Advisory group
From home births to health centers: Equipping maternity wards to provide high-quality care to a growing user base
28 huhtikuun, 2016
By Jerker Liljestrand
Senior Program Officer for Maternal, Newborn and Child Health, Bill & Melinda Gates Foundation

Anna is a farmer in Southern Malawi. This is her story of her first childbirth:

”I got married last year and got pregnant soon after that. My contractions started in the middle of the night, and my husband took me to the health center on our motorbike. In the early afternoon, our baby girl was born. I am happy that we could give birth with the midwife, but it was very crowded at the health center so it was also nice to get back home again. For me, I prefer to be with the midwife at the health center. She knows what to do, if there is a problem.”

Anna’s story is both a promising and an illustrative one. While an increase in institutional births has improved maternal and newborn health outcomes, it has also laid bare and created challenges within health facilities. Just 10 years ago in Malawi, the percentage of women giving birth in facilities was 54%. That number has since risen to 90%, and similar increases can be seen across the board in low- and middle-income countries. In Cambodia, a health center that might have seen few births per month in 2002 now sees several births every day.

When women can reach and trust health facilities and personnel, they can access health services, both for themselves – before, during, and after pregnancy – and for their children, that have tremendous impact. Two of the greatest contributors to the 43% global decline in maternal deaths since 1990 have included improved access to family planning services, and increased rates of facility births. When women give birth in a health center, they can receive timely treatment should complications arise and are supported by skilled health care providers, decreasing the risk of adverse outcomes.

Although the increase in facility births has made childbirth safer, it has also left some health centers inundated and stretched for resources. Given the statistics, it’s no wonder that although Anna’s childbirth in a health center was safer than a home birth, her experience was hampered by overcrowding. Her story exemplifies the fragility of the gains we have made in reducing maternal and newborn mortality. Sustaining these reductions requires recognizing both the ongoing and new challenges, including those generated by increased usage, that exist within facilities.

Overcrowded and unsanitary health facilities mean that women and newborns continue to die of preventable causes. While Anna’s health center supported her safe birth, it’s possible that she was met upon her arrival with the symptoms of an under-resourced and ill-equipped facility: a hurried care provider, unclear instructions, perhaps even a labor ward so congested that she couldn’t get to the bathroom. This is the reality of many birthing facilities around the world. Coupled with poor hygiene and a lack of sanitation, overcrowded health centers can increase rates of infection and disease, putting mothers and newborns at unnecessary risk.

The impacts of packed, poorly equipped or unclean facilities go beyond the physical: childbirth is not just a medical event, but also a psychosocial and life event. When facilities cannot offer high-quality attention and services, the experience of birth can be uncomfortable and depersonalized – and can ultimately undermine the woman’s trust in the system on which she relies.

Despite these challenges, relatively simple changes can be made in health facilities that can transform the birth experience, both in terms of safety and comfort. Ministries of health, with a number of organizations and partners, are working to improve infrastructure and staffing, and increase use of specific medical interventions that can improve the outcomes of birth for mothers and their children. Less frequently discussed are other important, non-medical interventions, including efforts to improve the space, products and services available to a woman in birth.

M4ID’s Lab.Our Ward specializes in innovating low-cost, strategic interventions like improved delivery beds, architectural design to maximize space and circulation, and better lighting and air flow. These innovations, developed through a collaborative process with partners from various sectors, help practitioners identify how they can best organize, revise and improve their facilities. The changes are simple and adaptable, and demonstrate our ability to rethink how we approach women’s experiences of birth. They allow the labor ward to serve its essential dual purpose: to enable practitioners to provide the highest-quality care, while ensuring that women feel welcomed and respected.

Looking at how mothers and newborns fare in childbirth remains one of the best indicators of a health system’s strength, and expanding access to facilities is just half the battle. A challenge we now face, across all levels of care, is ensuring that maternity wards are adequately designed and equipped to respond holistically to the needs of all their users. It is an ambitious goal, but it has to be. All the world over, women like Anna deserve an experience of childbirth that is not only safe, but that is comfortable, personal and dignified.

Photo: M4ID / Damaris Rodriguez

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