Maternal Health Literacy (MHL) for Improved Maternal and Child Outcomes: A Scoping Review

Abstract

Measuring a country’s health requires considering maternal and child health indices. Despite international efforts, the Sustainable Development Goals for maternal mortality and child health are still difficult to achieve. The current study aims to understand the maternal and children’s outcomes of maternal health literacy (MHL). A scoping review was conducted on maternal health literacy outcomes. We searched for English language publications on MHL and its effects on mother and child health that were published between 2005 and 2024 in PubMed, Scopus, and Google Scholar. PRISMA chart is used for the study selection process and the data findings were compiled and summarized narratively. A total of 13 articles were included in this scoping review. MHL gives women the ability to get, comprehend, assess, and use health information, which has an impact on pregnancies, deliveries, and postpartum care. Higher MHL may result in better mother and newborn health outcomes since studies link it to increased use of prenatal care, skilled delivery attendance, and postnatal care services. MHL may also have an impact on things like breastfeeding habits, vitamin supplementation, and warning sign knowledge. MHL investments are essential for enhancing the health of mothers and children. By providing women with the knowledge, they need to make educated decisions, MHL may encourage healthier habits and improve the health of both mothers and their offspring.

INTRODUCTION

As per the World Health Organization, Maternal Mortality, about 2,87,000 women died during and following pregnancy and childbirth in 2020. Southern Asia accounted for 16% of these deaths and achieved a decline in maternal mortality ratio of 67% (from MMR of 408 per 100,000 live births to 134 per 100,000 live births) between 2000 and 2020.[1] In 2022, 2.3 million children worldwide lost their lives in the first 20 days of life. About 6500 newborns die every day, which makes up 47% of all child mortality under the age of five. Since 1990, there has been a noticeable improvement in child survival worldwide.[2] The maternal and child health indicators serve as barometers for assessing the overall health status of nations and have been integrated into the Sustainable Development Goals (SDGs) framework for 2030. Under the SDGs, Target 3.1 focuses on reducing the maternal mortality ratio (MMR) globally to below 70 per 100,000 live births by 2030. Target 3.2 aims to decrease preventable causes of neonatal deaths to fewer than 12 per 1,000 live births by the same year.[3]

Regrettably, a United Nations report indicates that global progress towards achieving SDG Target 3.1 has stagnated, and certain regions within India, particularly the Empowered Action Group states, face significant obstacles in meeting these targets.[4,5] More than 4 out of 5 nations are probably going to miss the targets outlined in the Sustainable Development Goals for maternal mortality: 64 countries for neonatal mortality and 59 countries for child mortality under five if current trends continue. To meet these goals, the current rates of fall in maternal mortality would need to be increased nine times, and the rates of decline in mortality for newborns and children under five would need to be accelerated four times.[6]

Maternal health is and has always been intricately linked to child health and family health, as the well-being of mothers directly impacts the health outcomes of their children and the overall functioning of the family unit. Factors such as maternal nutrition, access to prenatal care, and management of maternal health conditions directly impact the health and development of the unborn child.[7] Similarly, adequate postnatal care, including breastfeeding support, immunizations, and maternal and infant health monitoring, is essential for promoting optimal growth and development in early childhood.[8]

Poor maternal health can exacerbate financial strain, limit caregiving capacity, and disrupt family routines, leading to adverse outcomes for both mothers and children. So, the welfare of mothers and children is a key public health issue that reflects each nation’s socioeconomic standing. Investing in maternal health benefits mothers directly and yields significant dividends in the well-being of generations to come (“the ripple effect”) and enhances the overall functioning of families and communities.[9,10,11] Maternal health is a social issue: Maternal illness and disability are the results of a complex interaction between individual-level determinants, lifestyle choices and exposures, and eco-social forces.[12] Despite the concerted efforts and the implementation of new healthcare schemes still maternal and neonatal morbidity and mortality persist. These may be due to a lack of awareness among mothers and families regarding pregnancy-related ailments, which results in the utilization of home remedies instead of seeking professional medical assistance. These are often compounded by instances where healthcare professionals fail to adequately communicate the danger signs of pregnancy and postpartum care.[13] Maternal mental health also influences parenting practices and the emotional well-being of children, highlighting the interconnectedness of maternal and child health within the family context.[14,15]

The healthcare system is continuously adapting and working extensively to treat patients and address this tragic state. The lacuna between patients’ understanding of alarming symptoms and availing benefits from the health care system is a significant problem for both patients and the health care system. Hence, to address this social issue, we need to implement strategies that will work at each facet of this complex problem. The objective of this review is to identify the available literature on maternal health literacy to understand what has been described in this topic, and to answer the research question “How does MHL influence maternal and child health outcomes?”

