Can skilled attendance at delivery reduce maternal mortality in developing countries

作者：Wendy Jane Graham, Jacqueline S. Bell, Colin H W Bullough · 年份：2001 · 被引用次数：306 · 研究领域：Global Maternal and Child Health、Global Health Care Issues、Healthcare Policy and Management

Summary This paper explores the scientific justification for the key action message “ensure skilled attendance at delivery.” Many governments and other provider agencies in poor countries will need to commit additional health resources in order to respond to this message, and opportunity costs will be incurred. Achieving targets will take time, and benefits in terms of maternal mortality may not be detected for several years. It is therefore crucial to review the basis for prioritising skilled attendance. This paper examines the historical and epidemiological evidence at both the individual and population levels of analysis. The lack of a clear definition has been, and continues to be, the cause of much confusion over the role, and thus the potential, of skilled attendants. Recent initiatives to specify minimum and additional skills have improved understanding not only of training requirements but also of the wider environment which is required for skilled attendants to function effectively. This paper proposes that skilled attendance be conceived as encompassing 1) a partnership of skilled attendants (health professionals with the skills to provide care for normal and/or complicated deliveries), AND 2) an enabling environment of equipment, supplies, drugs and transport for referral. At the individual level, there are sound clinical reasons for believing that the risk of maternal death can be reduced by skilled attendance, particularly as the causal pathways can be specified....