title: The global met need for emergency obstetric care: a systematic review.
abstract: BACKGROUND
  Of the 287,000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as 'Met need for EmOC'.
  
  
  OBJECTIVE
  To estimate the global met need for EmOC and to examine the correlation between met need, maternal mortality ratio and other indicators.
  
  
  METHODS
  A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and Google Scholar.
  
  
  METHODS
  Studies containing data on met need in EmOC were selected.
  
  
  METHODS
  Analysis was performed with data extracted from 62 studies representing 51 countries. World Bank data were used for univariate and multiple linear regression.
  
  
  RESULTS
  Global met need for EmOC was 45% (IQR: 28-57%), with significant disparity between low- (21% [12-31%]), middle- (32% [15-56%]), and high-income countries (99% [99-99%]), (P = 0.041). This corresponds to 11.4 million (8.8-14.8) untreated complications yearly and 951 million (645-1174 million) women without access to EmOC. We found an inverse correlation between met need and maternal mortality ratio (r = -0.42, P < 0.001). Met need was significantly correlated with the proportion of births attended by skilled birth attendants (β = 0.53 [95% CI 0.41-0.65], P < 0.001).
  
  
  CONCLUSIONS
  The results suggest a considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. Met need is a powerful indicator of the response to maternal mortality and strategies to improve EmOC act in synergy with the expansion of skilled birth attendance.
authors.affiliation: Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children's Hospital, Lund University, Lund, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Holmer
authors.forename: K
authors.initials: K
authors.lastname: Oyerinde
authors.forename: J G
authors.initials: JG
authors.lastname: Meara
authors.forename: R
authors.initials: R
authors.lastname: Gillies
authors.forename: J
authors.initials: J
authors.lastname: Liljestrand
authors.forename: L
authors.initials: L
authors.lastname: Hagander
mesh_terms: D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000600:supply & distribution*; D005260:Female; D014943:Global Health; D006301:Health Services Needs and Demand; D006801:Humans; D008428:Maternal Mortality; D009774:Obstetrics; D011247:Pregnancy
keywords: Emergency obstetric care; maternal health; met need; obstetrics; skilled birth attendance