METHODOLOGY

This scoping review aimed to comprehensively map the existing research on maternal health literacy. By including a wide range of article types, this review provided a broad understanding of the current state of knowledge in this field.

This scoping review followed the PCC framework which included [See Table 1].

Table 1.

Inclusion and exclusion criteria for the study

Criteria	Inclusion	Exclusion
Population	Pregnant women or postpartum mothers	Studies with a population other than pregnant women or postpartum mothers
Concept	Maternal health literacy (MHL). This includes studies that define, measure, or explore the impact of MHL on health outcomes.	Studies not focusing on MHL (e.g., studies solely on general health literacy).
Context	All studies published in English from 2001 to 2024	Articles published before 2001.
Study Types	Quantitative (e.g., randomized controlled trials, cohort studies), Qualitative (e.g., interviews, focus groups), Mixed-methods studies	Editorials, commentaries, letters to the editor, or book reviews, Review articles: Systematic reviews and meta-analyses
Language	English language articles	Non-English language articles

Search strategy

PubMed, Scopus, and Google Scholar were searched using a combination of keywords and Medical Subject Headings (MeSH) terms. Examples include: “Maternal health literacy” OR “maternal literacy” OR “health literacy” OR “maternal health” OR “postpartum education AND “pregnancy outcomes”. Reference lists of retrieved articles were scanned for additional relevant studies.

Study selection

Two co-authors independently reviewed titles and abstracts. Full texts of potentially relevant literature were sorted and screened for inclusion criteria. Agreement between these two was achieved by common consensus. Conflicts were resolved by joint discussions with the third arbitrator author. As this study was a scoping review, no critical appraisal of included literature was performed.

Data abstraction

A review of full-text articles and extraction of relevant data was independently done by two co-authors. Data extraction included information on study design, authors, year of study, country, and key findings.

Data summary and synthesis

Data were compiled in a single spreadsheet. Due to the anticipated heterogeneity of the included studies (e.g. different study designs, populations, and outcomes), a narrative synthesis approach is being used. This will involve summarizing the key findings of each study. No meta-analysis was conducted due to the potential for methodological differences between studies.

RESULTS

A total of 1,384 articles were searched through the database. After screening and checking for inclusion criteria 13 studies were included [See Figure 1]. Health literacy (HL), specifically maternal health literacy (MHL), emerges as a potent tool. HL bridges the gap between the health care system and patients to address this problem. Health literacy is a multifaceted idea, that encourages the application of a strengths-based, solution-focused strategy to enhance health outcomes and lessen health disparities [See Table 2].[16]

Figure 1.

PRISMA chart for study identification

Table 2.

