TY - JOUR
T1 - Linking families and facilities for care at birth
T2 - What works to avert intrapartum-related deaths?
AU - Lee, Anne C.C.
AU - Lawn, Joy E.
AU - Cousens, Simon
AU - Kumar, Vishwajeet
AU - Osrin, David
AU - Bhutta, Zulfiqar A.
AU - Wall, Steven N.
AU - Nandakumar, Allyala K.
AU - Syed, Uzma
AU - Darmstadt, Gary L.
PY - 2009/10
Y1 - 2009/10
N2 - 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.
AB - 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.
KW - Asphyxia neonatorum
KW - Birth asphyxia
KW - Cash transfers
KW - Community mobilization
KW - Community transport system
KW - Community-based health insurance
KW - Demand for obstetric care
KW - Hypoxia
KW - Maternity waiting homes stillbirth
KW - Neonatal mortality
KW - Risk screening
KW - Vouchers
UR - http://www.scopus.com/inward/record.url?scp=77949892340&partnerID=8YFLogxK
U2 - 10.1016/j.ijgo.2009.07.012
DO - 10.1016/j.ijgo.2009.07.012
M3 - Article
C2 - 19815201
AN - SCOPUS:77949892340
SN - 0020-7292
VL - 107
SP - S65-S88
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - SUPPL.
ER -