The Impact and Cost of Scaling up Midwifery and Obstetrics in 58 Low- and Middle-Income Countries
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{"title"=>"The impact and cost of scaling up midwifery and obstetrics in 58 low- and middle-income countries", "type"=>"journal", "authors"=>[{"first_name"=>"Linda", "last_name"=>"Bartlett", "scopus_author_id"=>"7006219085"}, {"first_name"=>"Eva", "last_name"=>"Weissman", "scopus_author_id"=>"36351295100"}, {"first_name"=>"Rehana", "last_name"=>"Gubin", "scopus_author_id"=>"55598335800"}, {"first_name"=>"Rachel", "last_name"=>"Patton-Molitors", "scopus_author_id"=>"56225669700"}, {"first_name"=>"Ingrid K.", "last_name"=>"Friberg", "scopus_author_id"=>"6602123807"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "pui"=>"373382349", "pmid"=>"24941336", "isbn"=>"1932-6203 (Electronic)\\n1932-6203 (Linking)", "doi"=>"10.1371/journal.pone.0098550", "sgr"=>"84903200411", "scopus"=>"2-s2.0-84903200411"}, "id"=>"3480e22c-6762-37e9-88ec-78d783991431", "abstract"=>"BACKGROUND AND METHODS: To guide achievement of the Millennium Development Goals, we used the Lives Saved Tool to provide a novel simulation of potential maternal, fetal, and newborn lives and costs saved by scaling up midwifery and obstetrics services, including family planning, in 58 low- and middle-income countries. Typical midwifery and obstetrics interventions were scaled to either 60% of the national population (modest coverage) or 99% (universal coverage).\\n\\nFINDINGS: Under even a modest scale-up, midwifery services including family planning reduce maternal, fetal, and neonatal deaths by 34%. Increasing midwifery alone or integrated with obstetrics is more cost-effective than scaling up obstetrics alone; when family planning was included, the midwifery model was almost twice as cost-effective as the obstetrics model, at $2,200 versus $4,200 per death averted. The most effective strategy was the most comprehensive: increasing midwives, obstetricians, and family planning could prevent 69% of total deaths under universal scale-up, yielding a cost per death prevented of just $2,100. Within this analysis, the interventions which midwifery and obstetrics are poised to deliver most effectively are different, with midwifery benefits delivered across the continuum of pre-pregnancy, prenatal, labor and delivery, and postpartum-postnatal care, and obstetrics benefits focused mostly on delivery. Including family planning within each scope of practice reduced the number of likely births, and thus deaths, and increased the cost-effectiveness of the entire package (e.g., a 52% reduction in deaths with midwifery and obstetrics increased to 69% when family planning was added; cost decreased from $4,000 to $2,100 per death averted).\\n\\nCONCLUSIONS: This analysis suggests that scaling up midwifery and obstetrics could bring many countries closer to achieving mortality reductions. Midwives alone can achieve remarkable mortality reductions, particularly when they also perform family planning services--the greatest return on investment occurs with the scale-up of midwives and obstetricians together.", "link"=>"http://www.mendeley.com/research/impact-cost-scaling-up-midwifery-obstetrics-58-low-middleincome-countries", "reader_count"=>59, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>14, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>3, "Other"=>6, "Student > Master"=>18, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>14, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>3, "Other"=>6, "Student > Master"=>18, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Engineering"=>1, "Unspecified"=>1, "Nursing and Health Professions"=>10, "Mathematics"=>1, "Medicine and Dentistry"=>22, "Agricultural and Biological Sciences"=>2, "Arts and Humanities"=>1, "Business, Management and Accounting"=>2, "Social Sciences"=>11, "Computer Science"=>1, "Economics, Econometrics and Finance"=>6, "Neuroscience"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>22}, "Neuroscience"=>{"Neuroscience"=>1}, "Social Sciences"=>{"Social Sciences"=>11}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>6}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>10}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>2}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}}, "reader_count_by_country"=>{"Bangladesh"=>1, "Brazil"=>1, "United Kingdom"=>1, "Kenya"=>1}, "group_count"=>6}

Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/1539178"], "description"=>"<p>Projected numbers of deaths averted under universal coverage, with costs per total deaths averted.</p>", "links"=>[], "tags"=>["epidemiology", "health care", "Nursing science", "Primary care", "Public and occupational health", "Global health", "women's health", "Obstetrics and gynecology", "Economics", "numbers", "deaths", "averted", "costs"], "article_id"=>1061113, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Linda Bartlett", "Eva Weissman", "Rehana Gubin", "Rachel Patton-Molitors", "Ingrid K. Friberg"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098550.g004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Projected_numbers_of_deaths_averted_under_universal_coverage_with_costs_per_total_deaths_averted_/1061113", "title"=>"Projected numbers of deaths averted under universal coverage, with costs per total deaths averted.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-18 03:51:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/1539176"], "description"=>"<p>Projected numbers and percentages of deaths averted, by provider and intervention type, under universal coverage.</p>", "links"=>[], "tags"=>["epidemiology", "health care", "Nursing science", "Primary care", "Public and occupational health", "Global health", "women's health", "Obstetrics and gynecology", "Economics", "numbers", "percentages", "deaths"], "article_id"=>1061111, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Linda Bartlett", "Eva Weissman", "Rehana Gubin", "Rachel Patton-Molitors", "Ingrid K. Friberg"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098550.g002", "stats"=>{"downloads"=>3, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Projected_numbers_and_percentages_of_deaths_averted_by_provider_and_intervention_type_under_universal_coverage_/1061111", "title"=>"Projected numbers and percentages of deaths averted, by provider and intervention type, under universal coverage.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-18 03:51:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/1539177"], "description"=>"<p>Total cost of scale-up by provider type.</p>", "links"=>[], "tags"=>["epidemiology", "health care", "Nursing science", "Primary care", "Public and occupational health", "Global health", "women's health", "Obstetrics and gynecology", "Economics", "scale-up"], "article_id"=>1061112, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Linda Bartlett", "Eva Weissman", "Rehana Gubin", "Rachel Patton-Molitors", "Ingrid K. Friberg"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098550.g003", "stats"=>{"downloads"=>2, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Total_cost_of_scale_up_by_provider_type_/1061112", "title"=>"Total cost of scale-up by provider type.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-18 03:51:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/1539175"], "description"=>"<p>Included <i>LiST</i> interventions and type of death averted by provider type.</p>", "links"=>[], "tags"=>["epidemiology", "health care", "Nursing science", "Primary care", "Public and occupational health", "Global health", "women's health", "Obstetrics and gynecology", "Economics", "interventions", "averted"], "article_id"=>1061110, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Linda Bartlett", "Eva Weissman", "Rehana Gubin", "Rachel Patton-Molitors", "Ingrid K. Friberg"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0098550.g001", "stats"=>{"downloads"=>4, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Included_LiST_interventions_and_type_of_death_averted_by_provider_type_/1061110", "title"=>"Included <i>LiST</i> interventions and type of death averted by provider type.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-18 03:51:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/1539184", "https://ndownloader.figshare.com/files/1539185", "https://ndownloader.figshare.com/files/1539186"], "description"=>"<div><p>Background and Methods</p><p>To guide achievement of the Millennium Development Goals, we used the Lives Saved Tool to provide a novel simulation of potential maternal, fetal, and newborn lives and costs saved by scaling up midwifery and obstetrics services, including family planning, in 58 low- and middle-income countries. Typical midwifery and obstetrics interventions were scaled to either 60% of the national population (modest coverage) or 99% (universal coverage).</p><p>Findings</p><p>Under even a modest scale-up, midwifery services including family planning reduce maternal, fetal, and neonatal deaths by 34%. Increasing midwifery alone or integrated with obstetrics is more cost-effective than scaling up obstetrics alone; when family planning was included, the midwifery model was almost twice as cost-effective as the obstetrics model, at $2,200 versus $4,200 per death averted. The most effective strategy was the most comprehensive: increasing midwives, obstetricians, and family planning could prevent 69% of total deaths under universal scale-up, yielding a cost per death prevented of just $2,100. Within this analysis, the interventions which midwifery and obstetrics are poised to deliver most effectively are different, with midwifery benefits delivered across the continuum of pre-pregnancy, prenatal, labor and delivery, and postpartum-postnatal care, and obstetrics benefits focused mostly on delivery. Including family planning within each scope of practice reduced the number of likely births, and thus deaths, and increased the cost-effectiveness of the entire package (e.g., a 52% reduction in deaths with midwifery and obstetrics increased to 69% when family planning was added; cost decreased from $4,000 to $2,100 per death averted).</p><p>Conclusions</p><p>This analysis suggests that scaling up midwifery and obstetrics could bring many countries closer to achieving mortality reductions. Midwives alone can achieve remarkable mortality reductions, particularly when they also perform family planning services - the greatest return on investment occurs with the scale-up of midwives and obstetricians together.</p></div>", "links"=>[], "tags"=>["epidemiology", "health care", "Nursing science", "Primary care", "Public and occupational health", "Global health", "women's health", "Obstetrics and gynecology", "Economics", "scaling", "midwifery", "obstetrics", "58", "low-", "middle-income"], "article_id"=>1061119, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Linda Bartlett", "Eva Weissman", "Rehana Gubin", "Rachel Patton-Molitors", "Ingrid K. Friberg"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0098550.s001", "https://dx.doi.org/10.1371/journal.pone.0098550.s002", "https://dx.doi.org/10.1371/journal.pone.0098550.s003"], "stats"=>{"downloads"=>7, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_Impact_and_Cost_of_Scaling_up_Midwifery_and_Obstetrics_in_58_Low_and_Middle_Income_Countries_/1061119", "title"=>"The Impact and Cost of Scaling up Midwifery and Obstetrics in 58 Low- and Middle-Income Countries", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-06-18 03:51:21"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"6", "full-text"=>"4", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
  • {"unique-ip"=>"13", "full-text"=>"15", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"10"}

Relative Metric

{"start_date"=>"2014-01-01T00:00:00Z", "end_date"=>"2014-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[291]}, {"subject_area"=>"/Medicine and health sciences", "average_usage"=>[285]}, {"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[283, 456]}, {"subject_area"=>"/Medicine and health sciences/Pediatrics", "average_usage"=>[304, 478]}, {"subject_area"=>"/Medicine and health sciences/Women's health", "average_usage"=>[286]}]}
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