Reducing the distance to EmOC and other child-brith related services

Providing basic obstetric facilities close to every community is not a viable option in sparsely populated and low-resource settings. An alternative way of reducing distance to care is to train midwives on home deliveries and in emergency management and position them at a community level.

In Bangladesh, where 91 per cent of births occur at home midwives are posted at the village level. Despite this, a study in Matlab finds that distance continues to prevent women from using the midwives - someone has to travel outside the household to call the midwife, the midwife has to walk or arrange transport (a country boat, rickshaw), and she may have to travel a long distance to reach the home or at night when security is of grave concern (ICDDR, B, 2005).

Maternity waiting homes are also used to overcome the geographical difficulties and transport problems faced by pregnant women in the rural areas. These residential facilities located near a qualified medical facility enable women to travel closer to services before they go into labour and await their delivery. The success of waiting homes has been mixed and up to date literature is limited.