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THE PROJECTED EFFECT OF SCALING UP MIDWIFERY
Author
Affilliation
Bloomberg School of Public Health. Department of International. Baltimore, MD, USA.
Fundação Oswaldo Cruz. Instituto Fernades Figueira. Departamento de Obstetrícia. Rio de Janeiro, RJ, Brasil.
Instituto de Cooperación Social Integrare. Barcelona, Spain.
Autonomous University of Barcelona. Barcelona, Spain.
St Thomas’ Hospital. King’s College London. Centre King’s Health Partners. Division of Women’s Health. Women’s Health Academic. London, UK.
St Thomas’ Hospital. King’s College London. Centre King’s Health Partners. Division of Women’s Health. Women’s Health Academic. London, UK.
Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Obstetrícia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Fernades Figueira. Departamento de Obstetrícia. Rio de Janeiro, RJ, Brasil.
Instituto de Cooperación Social Integrare. Barcelona, Spain.
Autonomous University of Barcelona. Barcelona, Spain.
St Thomas’ Hospital. King’s College London. Centre King’s Health Partners. Division of Women’s Health. Women’s Health Academic. London, UK.
St Thomas’ Hospital. King’s College London. Centre King’s Health Partners. Division of Women’s Health. Women’s Health Academic. London, UK.
Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Obstetrícia. Rio de Janeiro, RJ, Brasil.
Abstract
We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest eff ect when provided within a functional health system with eff ective referral and transfer mechanisms to specialist care.
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