Produce a report on approaches to: (i) increasing the proportion of deliveries which take place in health facilities; and (ii) providing referral transportation for women and children to access healthcare for childbirth and for emergency obstetric care. The focus is on Asia and particularly South East Asia.
Approaches to increasing facility based births:
- Eliminating user fees and voucher schemes have been found to improve
facility-based delivery rates.
- A systems approach was found to increase facility-based deliveries in
the Philippines. The strategy prioritised the creation of
community-based women’s health teams. Payment to a trained birth
assistant within a health team incentivised referral to a health
- Evaluations of an Indian state-led public private partnership where
the state pays accredited private obstetricians to perform deliveries
for poor/tribal women produced mixed results.
- Maternity waiting homes are included as an option in the safe
motherhood programme and recommended by experts. However, little
evidence was found to support the use of maternity waiting homes.
- A behaviour change communication initiative in Bangladesh was
estimated to increase the likelihood of mothers having institutional
Referral transport findings:
- A systematic review found some evidence to suggest that
community-based loan funds for transport during obstetric emergencies
in developing countries have positive effects.
- A CARE Village Emergency Referral System in Cambodia reports some
anecdotal success and some issues.
- An emergency obstetric transportation service in Madhya Pradesh,
India, was successful as part of a public private partnership. A
publicly financed and managed referral transport service model in
Haryana State, India, was assessed for cost effectiveness and found to
be operating at an efficient level
Bolton, L. Helpdesk Report: Increasing facility-based deliveries and providing referral transport for women in childbirth in Asia. Health and Education Advice and Resource Team, (2014) 30 pp.