Faculty of Health, University of Technology Sydney, NSW, Australia.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet. 2014 Sep 20;384(9948):1146-57. doi: 10.1016/S0140-6736(14)60790-X. Epub 2014 Jun 22.
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 effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.
我们使用 Lives Saved Tool（LiST）来估计如果在人类发展指数（HDI）分为三个三分位数的 78 个国家扩大助产服务规模可以避免的死亡人数。我们在 LiST 中选择了干预措施，以涵盖助产实践的范围，包括孕前、产前、分娩、产后和计划生育护理。在所有接受测试的国家中，即使从目前的基线水平适度（10%）、大量（25%）或普遍（95%）扩大规模，都可以在 2025 年前减少孕产妇死亡、死产和新生儿死亡。在所有 HDI 最低的国家，普及助产服务干预措施，包括孕产妇和新生儿健康，但不包括计划生育，可以预防所有孕产妇、胎儿和新生儿死亡的 61%。仅计划生育就可以预防所有死亡的 57%，因为生育率降低和妊娠减少。将计划生育和孕产妇及新生儿健康干预措施相结合，总共可以避免所有孕产妇死亡、死产和新生儿死亡的 83%。在这些情景中纳入专科护理，意味着可以预防更多的死亡人数，这意味着在具有有效转诊和转介机制的功能型卫生系统中提供助产服务可以产生最大的效果。
