Professional maternity care: scaling up provision in poor countries

Only half of women globally receive skilled professional care in childbirth, and those that do might not receive the quality of care needed. Most women prefer professional maternity care where accessible. Where not accessible, maternal mortality is high and the provision of this care has stagnated.

All women want to be safe in childbirth and to have access to care throughout pregnancy, birth and afterwards. This means the provision of medical care ranging from support during pregnancy to a caesarian section if needed. The provision of professional medical care increases the chance of survival of both mother and child. Most women choose professional maternity care when they are able to access it and can afford it. However, the provision and use of professional maternity care has come to a standstill globally: especially for the poorest women and those in rural areas.

The third paper in The Lancet Maternal Survival Series assesses global progress in the provision and uptake of maternity care for all women. It gives an overview of progress in scaling up maternity care provision in developing countries and examines the barriers to progress in the use of professional skilled care. 

The research finds that:

• Access to professional care increased by only 10 percent from 1992 to 2000, and so millions remain without access. One in four poor women is alone or has the help of only a relative or neighbour during childbirth.
• Progress in professionalising maternity care has been held back by the lack of progress in rural areas, especially in sub-Saharan Africa and South and South-East Asia.
• In areas of massive deprivation, where most women are outside of services, progress is held back by the lack of availability of professional care.
• In marginally deprived areas, where the poorest people are outside of services, progress suffers from financial barriers as well as from poor quality care and reluctance to use services for traditional and social reasons.
• The major barrier to increasing coverage of maternity care is determined by strategic decision-making in three areas – training, deployment and retention of health workers.

Strategies for improving maternal survival must start with a realistic assessment of the supply of skilled birth attendants and their uptake. They must also assess the problems with supply that have stopped progress being made in this area in developing countries in the past 20 years. The following are important issues for policy:

• All women need good quality maternity care that is respectful and humane, while health staff need to be managed and paid properly to ensure they remain in service.
• The biggest challenge for safe motherhood is the undersupply of maternity services in countries with extensive deprivation. These services should be scaled up as soon as possible.
• In countries where only some poor women are excluded from maternity services, existing infrastructure must be expanded, barriers to care must be removed, underserved groups must be targeted and financial protection must be ensured.
• Facility-based births attended by teams composed of skilled midwives and assistants could increase the number and proportion of women accessing professionally assisted births by up to 40 percent by 2015.
• Skilled attendance at birth could be scaled up ten times more rapidly if health workers were organized in teams rather than in solo practices conducting home deliveries.
• Safe motherhood strategies are not likely to succeed and the gaps in maternal care are not likely to be closed unless policymakers are convinced there is political value in responding to the population’s rising demand for professional care.

Source(s):
'Going to scale with professional skilled care’, The Lancet Maternal Survival Series 368(9544), pages 1377-1386, by Marge Koblinsky, Zoe Matthews, Julia Hussein, Dileep Mavalankar, Malay K. Mridha, Iqbal Anwar, Endang Achadi, Sam Adjei, P. Padmanabhan, B. Marchal, V. de Brouwere and Wim van Lerberghe, 2006 Full document.

Funded by: UK Department for International Development (DFID); US Agency for International Development (USAID); Initiative for Maternal Mortality Programme Assessment (Immpact)

id21 Research Highlight: 22 February 2007

Further Information:
Marge Koblinsky
68 Shahid Tajuddin Ahmed Sharani
Mohakhali (GPO Box 128, Dhaka 1000)
Dhaka 1212
Bangladesh

Tel: +880 2 886 0523 ext 2200
Fax: +880 2 882 3116
Contact the contributor: margek@icddrb.org

Other related links:
'Maternal health in poor countries: the broader context and a call for action'

'Understanding maternal mortality: achieving the fifth Millennium Development Goal'

'Reducing the cost of maternal health services to the poorest households'

'Women’s groups’ perceptions of maternal health issues in rural Malawi'

'Life saving or money wasting? What users think of caesarean sections in Bangladesh'

'Maternal health in sub-Saharan Africa: tackling the skills shortage'

'Comparing maternal health services in four countries'