Academic journal article Journal of Health Population and Nutrition

Investigating Financial Incentives for Maternal Health: An Introduction

Academic journal article Journal of Health Population and Nutrition

Investigating Financial Incentives for Maternal Health: An Introduction

Article excerpt


Globally, the UN estimates show that maternal mortality has fallen 47% between 1990 and 2010 (1). Even so, many countries are still not on track to achieve the UN Millennium Development Goal 5 (MDG 5) of 75% reduction in maternal mortality by 2015. Close to 290,000 women continue to die annually due to complications from pregnancy and childbirth (1). The goal to reduce maternal mortality remains challenging. In part, the toll of preventable maternal deaths represents persistent and heartbreaking inequities between the poor and the rich as well as between the uneducated and the educated. Over a lifetime, women are approximately 100 times more likely to die as a result of pregnancy in sub-Saharan Africa than in developed regions of the world. More than half of all maternal deaths occur in only eight countries, and 80% of all deaths occur in 22 countries (1).

The estimates of maternal death only capture a portion of the overall burden of maternal complications and disability on women and their families, communities, and societies. A recent study in Bangladesh found that, for every maternal death, there are 40 women who suffer obstetric complications, ranging from less severe to severe, and over 160 women live with postpartum morbidities and disabilities (2). This toll is much higher than previously thought (3). Postpartum morbidities and disabilities include such physical consequences as incontinence, uterine prolapse, obstetric fistula, anaemia, and hypertension. Following intrapartum complications and, sometimes, perinatal death, there can also be psychological consequences, such as postpartum depression and profound social consequences, including emotional, physical and sexual violence (2). Furthermore, the cost of maternal complications can result in debt that may compound emotional consequences and result in not seeking needed additional care.

Maternal death also has serious consequences for the survival of children. In Bangladesh, "infant mortality is approximately eight times higher for those infants whose mothers died than if the mother survived" (4). In addition, "the cumulative probability of survival to age 10 years was 24% in children whose mothers died before their 10th birthday compared to 89% in those whose mothers remained alive" (4).

Women in low- and middle-income countries (LMICs) with a high burden of maternal death often underutilize family planning and maternity services that facilitate healthy childbirths, save maternal and newborn lives, and ensure a healthy start for their young children. To address the lack of utilization and quality of maternal health services, many countries have recently used financial incentives (FIs). Evidence of the effectiveness of FIs for improved maternal healthcare was reviewed at the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives convened by the US Agency for International Development and the US National Institutes of Health on 24-25 April 2012 in Washington, DC. The papers in this JHPN Supplement provide an overview of each of the financial incentives, along with conclusions and recommendations based on the literature reviewed and presentations made at the Evidence Summit.

Inadequate use of lifesaving services

Women's use of healthcare services that potentially reduce the risk of death due to pregnancy is very low in many parts of the world. For example, contraceptive prevalence is 24% in Africa and 58% in South-East Asia compared to the 71-80% coverage in countries with high and upper mid-level income (5) where maternal mortality is demonstrably lower. Despite recent increases in facility-based delivery (6), 48% of women in Africa and 59% of women in South-East Asia still give birth without the presence of a birth attendant (5) who can recognize complications and provide stabilization and referral for emergency lifesaving care. Women who experience serious complications, such as prolonged/obstructed labour or severe pre-eclampsia/eclampsia, may require caesarean sections for health or survival of themselves or their newborns. …

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