Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

Lee, Anne CC; Lawn, Joy E.; Cousens, Simon; Kumar, Vishwajeet; Osrin, David; Bhutta, Zulfiqar A.; Wall, Steven N.; Nandakumar, Allyala K.; Syed, Uzma; Darmstadt, Gary L.

doi:10.1016/j.ijgo.2009.07.012

« Previous Next »International Journal of Gynecology & Obstetrics
Volume 107, Supplement , Pages S65-S88, October 2009

Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?

Anne CC Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Saving Newborn Lives/Save the Children-USA, Washington, DC, USA and Cape Town, South Africa
Joy E. Lawn
- Saving Newborn Lives/Save the Children-USA, Washington, DC, USA and Cape Town, South Africa
Simon Cousens
- London School of Hygiene and Tropical Medicine, London, UK
Vishwajeet Kumar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
David Osrin
- UCL Centre for International Health and Development, Institute of Child Health, London, UK
Zulfiqar A. Bhutta
- Division of Women and Child Health, the Aga Khan University, Karachi, Pakistan
Steven N. Wall
- Saving Newborn Lives/Save the Children-USA, Washington, DC, USA and Cape Town, South Africa
Allyala K. Nandakumar
- Heller School of Social Policy, Brandeis University, Waltham, MA, USA
Uzma Syed
- Saving Newborn Lives/Save the Children-USA, Washington, DC, USA and Cape Town, South Africa
Gary L. Darmstadt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. Integrated Health Solutions Development, Global Health Program, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA 98102, USA.
- Current address: Integrated Health Solutions Development, Global Health Program, Bill & Melinda Gates Foundation, Seattle, WA, USA.

Abstract

Background

Delays in receiving effective care during labor and at birth may be fatal for the mother and fetus, contributing to 2 million annual intrapartum stillbirths and intrapartum-related neonatal deaths each year.

Objective

We present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes.

Results

There is moderate quality evidence that community mobilization with high levels of community engagement can increase institutional births and significantly reduce perinatal and early neonatal mortality. Meta-analysis showed a doubling of skilled birth attendance and a 36% reduction in early neonatal mortality. However, no data are available on intrapartum-specific outcomes. Evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown. Current evidence for maternity waiting homes and risk screening is low quality.

Conclusions

Empowering communities is an important strategy to reduce the large burden of intrapartum complications. Innovations are needed to bring the poor closer to obstetric care, such as financial incentives and cell phone technology. New questions need to be asked of “old” strategies such as risk screening and maternity waiting homes. The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation.

Keywords: Asphyxia neonatorum, Birth asphyxia, Cash transfers, Community-based health insurance, Community mobilization, Community transport system, Demand for obstetric care, Hypoxia, Maternity waiting homes stillbirth, Neonatal mortality, Risk screening, Vouchers