Skilled Birth Attendant Coverage Research Articles

Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey

BackgroundSouth Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources.MethodsAnalysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data.FindingsPoorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2–6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group.ConclusionsAside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.

Monitoring and evaluation of skilled birth attendance: A proposed new framework

Background the Maternal Mortality Ratio (MMR) and proportion of births attended by skilled attendants are the two indicators selected to measure progress towards the achievement of MDG five. By the year 2015, the international community aims to have achieved a 75% reduction in MMR and 90% coverage of women having a skilled attendant at birth. In spite of the importance of this indicator, there is little consistency in how this is monitored and evaluated. This paper provides a review of the literature on the approaches and conceptual frameworks for evaluating progress with skilled birth attendance (SBA). The applicability of current frameworks is reviewed and a new simplified framework for monitoring and evaluation of SBA is proposed. Methods We searched electronic databases, internet, publications and databases of organisations. We hand searched reference lists of key papers, using search terms such as skilled attend ⁎, maternal health, maternal mortality, midwi ⁎, health professional, impact ⁎, monitor ⁎ and evaluat ⁎. Findings there were 44 potentially relevant articles from PUBMED, three from Scopus, seven from WHO, two from UNFPA, one obtained via hand search and one via personal communication. A total of 27 publications were found to be relevant after a review of their abstracts. Of these, 17 were on SBA and maternal mortality, and 10 were on monitoring and evaluation of SBA. Of the publications on monitoring and evaluation of SBA, two studies assessed global coverage of SBA, eight studies evaluated specific programmes and three of these had a ‘conceptual framework’. Conclusions no standard framework to evaluate progress made in ensuring increased coverage with skilled birth attendance currently exists. There are three published conceptual frameworks, each of which has valuable and workable components as well as limitations. A simplified systems approach to the Monitoring and Evaluation of SBA using structure, process and outcome criteria is proposed.