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Health facility births in Senegal have increased, but often lack safe obstetric and newborn care

5 March 2020

Although births in health facilities are increasingly common in Senegal, most take place in facilities unable to provide safe childbirth conditions, according to a study published today in BMJ Global Health.

Health facility births in Senegal have increased, but often lack safe obstetric and newborn care

A rising number of women in sub-Saharan Africa are giving birth in health facilities: in Senegal, the percentage of health facility births increased from 47% to 80% over the last 25 years. Giving birth in facilities helps women access emergency obstetric care rapidly in case complications develop during birth.

However, a study published today in BMJ Global Health found that most of the increase in facility births was accounted for by an increase in primary care facilities, health posts. Health posts are only rarely able to provide emergency obstetric care: most cannot provide all basic emergency obstetric care elements (such as antibiotics for infections), and less than two thirds had access to a vehicle for referring patients to hospitals providing more advanced care, such as caesarean sections.

Dr Francesca Cavallaro (UCL Great Ormond Street Institute of Child Health), lead author said: “Despite large increases in health facility births in Senegal, only 16% of births in public facilities take place in facilities with safe emergency obstetric care and referral capacity. Policy-makers should encourage births in facilities with the capacity to provide safe obstetric and newborn care.”

In addition, health posts in rural areas are often remote: 37% of rural health posts were located more than one hour away from a hospital providing caesareans. Long referral times can be life-threatening for mothers and babies with obstetric emergencies.

These results highlight that encouraging births in primary care facilities may indeed help more women give birth in health facilities, but may not always improve timely access to care if they develop complications.

Policy-makers should consider alternative health system configurations, where women give birth at higher level facilities. Improvements in emergency obstetric care and transport are needed in lower-level facilities – especially in rural areas – to accelerate reductions in maternal and perinatal deaths.

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Women and their babies in Ndienne, Senegal

 Photo © Dominic Chavez/The Global Financing Facility, no changes made