Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia
Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia
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DOI：
10.1093/heapol/czx060
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发表时间：
2017-10-01
影响因子：
3.2
通讯作者：
Donnay, France
中科院分区：
文献类型：
--
作者：
Montagu, Dominic;Sudhinaraset, May;Donnay, France
来自亚洲和非洲许多国家的越来越多的证据表明，过去十年中设施交付发生了巨大转变。这些增长并没有带来卫生政策研究人员过去预测的健康结果的改善。鉴于这一意想不到的证据，我们评估了多个来源的数据，包括来自亚洲和非洲 43 个国家的全国代表性数据，以了解亚洲和非洲送货地点变化的规模和范围。我们回顾了多个国家的政策、计划和融资经验，以了解实践变化的驱动因素，以及对孕产妇和新生儿健康以及为妇女和新生儿提供服务的卫生系统的影响。最后，我们考虑了随着我们进入全球行动的下一阶段，分娩地点的变化将对孕产妇和新生儿护理策略产生什么影响。根据我们的分析，我们提出四项主要政策建议。 (1) 扩大对中层配送服务设施的投资，并摆脱小批量的农村配送设施。 （2）通过交通基础设施资金、旅行券、定向服务补贴以及产前产后居住支持等方式保障农村妇女的出行。 (3) 提高大型机构内产科设施和专门产科病房的专业化程度。 (4) 重新关注私人和公共环境中各级交付设施的质量改进。
Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.