TY - JOUR
T1 - Unintended Consequences of Policy Decisions toReduce Maternal Mortality in the Asia Pacific
AU - Barclay, Lesley
AU - Gao, Yu
AU - Homer, Caroline
AU - Wild, Kayli Janine
PY - 2012
Y1 - 2012
N2 - Objectives: To describe the role of midwives and maternity care in
three low resource settings and to challenge some policy options introduced to
reduce maternal mortality for women residing in rural and remote areas.
Approach: A series of retrospective analyses were undertaken
drawing on work the authors have conducted in rural and remote China,
Timor-Leste, and Samoa over the past 5–20 years. Sources include our own
empirical research, grey literature, as well as published secondary sources.
Findings: In China, hospital birthing is promoted as a major
strategy in reducing maternal mortality. This has greatly increased financial
burdens for women and their families. In Samoa, traditional birth attendants
(TBAs) are integrated into Samoa's health system alongside midwives and other
health professionals, and they play a critical role in providing support for
pregnant and birthing women. In Timor-Leste, the government has moved away from
training TBAs and has shifted the focus from skilled attendance to
facility-based delivery. Evaluation of a national maternity waiting home
strategy, designed to improve access to facility-based delivery, did not
improve access for women in remote areas.
Conclusions: Low-income countries need to be cautious when adopting
global solutions, such as facility-based delivery, to tackle maternal deaths.
Women-centered and cost-effective care should be provided locally. Culturally
compatible maternity care can be achieved in concert with safety and emergency
obstetric care. Midwives can create the bridges between social and professional
systems that allow this to happen.
AB - Objectives: To describe the role of midwives and maternity care in
three low resource settings and to challenge some policy options introduced to
reduce maternal mortality for women residing in rural and remote areas.
Approach: A series of retrospective analyses were undertaken
drawing on work the authors have conducted in rural and remote China,
Timor-Leste, and Samoa over the past 5–20 years. Sources include our own
empirical research, grey literature, as well as published secondary sources.
Findings: In China, hospital birthing is promoted as a major
strategy in reducing maternal mortality. This has greatly increased financial
burdens for women and their families. In Samoa, traditional birth attendants
(TBAs) are integrated into Samoa's health system alongside midwives and other
health professionals, and they play a critical role in providing support for
pregnant and birthing women. In Timor-Leste, the government has moved away from
training TBAs and has shifted the focus from skilled attendance to
facility-based delivery. Evaluation of a national maternity waiting home
strategy, designed to improve access to facility-based delivery, did not
improve access for women in remote areas.
Conclusions: Low-income countries need to be cautious when adopting
global solutions, such as facility-based delivery, to tackle maternal deaths.
Women-centered and cost-effective care should be provided locally. Culturally
compatible maternity care can be achieved in concert with safety and emergency
obstetric care. Midwives can create the bridges between social and professional
systems that allow this to happen.
U2 - 10.1891/2156-5287.2.4.222
DO - 10.1891/2156-5287.2.4.222
M3 - Article
SN - 2156-5287
VL - 2
SP - 222
EP - 229
JO - International Journal of Childbirth
JF - International Journal of Childbirth
IS - 4
ER -