Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia

Abstract

Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.

Maternal Health Care Service Utilization Among Young Married Women in India, 1992-2016: Trends and Determinants

“…A remarkable increase in the proportion of young women who had SBA during birth was evident during 2005-2006 and 2015-2016, which may be attributed to a well-funded and well-publicized safe motherhood intervention named Janani Suraksha Yojana (JSY). JSY has led to an extensive and rapid increase in institutional deliveries, from 18% in 2008, to more than 80% 10 years later [34,35]. This trend is also validated by the results from multivariate analyses.…”

Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

“…Several policies, programs, and interventions were pursued to end obstetric related deaths in sub-Saharan African countries and other developing countries [2,3]. These countries vigorously embarked on programs that encouraged childbearing women to deliver in healthcare facilities [4,5]. Despite its positive impact, facility-based deliveries have become a source of worry to many women due to frequent reports and experiences of obstetric violence and abuse in the hands of maternity care providers [1,6].…”

A Comparison of Intensive vs. Light-Touch Quality Improvement Interventions for Maternal Health in Uttar Pradesh, India

“…Speci cally, Uttar Pradesh's MMR is one of the highest in India, reporting 201 deaths per 100,000 live births in 2014-16 (1). One factor contributing to this high MMR is poor quality care within clinics and hospitals (2). Poor quality care often deters women from accessing healthcare for both urgent current needs and for follow-on health needs, regardless of necessity; this is true for both poor clinical quality and poor person-centered quality (3)(4)(5).…”