60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

• Type of Material: Article
• Authors: Gary L. Darmstadt, Johns Hopkins University; Anne CC Lee, Johns Hopkins University; Simon Cousens, London School of Hygiene and Tropical Medicine; Lynn Sibley, Emory University; Zulgar A. Bhutta, The Aga Khan University; France Donnay, Bill & Melinda Gates Foundation; Dave Osrin, Institute for Child Health; Abhay Bang, Society for Education, Action and Research in Community Health; Vishwajeet Kumar, Johns Hopkins University; Steve N. Wall, Saving Newborn Lives/Save the Children-US; Abdullah Baqui, Johns Hopkins University; Joy E. Lawn, Saving Newborn Lives/Save the Children-US
• Language: English
• Date: 2009-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2009 Published by Elsevier Ireland Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijgo.2009.07.010
• Title of Journal or Parent Work: International Journal of Gynecology and Obstetrics
• ISSN: 0020-7292
• Volume: 107
• Issue: SUPPL.
• Start Page: S89
• End Page: S112
• Keywords: NEONATAL HEALTH-PROGRAM; Science & Technology; Life Sciences & Biomedicine; Community midwife; SCALING-UP; Community health worker; RURAL BANGLADESH; Obstetrics & Gynecology; Hypoxia; SYLHET DISTRICT; UTTAR-PRADESH; FIELD TRIAL; Stillbirth; Traditional birth attendant; Birth asphyxia; INTERVENTION; MATERNAL MORTALITY; Neonatal mortality; OBSTETRIC CARE; Intrapartum; IMPACT
• Research Categories: Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology

Abstract

Background: For the world's 60 million non-facility births, addressing who is currently attending these births and what effect they have on birth outcomes is a key starting point toward improving care during childbirth. Objective: We present a systematic review of evidence for the effect of community-based cadres-community-based skilled birth attendants (SBAs), trained traditional birth attendants (TBAs), and community health workers (CHWs)-in improving perinatal and intrapartum-related outcomes. Results: The evidence for providing skilled birth attendance in the community is low quality, consisting of primarily before-and-after and quasi-experimental studies, with a pooled 12% reduction in all cause perinatal mortality (PMR) and a 22%-47% reduction in intrapartum-related neonatal mortality (IPR-NMR). Low/moderate quality evidence suggests that TBA training may improve linkages with facilities and improve perinatal outcomes. A randomized controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a metaanalysis demonstrated an 11% reduction in IPR-NMR. There is moderate evidence that CHWs have a positive impact on perinatal-neonatal outcomes. Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2 quasi-experimental studies) showed a 28% reduction in PMR and a 36% reduction in early neonatal mortality rate; one quasi-experimental study showed a 42% reduction in IPR-NMR. Conclusion: Skilled childbirth care is recommended for all pregnant women, and community strategies need to be linked to prompt, high-quality emergency obstetric care. CHWs may play a promising role in providing pregnancy and childbirth care, mobilizing communities, and improving perinatal outcomes in low-income settings. While the role of the TBA is still controversial, strategies emphasizing partnerships with the health system should be further considered. Innovative community-based strategies combined with health systems strengthening may improve childbirth care for the rural poor, help reduce gross inequities in maternal and newborn survival and stillbirth rates, and provide an effective transition to higher coverage for facility births.