors contributing to socioeconomic disparities in infant mortality include:

1. Premature birth (PE: 15.25%)

2. Smoking during pregnancy (PE: 13.61%)

3. Maternal age <20 years at childbirth (PE: 10.52%) 4. Maternal depression (PE: 9.13%)

Although various interventions have been implemented to address maternal and child health disparities, further research is needed on alternative antenatal care models for vulnerable populations. Additionally, increasing access to and the quality of healthcare services during pregnancy and childbirth can provide long-term benefits for maternal and child health and contribute to achieving global development goals.

(10)

Previous research has identified the economy as a major factor in maternal and infant mortality, closely linked to knowledge and education. Economic conditions have long been recognized as a primary cause of high maternal and infant mortality rates.

However, studies show that economic status is strongly correlated with a mother's level of education and knowledge. A stable economic condition allows broader access to quality healthcare services, such as regular prenatal check-ups, facility-based deliveries, and adequate postpartum care. Conversely, economic limitations often hinder mothers from accessing essential healthcare services, increasing the risk of complications during pregnancy and childbirth.

Moreover, education plays a vital role in raising maternal awareness of reproductive health and infant care. Mothers with higher education levels are more likely to understand the importance of maintaining a healthy lifestyle during pregnancy, including consuming nutritious food, maintaining hygiene, and recognizing danger signs that require immediate medical attention. On the other hand, mothers with lower education levels may lack sufficient knowledge about the importance of prenatal check-ups or child immunization, making them more vulnerable to pregnancy complications and infant mortality.

Economic capability also directly impacts maternal and infant nutrition. In families with low economic conditions, limited access to nutritious food can result in maternal malnutrition during pregnancy, increasing the risk of anemia, premature birth, or low birth weight (LBW) infants. These conditions contribute to high infant mortality rates, especially in impoverished communities.

Furthermore, education also influences better health decision-making. Mothers with higher education levels are more aware of the importance of medical care, more proactive in seeking health information, and better able to plan for a healthy pregnancy. In contrast, mothers with lower education levels are more likely to rely on traditional practices that are not always evidence-based, which can increase the risk of maternal and infant mortality.

Economic and educational disparities create a cycle of poverty that affects maternal and child health from one generation to the next. Children born to mothers with low education and economic status tend to have limited access to quality education and healthcare services, thereby sustaining high infant mortality risks and other health problems in disadvantaged communities.

Thus, although economic factors are a major cause of high maternal and infant mortality rates, effective solutions should not only focus on improving economic well- being but also on increasing access to education and health education for pregnant mothers. These efforts will help enhance health awareness, ensure access to quality healthcare services, and ultimately improve maternal and child well-being.

CONCLUSIONS

Maternal and infant mortality rates remain significant challenges worldwide, particularly in developing countries, with economic, educational, and healthcare access factors being the main causes. Economic constraints often hinder access to adequate healthcare facilities, while low education levels result in a lack of awareness among mothers about proper health practices. To address these issues, comprehensive

(11)

solutions are needed, such as improving access to quality healthcare services, providing health education to pregnant women, and implementing policies that support women's education and economic empowerment. Furthermore, strengthening the healthcare system, including increasing skilled medical personnel and implementing social protection policies, can help reduce maternal and infant mortality rates. By adopting an integrated, evidence-based approach, it is hoped that health disparities can be minimized, significantly improving maternal and child well-being.