Elsevier

The Lancet

Volume 368, Issue 9544, 14–20 October 2006, Pages 1377-1386
The Lancet

Series
Going to scale with professional skilled care

https://doi.org/10.1016/S0140-6736(06)69382-3Get rights and content

Summary

Because most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. The main obstacles to the expansion of care are the dire scarcity of skilled providers and health-system infrastructure, substandard quality of care, and women's reluctance to use maternity care where there are high costs and poorly attuned services. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. Based on results from simulations, teams of midwives and midwife assistants working in facilities could increase coverage of maternity care by up to 40% by 2015. Teams of providers are the efficient option, creating the possibility of scaling up as much as 10 times more quickly than would be the case with deployment of solo health workers in home deliveries with dedicated or multipurpose workers.

Section snippets

Trends and patterns of care

We know the care that is needed, but how far have we moved towards providing care for all women? In this section we provide an overview of progress in scaling up maternity care in poor countries. We focus on available information for professional assistance at childbirth, back-up care in the case of complications at childbirth, and antenatal and postpartum care.

Barriers to progress in use of professional skilled care

The slow movement towards care that is increasingly professional, institutional, and, in a few countries, privately provided is evidence of women's choices. That these increases have kept up with and surpassed the increase in the numbers of births in many settings is encouraging. However, the speed of scale-up globally is not rapid enough and gaps in coverage are all too apparent in almost all developing countries. This leaves those excluded from services at risk and opens up wide inequalities

Conclusions

A new era of strategic thinking for maternal and neonatal health should start with a realistic assessment of present care coverage, and move forward by understanding the supply constraints that have blocked progress in developing countries for 20 years. Nowadays, only half the world's women receive care from a skilled professional when giving birth—and they might not receive the quality of care they need. Even fewer women receive the full package of care from pregnancy to the end of the

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