Below are extracts of a blog by Bethany Kotlar, Associate Director of the Maternal Health Task Force, and a comment from me. Full text here: https://www.mhtf.org/2022/04/26/challenging-the-reliance-on-facility-bas...
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The burden of maternal mortality in low- and middle-income countries (LMICs) remains high, notwithstanding heavy investment in maternal healthcare. Historically, these strategies have prioritized increasing facility-based birth. However, emerging evidence has challenged facility-based birth as an appropriate or effective strategy for reducing maternal mortality.
Human rights groups highlight prevalent disrespect and abuse during childbirth and low-quality facilities as factors in the failure to increase uptake of facility-based birth and improve birth outcomes...
This violence includes physical assault or derogatory language from healthcare providers as well as institutional practices such as policies preventing the use of traditional birthing practices, requiring unnecessary medical preventions, and forcibly keeping postpartum people for failure to pay for the birth of their child. Disrespect and abuse during childbirth is a strong deterrent for seeking medical care during childbirth and a direct contributor to poor maternal health outcomes...
Given lack of concrete evidence that facility-based birth in LMICs leads to better outcomes and overwhelming evidence that facility-based birth exposes marginalized groups to harm, reliance on increasing facility-based birth as a frontline public health tool is fundamentally unethical...
More recently, some maternal health proponents have instead shifted towards improving an uptake in skilled birth attendance, rather than facility-based birth...
It’s time to abandon facility-based birth as the “gold standard” in maternal healthcare...
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COMMENT: This is a controversial piece. Should the aim of facility-based care be abandoned because some staff in some facilities show disrespect and abuse? The alternative approach would be to do everything possible to reduce disrespect and abuse in facilities. The blog acknowledges the problem of 'low-quality facilities' and this is surely central.Previous research has found that indicators of poor-quality care (ranging from lack of equipment and medicines to staff shortages and excessive workload) are themselves contributors to disrespect and abuse. So an alternative approach would be to do everything possible to improve quality of care.
Better quality care and less abuse in facilities would lead to better health outcomes, and this would encourage more women to attend facilities. However, many women will remain unable to use such facilities for childbirth. For them, quality of care in the home or community is just as vital as quality of care in the facility.
Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
