Abstract
BackgroundIn 2007, the Government of Pakistan introduced a new cadre of community midwives (CMWs) to address low skilled birth attendance rates in rural areas; this workforce is located in the private-sector. There are concerns about the effectiveness of the programme for increasing skilled birth attendance as previous experience from private-sector programmes has been sub-optimal. Indonesia first promoted private sector midwifery care, but the initiative failed to provide universal coverage and reduce maternal mortality rates.MethodsA clustered, stratified survey was conducted in the districts of Jhelum and Layyah, Punjab. A total of 1,457 women who gave birth in the 2 years prior to the survey were interviewed. χ2 analyses were performed to assess variation in coverage of maternal health services between the two districts. Logistic regression models were developed to explore whether differentials in coverage between the two districts could be explained by differential levels of development and demand for skilled birth attendance. Mean cost of childbirth care by type of provider was also calculated.ResultsOverall, 7.9% of women surveyed reported a CMW-attended birth. Women in Jhelum were six times more likely to report a CMW-attended birth than women in Layyah. The mean cost of a CMW-attended birth compared favourably with a dai-attended birth. The CMWs were, however, having difficulty garnering community trust. The majority of women, when asked why they had not sought care from their neighbourhood CMW, cited a lack of trust in CMWs’ competency and that they wanted a different provider.ConclusionsThe CMWs have yet to emerge as a significant maternity care provider in rural Punjab. Levels of overall community development determined uptake and hence coverage of CMW care. The CMWs were able to insert themselves into the maternal health marketplace in Jhelum because of an existing demand. A lower demand in Layyah meant there was less ‘space’ for the CMWs to enter the market. To ensure universal coverage, there is a need to revisit the strategy of introducing a new midwifery workforce in the private sector in contexts of low demand and marketing the benefits of skilled birth attendance.
Highlights
In 2007, the Government of Pakistan introduced a new cadre of community midwives (CMWs) to address low skilled birth attendance rates in rural areas; this workforce is located in the private-sector
Drawing on this well-acknowledged evidence, the Government of Pakistan introduced a new cadre of skilled birth attendants, the Community Midwives (CMWs) [3]
Of these 47%, the majority knew that the CMW provided childbirth services and nearly 80% had had contact with her in the context of an introductory home-visit or provision of antenatal, postnatal, and general medical care(Table 2)
Summary
A large body of historic and contemporary evidence from around the world has shown the introduction of an effective midwifery workforce is one of the most important elements of any maternal mortality reduction strategy Drawing on this well-acknowledged evidence, the Government of Pakistan introduced a new cadre of skilled birth attendants, the Community Midwives (CMWs) [3]. The CMWs were to establish home-based clinics and provide domiciliary antenatal care (ANC), childbirth, and postnatal care to rural women, as well as divert those currently using traditional birth attendants, or dais, to their skilled care They were supported with a small stipend for the first 2 years after their training while establishing their practices. Over 8,000 CMWs have been deployed [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
