This post is part of our “Continuum of Care” blog series hosted by the Maternal Health Task Force
As the deadline for the Millennium Development Goals approaches, it is time for the global health community to take stock of what we have accomplished thus far. In the area of maternal and child health some great strides have been made. Maternal, neonatal and child mortality rates have all fallen, although in many areas of the world far more needs to be done still to achieve the ambitious targets that were set.
When it comes to the care women receive during their pregnancy and childbirth, we also see encouraging improvements. The World Health Organization reports that in developing countries 68 out of every 100 women delivered their babies in the presence of a skilled health care worker in 2012, as opposed to only 56 in 1990. Also, 83% of women in these countries received antenatal care (ANC) at least once during their pregnancy. Nonetheless, still far too many women suffer unnecessary complications or even die as a result of pregnancy and labour. In addition, many women suffer from conditions that can put them and their children at risk, but for which they are not receiving appropriate care. So what more can we do to ensure that all women receive the health care they need and deserve?
Seizing the opportunity
Part of the solution may rest in how we use the ANC encounter. Despite recommendations from the World Health Organization, emphasizing a model known as Focused Antenatal Care (FANC), we know that all too often ANC visits comprise only the most basic checks and services. This is a shame, especially since in many low-income countries ANC may be one of the few times in her life a woman comes into contact with formal health services. As such, ANC could be an extremely important platform to also deliver health services like diagnosis and treatment of HIV, other sexually transmitted infections, and even non-communicable diseases – like diabetes and heart disease.
Although integrating these services with ANC could hold great promise, it is not entirely without risk. Having to deliver a more complex care package puts additional demands on health workers, who often are already severely overworked and under-resourced. If not done properly, integration of services could jeopardise the quality of services delivered. Whether integration of services with ANC can indeed improve women’s access to essential health care, and how this impacts quality, has been the topic of a study conducted by a team of researchers from the Harvard School of Public Health, the London School of Hygiene and Tropical Medicine and Gephyra International Health Consultancy.
Reviewing the evidence
Using studies from the peer-reviewed and grey literature, we have looked for examples of services that have been integrated into ANC. We conducted a systematic review to analyse how integrated service delivery models compare to other models in terms of uptake of services, health outcomes and costs, and whether integration had any unintended consequences.
We found limited evidence to suggest that integration can indeed improve uptake of some important services such as HIV testing, antiretroviral treatment and measures to prevent transmission from mother to child – potentially leading to better health outcomes for mother and child.
At the same time, our review shows that very little attention has been paid to the potential risks associated with integration. In a separate study, we have reviewed the main barriers to, and conditions for successful service integration. Both studies are expected to be published later this year.
It is our hope that these studies will contribute to shaping the debate on how we can best use ANC to improve health care for all women.