Many pregnancy complications are unpredictable and many women in developing countries live far away from where life-saving care is available. Referral interventions aim to address these problems. A systematic literature review was conducted to assess studies on the transfer of women with emergency obstetric complications from their homes, or from first contact with the health service, to an emergency obstetric care facility. Nineteen studies were included that assessed the effect of referral interventions from rural settings in Bangladesh, Burkina Faso, Guatemala, India, Indonesia, Malawi, Nepal, Pakistan, Zambia and Zimbabwe. In several South Asian settings, the organisation of communities to generate funds for transport, implemented as part of other community mobilisation activities, reduced neonatal deaths. The studies from Zambia and Zimbabwe suggested that the use of maternity waiting homes may reduce stillbirths. There is some evidence that referral interventions improve the utilisation of health services.
This review has strengthened the evidence for continuing to implement interventions that overcome delays in reaching obstetric care during emergencies. There are constraints limiting the conclusiveness of the evidence. Continued inclusion of referral interventions within maternal and newborn health programmes and as part of wider health system improvements is recommended, but practices in monitoring, research and evaluation of these interventions need to be improved.
EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK, ISBN: 978-1-907345-16-6, 54 pp.
What kinds of policy and programme interventions contribute to reductions in maternal mortality? The effectiveness of primary level referral systems for emergency maternity care in developing countries