Abstract

Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated.

Highlights

  • Increasing the use of skilled maternity care services was a key objective under the Millennium Development Goals and continues to be a focus of the post-2015 development agenda (United Nations 2008, 2014; Langer et al 2013)

  • We report on a systematic review to examine evidence on the effects of interventions to provide culturally appropriate maternity care services on the uptake of skilled care during pregnancy, for birth or in the postpartum period

  • The studies reviewed suggest that interventions to provide culturally appropriate maternity care services largely have positive effects on use of skilled maternity care

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Summary

Introduction

Increasing the use of skilled maternity care services was a key objective under the Millennium Development Goals and continues to be a focus of the post-2015 development agenda (United Nations 2008, 2014; Langer et al 2013). Minority groups across world regions frequently have poorer maternal and newborn health outcomes and may be less likely than other populations to use skilled maternity care services (Wasserman et al 2007; Harris et al 2010; Kildea and Van Wagner 2012). Studies have shown that cultural factors can affect uptake of maternity care services, and addressing them has been recognized as an important step in increasing the use of services (Thaddeus and Maine 1994; WHO 2003; UNFPA 2005; Camacho et al 2006; Gabrysch and Campbell 2009; Castro 2012; Bohren et al 2014). The need for ‘culturally appropriate’ maternity care services is core to the World Health Organization’s (WHO) strategy for improving maternal and newborn health (WHO 2003) and ending preventable maternal mortality (WHO 2015a)

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