Metcalfe Roseanna, Adegoke Adetoro A
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Int Health. 2013 Jun;5(2):96-105. doi: 10.1093/inthealth/ihs001. Epub 2012 Dec 19.
Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery as well as access to emergency obstetric care. South Asia has the lowest rates of skilled birth attendance in the world, and Nepal is lagging behind neighbouring countries. This review looks at the demand-side barriers to seeking care as well as strategies to increase facility delivery in rural South Asia. A search was made of key databases, including PubMed and the WHO, for literature relating to utilisation of facility delivery in South Asia. The main factors found to influence facility delivery in South Asia were physical and financial barriers, socioeconomic and educational status, obstetric history and awareness of danger signs, sociocultural factors and perceived quality of care. Strategies to increase facility delivery include maternity waiting homes, demand-side financing schemes, education programmes and participatory women's groups. Increasing utilisation of delivery services in South Asia requires a multisectoral approach. Key areas are increasing education for girls as well as empowering women through women's groups and community mobilisation. Removal of user fees appears to be successful but needs to be sustainable and equitable in its delivery.
针对孕产妇死亡率高的全球战略重点在于提供分娩时的专业护理以及获得紧急产科护理的机会。南亚是世界上专业助产率最低的地区，尼泊尔在这方面落后于邻国。本综述探讨了寻求护理的需求侧障碍以及提高南亚农村地区机构分娩率的策略。我们检索了包括PubMed和世界卫生组织在内的主要数据库，以查找与南亚机构分娩利用情况相关的文献。发现影响南亚机构分娩的主要因素包括身体和经济障碍、社会经济和教育状况、产科病史以及对危险信号的认知、社会文化因素和对护理质量的感知。提高机构分娩率的策略包括产妇候产之家、需求侧融资计划、教育项目和参与性妇女团体。提高南亚分娩服务的利用率需要采取多部门方法。关键领域包括增加女童教育以及通过妇女团体和社区动员增强妇女权能。取消使用费似乎取得了成功，但在实施过程中需要可持续且公平。
