Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

Abstract

Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have not been well evaluated.

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

“…Marmots' review of the social determinants of health encourages the development of partnerships, with those affected by social inequities working with their health practitioners . Central to this approach is the development of a system that empowers women to have a real say in decisions that affect their lives, and that recognizes their fundamental human rights . These values are echoed in the National Institute of Clinical Excellence (NICE) guidelines for women with complex social factors, which called for a reorganization of maternity services to improve antenatal care for this population and identified gaps in evidence with respect to effective service provision.…”

Principles and processes behind promoting awareness of rights for quality maternal care services: a synthesis of stakeholder experiences and implementation factors

“…In a previous systematic review, we assessed the effects of interventions that promote awareness of rights on the use of maternity care services in low and middle income countries (LMICs) [ 9 ]. We identified four studies promoting awareness of rights that reported health outcomes with clear research methods detailing increases in antenatal care [ 10 – 12 ] and facility births [ 11 – 13 ].…”

State-society relations in low- and middle-income countries: an evidence gap map

“…One finds no evidence that reducing supervision frequency has any effect on service use. George et al (2015) find that all four included studies of interventions to promote rights awareness for maternity healthcare report increased use of health facilities (though one is not statistically significant) They also find that studies reported improvements in perceptions and observed quality of services. Willey et al's (2013) review of interventions to improve healthcare delivery finds mixed results for impact on quality of care.…”

“…Three high-confidence reviews (Guerrero et al, 2012;Carr-Hill et al 2015;Snilstveit et al 2015) and one medium-confidence review (George et al 2015) assess the impact on public servant characteristics and behaviours. All three high-confidence reviews relate to education programmes.…”

“…They also find that, while teacher incentives do not on average have an impact on teacher attendance or performance, they may improve teacher attendance if it is an explicit condition for a bonus. George et al (2015) include four studies in a review of the effect of promoting rights awareness for maternity healthcare. The three studies that report on staff behaviours all find an increase in attendance or the number of visits to patients.…”