ArticleHealth affairs (Project Hope)2019
In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible?
Article in Health affairs (Project Hope), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 40 papers, 3 of them syntheses that pooled it.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The Cost and Cost-Effectiveness of Childbirth Settings: A Systematic Review.Applied health economics and health policy · 2025Pooled it
- Respectful Maternal Care Experience in Low- and Middle-Income Countries: A Systematic Review.Medicina (Kaunas, Lithuania) · 2023Pooled it
- The effects of mHealth interventions on improving institutional delivery and uptake of postnatal care services in low-and lower-middle-income countries: a systematic review and meta-analysis.BMC health services research · 2023Pooled it
- Perceived barriers to maternal healthcare utilization: insights from skilled birth attendants in six high-burden states of northern Nigeria.BMC public health · 2026Article
- Enhancing perinatal care in Rwanda: building quality improvement into system strengthening.BMJ paediatrics open · 2026Review
- Trends, determinants and inequality of utilization of maternal healthcare services in Bangladesh: an analysis of demographic and health surveys from 2004 to 2022.BMC pregnancy and childbirth · 2026Article
- Bypassing primary healthcare facilities for maternal and child health services in low- and middle-income countries: a scoping review.Reproductive health · 2026Article
- Newborn Resuscitation Practices and Outcomes in Rural Tanzania-A Real-Time Observational and Video Study.Children (Basel, Switzerland) · 2026Article
- The impact of maternal and child health on sustainable development goals: evidence from Turkic Republics (2000-2020).BMC public health · 2025Article
- Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries.PLoS medicine · 2024Article
- Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia.BMC pregnancy and childbirth · 2024Article
- Evaluation of an obstetric and neonatal care upskilling program for community health workers in Papua New Guinea.BMC pregnancy and childbirth · 2024Article
- Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites.BMJ global health · 2024Article
- The effect of "typical case discussion and scenario simulation" on the critical thinking of midwifery students: Evidence from China.BMC medical education · 2024Article
- Task sharing for increasing access to obstetric ultrasonography: a formative qualitative study of nurse-led scanning with telemedicine review in Kenya.Oxford open digital health · 2024Article
- Adverse birth outcomes among women with 'low-risk' pregnancies in India: findings from the Fifth National Family Health Survey, 2019-21.The Lancet regional health. Southeast Asia · 2023Article
- To what extent is antenatal care in public health facilities associated with delivery in public health facilities? Findings from a cross-section of women who had facility deliveries in Nigeria.BMC public health · 2023Article
- Commentary: Developing technical support and strategic dialogue at the country level to achieve primary health care-based health systems beyond the COVID-19 era.Frontiers in public health · 2023Article
- Practice of Non-Institutional Delivery and Its Associated Factors Among Women Who Gave Birth in Southern Ethiopia, 2022.Women's health reports (New Rochelle, N.Y.) · 2023Article
- A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century.BMC pregnancy and childbirth · 2022Article
Corrections and comments
- Erratum issuedErrata.2019
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.
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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.