title: Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: a systematic review.
abstract: OBJECTIVE
  To review quantitative evidence of the effect on maternal health of different childbirth attendance strategies in low-income settings.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Studies using quantitative methods, referring to the period 1987-2011, written in English and reporting the impact of childbirth attendance strategies on maternal mortality or morbidity in low-income settings were included. Guidelines developed by the Cochrane collaboration and the Centre for Review and Dissemination, University of York were followed. The included articles were read and sorted by category of strategy that emerged from the reading.
  
  
  RESULTS
  The search criteria yielded 29 articles. The following three main categories of strategy emerged: (i) those primarily intended to improve quality of care; (ii) "centrifugal strategies," which sought to bring services to the women; and (iii) "centripetal strategies," which sought to bring the women to the services. Few of the studies had a design that provided strong evidence for the impact of the strategy concerned.
  
  
  CONCLUSIONS
  The evidence emerging from the studies was difficult to compare, because concepts were not defined in a consistent manner (such as "skilled birth attendance") and many studies examined the impact of a package of interventions without ferreting out the impact of individual components. Yet, some studies described individual aspects with great promise (such as cost, transport, outreach-friendly drugs or targeted training). There is a need for clearer conceptual frameworks, including some which permit assessment of packages of interventions.
authors.affiliation: Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark. tdpyone@gmail.com
authors.forename: Thidar
authors.initials: T
authors.lastname: Pyone
authors.forename: Bjarke Lund
authors.initials: BL
authors.lastname: Sorensen
authors.forename: Siri
authors.initials: S
authors.lastname: Tellier
mesh_terms: D003906:Developing Countries; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008428:Maternal Mortality; D008880:Midwifery; D009017:Morbidity; D016017:Odds Ratio; D036801:Parturition; D011203:Poverty; D011247:Pregnancy; D058996:Quality Improvement; D012107:Research Design