Study characteristics

Year	First Author	Country	Type of Study	Study Participants	Major Finding	Conclusion
2008	Kohan, S et al.[20]	Iran	Descriptive	150 women from post-partum ward	Women with adequate health literacy had significant differences in starting earlier and frequency of antenatal care, neonatal birth, and breastfeeding.	Higher health literacy associated with better prenatal care and pregnancy outcomes
2011	Mojoyinola, J.K.[11]	Nigeria	Cross-Sectional	250 pregnant women and nursing mothers	Higher health literacy associated with healthier behaviors during pregnancy	Improved health literacy can promote positive behaviors during pregnancy
2015	Johri, M et al.[13]	India	Cross-Sectional	590 mothers	Lower health literacy linked to incomplete childhood vaccination	Improving health literacy is crucial to ensure complete childhood vaccination
2016	Malik, M.R et al.[22]	Pakistan	Cross-Sectional	214 pregnant women	Factors affecting health literacy influence the use of skilled birth services	Addressing factors that influence health literacy can improve the utilization of skilled birth services
2018	Thomas, S.D et al.[10]	USA	Mixed method	37 prenatal-inter- conceptional women	High-risk factors (e.g., prior preterm birth) can negatively impact health literacy	Addressing risk factors can improve health literacy among high-risk pregnant women
2020	Wagner, T et al.[26]	USA	Cross-Sectional	Post Natal educational material	The study highlighted the need for health-literate and culturally sensitive postpartum education	Lower health literacy is a risk factor for maternal mortality
2021	Bello, C.B. et al.[27]	Nigeria	Cross-Sectional	185 newly delivered mothers	Higher health literacy linked to better prenatal care & knowledge of pregnancy danger signs	Improved health literacy can lead to better pregnancy outcomes
2021	Habte, A et al.[21]	Ethiopia	Cross-Sectional	635 pregnant women	Low health literacy prevalent among pregnant women	Interventions needed to improve health literacy among pregnant women in Ethiopia
2021	Forghani, T et al.[28]	Iran	Cross-Sectional	121 pregnant women	There was a significant relationship between health literacy score and the mother’s education, household income, number of children, place of residence, pregnancy weight gain, supplementation, and, dairy products.	Health policy-makers should simplify the health literacy training program for pregnant and lactating women to reduce the various factors that affect their health literacy.
2022	Ghotbizadeh, F et al.[25]	Iran	Cohort	323 participants from prenatal clinics	Sufficient/excellent health literacy associated with earlier & more frequent prenatal care, healthier behaviors	Higher health literacy is a factor in positive pregnancy outcomes
2022	Nawabi, F et al.[29]	Germany	RCT	1365 pregnant women	The intervention was significantly positively associated with pregnancy-specific knowledge of lifestyle	Socioeconomic factors influence health literacy among pregnant women
2023	Melwani, S et al.[23]	Tasmania	Qualitative co-design	Various stakeholders working in maternal and child health	The co-design workshops generated multiple solutions and recommendations grounded in the local knowledge and expertise of the various stakeholders.	Importance of codeveloping health literacy interventions with target audience
2024	Jiregna, B et al.[30]	Ethiopia	Cross-Sectional	411 mothers	Women’s health literacy is positively associated with child healthcare utilization	Improved health literacy in women can lead to better health outcomes for both mothers and children

MATERNAL HEALTH OUTCOMES

Social and behavioral effects

MHL encompasses cognitive and social abilities that empower women to access, comprehend, evaluate, and apply health information to enhance the well-being of mothers and their children.[17] This includes functional, interactive, and critical aspects of MHL, enabling women to navigate pregnancy, childbirth, and postpartum care with informed decision-making.[18] The functional domain includes the diffusion of health-related information, which leads to increased knowledge regarding the risk factors, The Interactive domain provides an enabling environment for the development of skills required to sustain health and help individuals to act upon the knowledge that they have acquired and the Critical domain involves a deeper understanding of the various social and economic determinants of health that makes individuals resilient to various social and economic adversities.[19]

Health practices

Research studies included in this review are across countries and they reveal a positive association between MHL and various maternal and child outcomes. Studies in Iran, Ethiopia, and the United States highlight that mothers with higher MHL are more likely to engage in practices that benefit both themselves and their babies. This includes starting prenatal care early and attending regularly, taking folic acid supplements, exercising during pregnancy, recognizing pregnancy warning signs, delivering babies with healthy birth weights, and initiating breastfeeding.[10,20,21]

Health care utilization

Furthermore, MHL seems to be a key factor in how mothers utilize available healthcare services. Research from Nigeria, Pakistan, and India suggests that mothers with better health literacy are more likely to register for antenatal care early in their pregnancy, receive recommended vaccinations, and attend enough prenatal care visits throughout their pregnancy.[11,13,22] It is important to note that social determinants of health can also influence MHL. Studies in Ethiopia and Iran demonstrate that a mother’s education level, income, and even where she lives can impact her health literacy.[21]

Targeted intervention

Research conducted in Germany and Tasmania suggests that brief counseling sessions or providing educational materials written in clear, understandable language can be effective in enhancing a mother’s pregnancy-specific health knowledge.[23,24] These targeted interventions can empower mothers to make informed decisions during their pregnancy journey.

CHILDREN’S HEALTH OUTCOME

The studies included in this review offer a compelling look at how a mother’s health literacy can influence the health of her child.

Vaccinations

Research conducted in India revealed a positive link between MHL and a child’s complete vaccination status.[13] Mothers with better health literacy were more likely to ensure their children received all the recommended vaccinations. This suggests that when mothers can understand information about vaccines, they are better equipped to make informed decisions about their child’s immunization schedule.

