SynthesisInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2009
60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?
Synthesis in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 120 papers, 20 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
120 citing papers in PubMed, 20 syntheses or guidelines pooled it.
- Umbilical cord antiseptics for preventing sepsis and death among newborns.The Cochrane database of systematic reviews · 2026Pooled it
- Equity in prenatal healthcare services globally: an umbrella review.BMC pregnancy and childbirth · 2024Pooled it
- Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.Maternal and child health journal · 2019Pooled it
- Health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review of observational and qualitative studies.F1000Research · 2019Pooled it
- What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers.Human resources for health · 2018Pooled it
- Delivery arrangements for health systems in low-income countries: an overview of systematic reviews.The Cochrane database of systematic reviews · 2017Pooled it
- Who is a community health worker? - a systematic review of definitions.Global health action · 2017Pooled it
- Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings.The Cochrane database of systematic reviews · 2016Pooled it
- Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis.Global health action · 2016Pooled it
- Skilled health personnel attended delivery as a proxy indicator for maternal and perinatal mortality: a systematic review.Ethiopian journal of health sciences · 2014Pooled it
- Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview.BMJ open · 2014Pooled it
- Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990.Pediatric research · 2013Pooled it
- Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010.Pediatric research · 2013Pooled it
- Umbilical cord antiseptics for preventing sepsis and death among newborns.The Cochrane database of systematic reviews · 2013Pooled it
- The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis.BMC public health · 2013Pooled it
- Traditional birth attendant training for improving health behaviours and pregnancy outcomes.The Cochrane database of systematic reviews · 2012Pooled it
- Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis.BMJ (Clinical research ed.) · 2011Pooled it
- Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect.BMC public health · 2011Pooled it
- The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths.BMC public health · 2011Pooled it
- Linking families and facilities for care at birth: what works to avert intrapartum-related deaths?International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2009Pooled it
60 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundFor the world's 60 million non-facility births, addressing who is currently attending these births and what effect they have on birth outcomes is a key starting point toward improving care during childbirth.
objectiveWe present a systematic review of evidence for the effect of community-based cadres-community-based skilled birth attendants (SBAs), trained traditional birth attendants (TBAs), and community health workers (CHWs)-in improving perinatal and intrapartum-related outcomes.
resultsThe evidence for providing skilled birth attendance in the community is low quality, consisting of primarily before-and-after and quasi-experimental studies, with a pooled 12% reduction in all cause perinatal mortality (PMR) and a 22%-47% reduction in intrapartum-related neonatal mortality (IPR-NMR). Low/moderate quality evidence suggests that TBA training may improve linkages with facilities and improve perinatal outcomes. A randomized controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a meta-analysis demonstrated an 11% reduction in IPR-NMR. There is moderate evidence that CHWs have a positive impact on perinatal-neonatal outcomes. Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2 quasi-experimental studies) showed a 28% reduction in PMR and a 36% reduction in early neonatal mortality rate; one quasi-experimental study showed a 42% reduction in IPR-NMR.
conclusionSkilled childbirth care is recommended for all pregnant women, and community strategies need to be linked to prompt, high-quality emergency obstetric care. CHWs may play a promising role in providing pregnancy and childbirth care, mobilizing communities, and improving perinatal outcomes in low-income settings. While the role of the TBA is still controversial, strategies emphasizing partnerships with the health system should be further considered. Innovative community-based strategies combined with health systems strengthening may improve childbirth care for the rural poor, help reduce gross inequities in maternal and newborn survival and stillbirth rates, and provide an effective transition to higher coverage for facility births.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.