BJOG: An International Journal of Obstetrics & Gynaecology

Systematic Review

The global met need for emergency obstetric care: a systematic review

Corresponding Author

H Holmer

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children's Hospital, Lund University, Lund, Sweden

Correspondence: H Holmer, Department of Clinical Sciences, Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Children's Hospital, Lasarettsgatan 40, 22185 Lund, Sweden. Email [email protected]Search for more papers by this author

K Oyerinde,

K Oyerinde

Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA

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JG Meara,

JG Meara

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA

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R Gillies,

R Gillies

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA

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J Liljestrand,

J Liljestrand

Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden

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L Hagander,

L Hagander

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children's Hospital, Lund University, Lund, Sweden

Search for more papers by this author

H Holmer,

Corresponding Author

H Holmer

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children's Hospital, Lund University, Lund, Sweden

K Oyerinde,

K Oyerinde

Averting Maternal Death and Disability Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA

Search for more papers by this author

JG Meara,

JG Meara

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA

Search for more papers by this author

R Gillies,

R Gillies

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA

Search for more papers by this author

J Liljestrand,

J Liljestrand

Division for Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden

Search for more papers by this author

L Hagander,

L Hagander

Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children's Hospital, Lund University, Lund, Sweden

Search for more papers by this author

First published: 26 December 2014

https://doi.org/10.1111/1471-0528.13230

Citations: 55

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Abstract

Background

Of the 287 000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as ‘Met need for EmOC’.

Objective

To estimate the global met need for EmOC and to examine the correlation between met need, maternal mortality ratio and other indicators.

Search strategy

A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and Google Scholar.

Selection criteria

Studies containing data on met need in EmOC were selected.

Data collection and analysis

Analysis was performed with data extracted from 62 studies representing 51 countries. World Bank data were used for univariate and multiple linear regression.

Main results

Global met need for EmOC was 45% (IQR: 28–57%), with significant disparity between low- (21% [12–31%]), middle- (32% [15-56%]), and high-income countries (99% [99–99%]), (P = 0.041). This corresponds to 11.4 million (8.8–14.8) untreated complications yearly and 951 million (645–1174 million) women without access to EmOC. We found an inverse correlation between met need and maternal mortality ratio (r = −0.42, P < 0.001). Met need was significantly correlated with the proportion of births attended by skilled birth attendants (β = 0.53 [95% CI 0.41–0.65], P < 0.001).

Authors’ conclusions

The results suggest a considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. Met need is a powerful indicator of the response to maternal mortality and strategies to improve EmOC act in synergy with the expansion of skilled birth attendance.

Supporting Information

Filename	Description
bjo13230-sup-0001-FigS1.pdfapplication/PDF, 36.1 KB	Figure S1. Causes of maternal deaths: Global estimates.
bjo13230-sup-0002-FigS2.pdfapplication/PDF, 129.2 KB	Figure S2. Number of surveys for met need for emergency obstetric care by survey year and World Bank Region.
bjo13230-sup-0003-TableS1.pdfapplication/PDF, 293.7 KB	Table S1. Definitions and corresponding signal functions for major direct obstetric complications.
bjo13230-sup-0004-TableS2.pdfapplication/PDF, 373.6 KB	Table S2. Definitions and acceptable levels for indicators of emergency obstetric care services.
bjo13230-sup-0005-TableS3.pdfapplication/PDF, 375.1 KB	Table S3. Definition of national indicators examined for association with levels of met need for emergency obstetric care (EmOC).
bjo13230-sup-0006-TableS4.pdfapplication/PDF, 348.1 KB	Table S4. Levels of national indicators by income group and previously published correlation with maternal mortality ratio.
bjo13230-sup-0007-TableS5.pdfapplication/PDF, 477 KB	Table S5. Met need for emergency obstetric care (EmOC) by country and year of survey included in systematic review, with survey characteristics.
bjo13230-sup-0008-TableS6.pdfapplication/PDF, 334.6 KB	Table S6. Univariate linear regression with met need for emergency obstetric care as dependent variable.
bjo13230-sup-0009-TableS7.pdfapplication/PDF, 192.9 KB	Table S7. Stepwise multivariate linear regression with met need for emergency obstetric care as dependent variable.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume122, Issue2

Special Issue:Beyond 2015: The future of women's health globally

January 2015

Pages 183-189

This article also appears in:

January 2015: Beyond 2015: The Future of Women's Health Globally

The global met need for emergency obstetric care: a systematic review

Abstract

Background

Objective

Search strategy

Selection criteria

Data collection and analysis

Main results

Authors’ conclusions

Supporting Information

References

Citing Literature

References

Information

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The global met need for emergency obstetric care: a systematic review

Abstract

Background

Objective

Search strategy

Selection criteria

Data collection and analysis

Main results

Authors’ conclusions

Supporting Information

References

Citing Literature

References

Related

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