Who provides reproductive and maternal and reproductive healthcare for women in low- and middle-income countries?

The Maternal healthcare markets Evaluation Team (MET) at the London School of Hygiene & Tropical Medicine is publishing the most comprehensive analysis to date of where women in low- and middle-income countries seek reproductive and maternal healthcare, and the quality of care they receive, drawing on data from Demographic and Health Surveys in 57 countries.

The findings, due to be launched in January 2016, will build on a series of papers assessing the coverage, equity and quality indicators of family planning, antenatal and delivery care provided by both the public and the private sectors. The research has found that while the majority of women who sought care did so in the public sector, the private sector also provided a substantial proportion of services, serving about 4 in 10 women who use care. However, these analyses also show that a large proportion of women who need services use neither public nor private sector services (i.e. have unmet need for care).

Given the number of women private sector providers currently serve, LSHTM’s Maternal Healthcare Markets Evaluation Team (MET) is seeking to understand why women seek care in this sector, the quality of care the private sector provides, and how quality can be improved. These questions are particularly important given global efforts to achieve universal health coverage and ensure that women have access to affordable, quality maternal health services wherever they seek care.

Dr Caroline Lynch, Principal Investigator for MET, said: “We see that while the private sector is serving a large proportion of women with both reproductive and maternal healthcare, we know relatively little about this sector, including the quality of care it provides or why women choose it over the public sector. MET is seeking to better understand this and other questions around private sector provision through rigorous evaluations. These will generate further evidence on the role of this sector in the delivery of reproductive and maternal healthcare.”

Dr Lenka Benova, who led the analysis, said: “We used the available Demographic and Health Survey data about the care women received in order to go beyond coverage indicators to also look at the content of care. We found that across these services, the content of care was comparable between the public and the private sectors, but that both sectors require substantial improvement to reach adequate levels of care.”

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Figure 1. Use of care among women in need, by service and sector of provision

The research is taking place as part of an independent evaluation of several interventions supported by MSD for mothers – a 10-year, $500 million initiative focused on improving the health and wellbeing of mothers during pregnancy and childbirth. In an effort to contribute knowledge to advance the maternal health field, LSHTM is generating evidence on the use, quality, equity, and market dynamics of maternal health services, and whether interventions, such as social franchising, can increase access to lifesaving care for all women. The research will help to answer tough questions on how to improve the affordability and quality of both private and public maternal health services, such as how and why interventions work, whether they are cost-effective, how likely they are to be sustainable, and their potential impact, if implemented at scale, on maternal mortality.

The full papers in this series can be accessed here