This synopsis is from an article featured in our recent update of the MHTF-PLoS Collection, Integrating Health Care to Meet the Needs of the Mother-Infant Pair.
Our recent systematic mapping indicates a growing global awareness of the need to design culturally-appropriate maternity care services in order to improve service utilization and thus maternal and newborn health outcomes, which is core to the World Health Organization’s mandate on ‘health for all.’
Scaling up women’s use of skilled maternity care is an important component of global strategies to improve maternal and newborn health, but the availability and provision of skilled care does not necessarily lead to increased utilisation of services. Culture can often influence women’s use of maternity care services, either leading women to avoid services or to seek them. Differences between the cultures of maternity care services and service users have been recognised as a major issue in service delivery.
The systematic mapping also indicates a critical need for creative, innovative interventions in lower-income countries. Whilst the inventory details interventions in 29 middle-income countries and 25 low-income countries, future research should consider additional interventions that evaluate the ways in which cultural factors can be systematically integrated and main streamed into programs to increase maternal health care use.
Given that the cultural groups and the nature of cultural factors that affect use of skilled maternity care are context-specific, we developed and defined five intervention categories:
- Service delivery models
- Service provider interventions
- Health education interventions
- Participatory approaches
- Mental health interventions
From narrative descriptions of interventions to studies evaluating impact through the use of randomized controlled trials, the inventory items clearly reflect great differences in levels of evidence. Whilst much of the identified literature states a clear aim to address cultural factors, studies often provide insufficient detail about how exactly the interventions addressed these cultural factors. Given that ‘culture’ is a complex concept with varied definitions and usages in the literature, this finding is perhaps unsurprising.
Through this process, we found that impact evaluations of interventions addressing culture and maternity care service use is heavily weighted in favor of evidence from high-income countries, particularly from the United States, followed by Australia, Canada and the United Kingdom. This finding suggests increased research efforts are needed to evaluate cultural sensitivity of health services in low- and middle-income countries.
Literature on interventions addressing cultural factors as evaluated models of practice remains limited, as analysis of the inventory indicates that few studies have used designs that provide strong evidence of intervention impact. To better understand the impact of culturally-appropriate skilled maternity care on maternal and newborn health outcomes, we are finalizing a systematic review of interventions. When paired with the systematic mapping, we hope that these resources will provide a rich source of information for researchers, programmers and policymakers seeking to deliver more responsive, effective maternity care services to culturally-diverse populations.