title: Measuring the cost-effectiveness of midwife-led versus physician-led intrapartum teams in developing countries.
abstract: International agencies have advocated scaling-up of midwifery resources as an important method for improving maternal health and reducing maternal mortality rates (MMR). The cost-effectiveness of midwife-led versus physician-led intrapartum care is an important consideration in the human resource planning required to reduce MMR. Studies suggest that midwife-led teams can achieve comparable effectiveness and outcomes using less medically intensive care compared with physician-led teams. In the absence of adequate medical cost data, decision makers should consider the substantially lower average costs for three main drivers: salaries, benefits and incentives (≥two-times lower); preservice training (three-times lower) and attrition (two-times lower) necessary to deliver intrapartum care at the level of midwife competencies. This suggests that scale-up of midwifery resources is a less expensive and more cost-effective way to reduce MMRs and could potentially increase access to skilled intrapartum care.
authors.affiliation: United Nations Population Fund (UNFPA), Technical Division, 605 3rd Avenue, New York, NY 10158, USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Friedman
authors.affiliation: United Nations Population Fund (UNFPA), Technical Division, 605 3rd Avenue, New York, NY 10158, USA.
authors.forename: Mengjia
authors.initials: M
authors.lastname: Liang
authors.affiliation: Collaborative Health Advisors, LLC, Lincoln, MA, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Banks
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D008427:Maternal Health Services / Q000191:economics*; D008428:Maternal Mortality; D008880:Midwifery / Q000191:economics* / Q000193:education / Q000706:statistics & numerical data*; D017059:Models, Econometric; D007744:Obstetric Labor Complications / Q000191:economics / Q000453:epidemiology; D009774:Obstetrics / Q000191:economics* / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011247:Pregnancy; D012456:Salaries and Fringe Benefits
keywords: childbirth; costs; cost–effectiveness; developing countries; economics; midwife; physician