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Lancet. 2014 Sep 20;384(9948):1146-57. doi: 10.1016/S0140-6736(14)60790-X. Epub 2014 Jun 22.

The projected effect of scaling up midwifery.

Author information

  • 1Faculty of Health, University of Technology Sydney, NSW, Australia. Electronic address: caroline.homer@uts.edu.au.
  • 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • 3Department of Obstetrics, Instituto Fernandes Figueira-FIOCRUZ, Rio de Janeiro, Brasil.
  • 4Instituto de Cooperaci√≥n Social Integrare, Barcelona, Spain.
  • 5Division of Women's Health, King's College London, Women's Health Academic Centre King's Health Partners, St Thomas' Hospital, London, UK.
  • 6Autonomous University of Barcelona, Barcelona, Spain.

Erratum in

  • Lancet. 2014 Sep 20;384(9948):1098.

Abstract

We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.

Copyright © 2014 Elsevier Ltd. All rights reserved.

PMID:
24965814
[PubMed - indexed for MEDLINE]
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