Skilled Care Initiative: Household survey results

Background: Clinical, historical, and epidemiological evidence indicates that providing skilled care during pregnancy, childbirth, and the postpartum period can significantly reduce maternal mortality and morbidity. However, programmatic evidence is lacking on how to equitably increase skilled attendance rates in low-resource settings. The Skilled Care Initiative (SCI) was developed specifically to generate this programmatic evidence through experience in four rural, underserved districts in Burkina Faso, Kenya and Tanzania.

Materials and Methods: The SCI used a quasi-experimental pre-test/post-test design. Survey questionnaires were developed and administered to households, women of reproductive age and co-resident husbands. Information was collected of the use of skilled care at childbirth, and related knowledge, attitudes, and behaviors among the study populations. In total, 20,000 households in the intervention and comparison districts were surveyed at baseline in 2003 and endline in 2006.

Results: The intervention districts in all three countries show an overall improvement of the use of skilled care during childbirth and the percentage of deliveries taking place in a facility. The improvement is most impressive in Burkina Faso, where at baseline 24% of women delivered with a skilled attendant, while at the end of the project 55% of women delivered with a skilled attendant. In Tanzania, the use of a skilled attendant at childbirth in the intervention district increased from 43% at baseline to 55%. Increases in Kenya, were FCI was testing two different packages of interventions, were more modest.

Conclusions: Contributing to significant increases in the use of skilled care at childbirth, even among the poorest women, the skilled care approach holds promise for meeting global and national commitments to reducing maternal mortality.