B!RTH Blog: Professor Matthews Mathai, Centre for Maternal and Newborn Health, LSTM
What are the main birth inequalities that you've seen through your work?
burden of maternal ill health is unequally distributed across the world - 99% of all maternal deaths in the world happen in low and middle income countries. Maternal deaths in high income countries are rare events. In addition to inequalities related to uneven distribution of global resources, there are inequities within countries related to factors such as marginalisation and exclusion, poor governance, lack of accountability, etc.
What single action or change would make the largest contribution towards women surviving and thriving?
Mothers succumb to complications during and after pregnancy and childbirth. The medical causes of maternal death are well known. Relatively inexpensive interventions are available to prevent these complications and/or to treat these complications when they arise. However there is no magic bullet that can prevent or treat all these complications. Maternal health and survival is a health systems issue and timely access to the appropriate skilled and competent providers and functional health facilities is critical.
as noted earlier there are many non-medical factors which contribute to inequities in maternal health. These factors also should be addressed if women should “survive, thrive and transform”. Some of these factors are socio-cultural and require different approaches. For example, family planning contributes to significant improvements in maternal health and survival. However in many settings, the woman cannot make decisions on family planning for herself. Decisions are made for her by her husband or perhaps her mother-in-law. In places where women are educated and/or gainfully employed, they have greater say in decision making. Education of women and gainful employment could empower women to make their own decisions and improve their chances to “survive, thrive and transform”.
What do we mean by Quality of Care?
Quality of care is defined by WHO as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes”. Improvements in quality of care should address six areas: Firstly, care should be EFFECTIVE - evidence based care that is based on need. Secondly, care should be EFFICIENT - maximises resource use and avoids waste. Thirdly, care should be ACCESSIBLE - timely, geographically reasonable and provided in a setting where skills and resources are appropriate to medical need. Fourthly, ACCEPTABLE/PATIENT CENTRED - takes into account preferences and aspirations of individuals and culture of communities. Fifthly, EQUITABLE - does not vary in quality because of personal characteristics of individuals. Sixthly, SAFE - minimises risks and harm to users
Why should it be a priority?
In the past, the focus was on ensuring "coverage" - by which governments tried to ensure that larger numbers of the population were able to access care. For example, in efforts to reduce maternal mortality, many governments invested in schemes that increased the number of women giving birth in facilities. However although the coverage rates increased rapidly, there was no corresponding fall in maternal mortality. The poor quality of care - in terms of content and timeliness - provided in the facilities became a major concern.
How would you measure Quality of Care? What does measuring it enable us to do?
The WHO framework for Quality of Care in maternal and newborn health measures both the provision of care and the experience of care. While provision of care can be compared objectively against set standards, experience of care is very subjective and can be related to prior experiences and expectations.
Measuring quality of care has various purposes. Most importantly, at the health facility level, one should use measurements to periodically monitor, respond to findings and improve services provided by the facility. At sub-national level and national levels, data on quality should be used to monitor, compare and improve performance in districts and regions through targeted interventions. At global level, data contribute to monitoring of progress towards global targets for maternal, newborn and child health and to advocate for better allocation of resources where required.