Abstract
BackgroundThe recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications. However, these interventions are complex and relate strongly to the context in which they are implemented. In this article we explore factors to consider when implementing these interventions.MethodsThis paper reports a secondary analysis of 64 studies on birth preparedness and complication readiness interventions identified through a systematic review and updated searches. Analysis was performed using the Supporting the Use of Research Evidence (SURE) framework to guide thematic analysis of barriers and facilitators for implementation.ResultsDifferences in definitions, indicators and evaluation strategies of birth preparedness and complication readiness interventions complicate the analysis. Although most studies focus on women as the main target group, multi-stakeholder participation with interventions occurring simultaneously at both community and facility level facilitated the impact on seeking skilled care at birth. Increase in formal education for women most likely contributed positively to results. Women and their families adhering to traditional beliefs, (human) resource scarcities, financial constraints of women and families and mismatches between offered and desired maternity care services were identified as key barriers for implementation.ConclusionsImplementation of birth preparedness and complication readiness to improve the use of skilled care at birth can be facilitated by contextualizing interventions through multi-stakeholder involvement, targeting interventions at multiple levels of the health system and ensuring interventions and program messages are consistent with local knowledge and practices and the capabilities of the health system.
Highlights
The recent World Health Organization (WHO) report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications
Our systematic review on the impact of birth preparedness and complication readiness (BPCR) interventions on birth with a skilled attendant revealed that BPCR is a complex intervention, highly dependent on the context in which it is implemented [1]
In 2005 BPCR was included in the World Health Organization (WHO) antenatal care package [3, 4], with emphasis on the following elements: deciding on desired place of birth; preferred birth attendant; location of the closest facility for birth and in case of complications: funds for expenses related to birth and/or complications; Solnes Miltenburg et al BMC Pregnancy and Childbirth (2017) 17:270 supplies necessary to bring to the facility; an identified labour and birth companion; an identified support to look after home and other children while the woman is away; transport to a facility for birth or when complications arise; and identification of compatible blood donors when needed
Summary
The recent WHO report on health promotion interventions for maternal and newborn health recommends birth preparedness and complications readiness interventions to increase the use of skilled care at birth and to increase timely use of facility care for obstetric and newborn complications. These interventions are complex and relate strongly to the context in which they are implemented. Our recent systematic review of the available evidence found that BPCR, as part of a package of interventions, has the potential to increase skilled care at birth and timely use of facility care for obstetric and newborn complications [1]. The results of the review have been included in recently published WHO guidelines on health promotion interventions for maternal and newborn health, where WHO recommends implementation of BPCR interventions [5]
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