An Intra-partum Care Strategy with Two-Distribution Points model to address maternal and newborn deaths in low-income countries

For the last three-years, ChildFund International piloted a hybrid community-based service delivery strategy to address obstetric and neonatal health in rural communities of three of the most affected countries in the Latin American region: Bolivia, Guatemala, and Honduras, in collaboration with their respective ministries of health. The intra-partum care strategy consisted of provision of an evidence-based intervention package to women in labor and newborns via two distribution points: a community based one (care administered during home births by traditional birth attendants) and an institutional one (care administered during birth by professional health care personnel). A quantitative descriptive transversal study was conducted in 2006 and 2008. A total of 684 women were interviewed about prenatal care, care during childbirth, and postnatal care. Danger sign knowledge rose by 38 percent points, while access to care during childbirth by professional health providers increased by an average of 18 percent points, which is equivalent to an 86% increased; likewise, access to post-partum care increased by 45 percent points, equivalent to a 450% increase. The average improvement in quality of care was 27 percent points. An impact measurement model on neonatal mortality showed that neonatal mortality had decreased by 31.3% in Guatemala, 16% in Bolivia, and 12.5% in Honduras. In conclusion, the epidemiology of maternal death calls for prioritization of the intra-partum period; and a dual distribution point might be the most useful way to bring maternal and newborn services in poor and neglected areas of the world.