Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey

Nove, Andrea; Bazirete, Oliva; Hughes, Kirsty; Turkmani, Sabera; Callander, Emily; Scarf, Vanessa; Forrester, Mandy; Mandke, Shree; Pairman, Sally; Homer, Caroline

doi:10.1016/j.midw.2023.103717

Cited by 4 publications

(5 citation statements)

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“…Bangladesh, Pakistan and Uganda were selected to participate in this study, based on the findings of a global literature review and survey 15 and consultation with the project’s advisory group. The advisory group consisted of experts in MLBCs from high-income, middle-income and low-income contexts and representatives of the International Confederation of Midwives, WHO, United Nations Population Fund, Bill & Melinda Gates Foundation and World Bank.…”

Section: Methodsmentioning

confidence: 99%

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

Callander,

Scarf,

Nove

et al. 2024

BMJ Glob Health

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IntroductionAchieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative to hospital-based care for low-risk pregnancies where the lead professional at the time of birth is a trained midwife. These have been used in many countries to improve birth outcomes.MethodsThe cost analysis used primary data collection from four MLBCs in Bangladesh, Pakistan and Uganda (n=12 MLBC sites). Modelled cost-effectiveness analysis was conducted to compare the incremental cost-effectiveness ratio (ICER), measured as incremental cost per disability-adjusted life-year (DALY) averted, of MLBCs to standard care in each country. Results were presented in 2022 US dollars.ResultsCost per birth in MLBCs varied greatly within and between countries, from US$21 per birth at site 3, Bangladesh to US$2374 at site 2, Uganda. Midwife salary and facility operation costs were the primary drivers of costs in most MLBCs. Six of the 12 MLBCs produced better health outcomes at a lower cost (dominated) compared with standard care; and three produced better health outcomes at a higher cost compared with standard care, with ICERs ranging from US$571/DALY averted to US$55 942/DALY averted.ConclusionMLBCs appear to be able to produce better health outcomes at lower cost or be highly cost-effective compared with standard care. Costs do vary across sites and settings, and so further exploration of costs and cost-effectiveness as a part of implementation and establishment activities should be a priority.

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Section: Methodsmentioning

confidence: 99%

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

Callander,

Scarf,

Nove

et al. 2024

BMJ Glob Health

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“…Country selection was informed by a literature review and scoping survey, [ 11 , 16 ] and consultation with ICM and the EAG. The main inclusion criteria were: (a) the country was classed by the World Bank in 2022 as low-, lower-middle, or upper-middle income, (b) there was evidence from the literature and the survey that the country had at least four MLBCs that were either in the public sector or well-integrated within the national health system, (c) good research capacity within the country, and (d) data was available for an economic analysis (to be reported separately).…”

Section: Methodsmentioning

confidence: 99%

“…For example, MLBC clients in HICs tend to belong to more wealthy demographics, [ 3 ] whereas in many low- and middle-income countries (LMICs), MLBCs primarily cater to clients from disadvantaged and marginalized communities [ 11 ]. The weak referral systems evident in many LMICs may compromise the safety of women and newborns who use MLBCs, especially if the MLBC is a freestanding one (the most prevalent type in LMICs [ 11 ]), whereas in HICs the evidence indicates better outcomes in freestanding MLBCs [ 3 ]. Further, in low-income nations, MLBC services are predominantly offered by private, not-for-profit entities.…”

Section: Introductionmentioning

confidence: 99%

“…Further, in low-income nations, MLBC services are predominantly offered by private, not-for-profit entities. Consequently, the accessibility of care for clients from underprivileged and marginalized backgrounds heavily relies on sustained support from these sources [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Our previous work has shown that MLBCs exist in at least 24 LMICs [ 11 ]. Much of the evidence about these MLBCs was collected in a survey and there was limited information in the peer reviewed literature, especially understanding how the MLBCs were successful.…”

Section: Introductionmentioning

confidence: 99%

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Midwife-led birthing centres in four countries: a case study

Bazirete,

Hughes,

Lopes

et al. 2023

BMC Health Serv Res

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Background Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. Methods A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. Results Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. Conclusion The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.

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Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?

Nabirye,

Mbalinda,

Epuitai

et al. 2024

Women and Birth

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Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey

Cited by 4 publications

References 68 publications

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

Midwife-led birthing centres in four countries: a case study

Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?

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