Strategies to increase facility-based skilled birth attendance in South Asia: a literature review

Global strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery as well as access to emergency obstetric care. South Asia has the lowest rates of skilled birth attendance in the world, and Nepal is lagging behind neighbouring countries. This review looks at the demand-side barriers to seeking care as well as strategies to increase facility delivery in rural South Asia. A search was made of key databases, including PubMed and the WHO, for literature relating to utilisation of facility delivery in South Asia. The main factors found to influence facility delivery in South Asia were physical and financial barriers, socioeconomic and educational status, obstetric history and awareness of danger signs, sociocultural factors and perceived quality of care. Strategies to increase facility delivery include maternity waiting homes, demand-side financing schemes, education programmes and participatory women's groups. Increasing utilisation of delivery services in South Asia requires a multisectoral approach. Key areas are increasing education for girls as well as empowering women through women's groups and community mobilisation. Removal of user fees appears to be successful but needs to be sustainable and equitable in its delivery.