Every day an estimated 1600 women die world-wide as a result of problems during pregnancy or childbirth. Many of these deaths are preventable. But which safe motherhood interventions are the most cost-effective in resource-poor settings?

There is little detailed evidence on the relative cost effectiveness of antenatal, post-abortion and obstetric care in low-income countries. A study by the UK University of York examines the economic case for investing in safe motherhood, and reviews studies that evaluate the cost-effectiveness of different interventions. It concludes that improving access to obstetric care need not be costly and is the key to reducing maternal mortality.

Maternal illness and mortality have a direct negative impact on the welfare of infants and children. They lead to a reduction in household income as women commonly play an important role in agricultural production and trading. They can also harm children’s education through lower levels of school enrolment.

Investigating the cost-effectiveness of investments in maternal health, the study found that antenatal care can reduce maternal mortality in low-income countries by around 26 percent on average. Providing essential obstetric services can reduce the figure by a further 48 percent on average. They also found that:

• Investments in maternal care can significantly reduce hospital bed use. It is estimated that women with complications from unsafe abortions occupy 20 to 50 percent of gynaecology wards in some countries and consume up to 50 percent of hospital budgets.
• Training traditional birthing attendants is often not cost-effective in weak health systems, given the problem in predicting whether or not a pregnant woman is at risk. But their efficacy is likely to increase as other areas of maternal healthcare begin to function more effectively.
• Improvements in systems, management and staff motivation can reap significant gains in maternal health outcomes.
• The use of manual vacuum aspiration rather than dilatation and curettage for abortion can substantially reduce costs to both patient and hospital.
• Improving referral systems, for example by using radio communications and setting up arrangements with local vehicle owners, can significantly reduce maternal death and illness at fairly low cost.

In addition, improving obstetric care can act as a useful entry point for wider health sector reform as obstetric emergencies demand skills and supplies such as functional operating theatres, which are also important for treating other health problems.

The study proposes that policy-makers could improve the efficiency of maternal healthcare by:

• reducing spending on interventions that are ineffective, such as routine episiotomy, or that may cause more harm than good, such as the administration of enemas during childbirth
• increasing spending on interventions proven to be cost effective such as treatment of sexually transmitted infections and vaccination against tetanus
• introducing community-based delivery units run by midwives to reduce the incidence of unplanned home deliveries
• increasing spending on psychological support to women during pregnancy which can, through stress reduction, reduce perinatal mortality.

Source(s):
‘Safe motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness’ by M. Jowett, Health Policy 53 (2000)

Funded by: HP-ACORD Scheme, UK Department for International Development

id21 Research Highlight: 24 April 2001

Further Information:
Matthew Jowett
c/o International Programme
Centre for Health Economics
University of York
York, Y010 5DD
UK

Tel: +44 (0)1904 433716
Fax: +44 (0)1904 432701
Contact the contributor: mjl4@york.ac.uk

Centre for Health Economics, University of York, UK

Other related links:
Check the Health Economics site for links to health economics resources on the internet.

See this issue of International Health Matters on safer motherhood.

WHO provides information on indicators of maternal mortality.

Find details of research and other initiatives on the WHO's safer motherhood site.

Check the Safer Motherhood site for a variety of factsheets and other resources.