Linking families and facilities for care at birth: what works to avert intrapartum-related deaths?
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.
Lee
Anne C C
AC
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lawn
Joy E
JE
Cousens
Simon
S
Kumar
Vishwajeet
V
Osrin
David
D
Bhutta
Zulfiqar A
ZA
Wall
Steven N
SN
Nandakumar
Allyala K
AK
Syed
Uzma
U
Darmstadt
Gary L
GL
D003906:Developing Countries; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D006801:Humans; D009774:Obstetrics / Q000458:organization & administration*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality* / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration*; D011368:Professional-Family Relations