Birth weight

Studies from Iran and Ethiopia highlight a connection between adequate MHL and higher newborn birth weight. This indicates that mothers who have a solid grasp of pregnancy health information are more empowered to make choices that promote healthy fetal development. Understanding factors like nutrition and prenatal care can significantly impact a baby’s birth weight.[21,25]

Prenatal care

Several studies reported a positive association between MHL and a mother’s utilization of antenatal care services. Mothers with higher MHL were more likely to register for prenatal care early in their pregnancy, attend enough prenatal visits, and receive essential preventive measures like screenings and vaccinations. This suggests that health literacy empowers mothers to take a more proactive approach to their health during pregnancy, which can have a positive impact on their baby’s well-being.

These studies collectively highlight the potential benefits of improving MHL for children’s health. By equipping mothers with health knowledge and resources, we can contribute to several positive outcomes for children.

DISCUSSION

MHL includes the knowledge and social skills individuals need to embrace good nutrition and healthy lifestyles, be aware of risk factors, and make the right decisions during pregnancy and childbirth.[27] This review is an attempt to summarise the existing understanding of MHL. Understanding the health literacy levels of pregnant women can empower them to access and identify areas where information gaps exist. This helps to improve health utilization among both the mothers and their children’s health. The use of maternal healthcare services, such as early ANC visits, tetanus toxoid vaccine uptake, and ANC attendance in facilities with trained birth attendants, were found to have a significant association with MHL in a study done by Bello et al.[27] Early pregnancy screening for ANC, particularly in the first trimester, offers the chance to obtain health information that is essential for obtaining favorable health outcomes. A study by Kharazi et al.[31] on Maternal health literacy and pregnancy outcomes demonstrated that MHL needs to be given more emphasis in health promotion programs as there is a strong association of MHL with prenatal care, pregnancy outcomes, and birth weight. Also improving maternal health literacy is important for health behaviors that are crucial during pregnancy and to ensure complete childhood vaccination, which protects children from serious illness and even death.[11,13]

A study by Azugbene et al.[32] stated that the inability of many women to appropriately process and apply health information is a result of poor health literacy. Child health outcomes are impacted under the care of carers with low health literacy. A woman’s role as a parent is crucial for her children’s health to be successful. Charoghchian Khorasani et al.[33] conducted a study in Iran and stated that there exists a correlation between higher self-efficacy in breastfeeding and maternal health literacy. Breastfeeding promotes nutrition in children, and increased maternal health literacy may help with this Furthermore, Johri et al.[13] found in their study that children of low health literacy mothers were approximately half as likely to develop severe underweight or severe stunting than children of high health literacy mothers. Findings from our study have shown a strong involvement between socioeconomic status and maternal healthcare literacy.[28,29] Lower health literacy is prevalent among pregnant mothers and training programs are needed that focus on the basic needs of the target audience.[21,23]

Research on health literacy helps policymakers and healthcare professionals design interventions and policies that effectively communicate health information to pregnant women, reducing disparities and improving overall care. A grasp of how health literacy influences adherence can contribute to preventing complications during pregnancy. In essence, studying health literacy in pregnant women can be a driven approach to enhance the quality of maternal healthcare, promoting informed decision-making, and fostering better health outcomes for mothers. Investing in maternal health literacy can catalyze achieving SDG targets, reducing inequalities, and fostering comprehensive societal development while ensuring the well-being of mothers, children, and communities alike.

Limitations of the study

Like any other study, the present study also has certain limitations. The study did not quantify the health outcome; rather, it discussed the maternal and child health outcomes descriptively. Also, the study’s methodology varied and did not include articles from other languages except English.

CONCLUSION

Investments in maternal health literacy (MHL) are essential to enhancing the health of mothers and their children. MHL gives women the power to make educated decisions as they navigate pregnancy, delivery, and parenting. Studies have linked higher MHL to healthier habits and better outcomes for the health of expectant mothers and their babies.

Public health recommendation

Enhancing MHL should be the top priority for public health initiatives. Improved communication between moms and healthcare practitioners, as well as educational initiatives and easily accessible healthcare information, can help achieve this. We can reduce maternal mortality and morbidity and create a brighter future for future generations by empowering women with the knowledge and critical thinking skills necessary to make decisions about their own and their children’s health.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.