Pregnancy and childbirth are critical periods for women, particularly in countries with limited access to reproductive and maternal healthcare. While the continuum of reproductive and maternal healthcare is essential for healthy pregnancies and maternal and child survival, skilled birth attendance is especially important for reducing maternal and neonatal mortality risks. However, barriers such as cost, mobility, quality of services, and social norms often prevent women from accessing these services. Disruptive events like the COVID-19 pandemic, disasters, and conflicts further exacerbate these barriers.
The World Bank has been involved for over a decade in efforts to ensure skilled birth attendance as part of the reproductive and maternal health continuum of care. Beginning with its 2010-2015 Reproductive Health Action Plan, the World Bank focused on supporting reproductive and maternal health through project lending. By 2015, along with other partners, it established the Global Financing Facility (GFF) to leverage grants for IDA countries. These grants have successfully improved service availability and quality in areas with high burdens of poor maternal and child health outcomes. Currently, the World Bank supports reproductive and maternal health through direct lending and grants.
To enhance availability and access to skilled birth attendance, the World Bank has implemented various approaches:
1. **Improving Service Delivery:** The focus includes refurbishing maternity wards, strengthening referral systems, and improving access to emergency obstetric and neonatal care services.
2. **Training Programs:** Investments have been made in hiring, training, and deploying skilled birth attendants to scale up service delivery.
3. **Results-Based Financing:** Performance incentives for meeting service delivery targets are used to improve quality.
4. **Demand-Generation Strategies:** Information campaigns, social behavior change communication, cash transfers, vouchers for free or low-cost healthcare services aim to increase utilization of skilled attendance at birth.
Between FY18-FY23, nearly 95 million women received skilled attendance at birth due to World Bank project investments in 47 low- and middle-income countries.
In Indonesia, where maternal mortality was notably high (173 deaths per 100,000 live births in 2020), interventions included emergency obstetric care support via results-based financing mechanisms which facilitated over 26.5 million women receiving skilled attendance between 2018-2023.
In Mozambique’s Primary Health Care Strengthening Program initiated in 2017 aimed at improving care quality led to almost six million skilled deliveries by December 2022.
Kenya’s Transforming Health Systems for Universal Care Project supported an increase in skilled birth attendance from 57 percent to 75 percent between FY17-FY23 translating into over seven million deliveries.
Overall data highlights indicate that most support was directed toward vulnerable communities primarily in Africa followed by East Asia. Top beneficiaries included Indonesia, Tanzania Nigeria Kenya Mozambique Myanmar Burundi Afghanistan Ghana Niger.
The World Bank Group contributed over $3.5 billion between FY18-FY23 towards reproductive maternal newborn child adolescent health focusing mainly on Africa which bears significant burden of poor outcomes
Key partnerships include:
- Global Financing Facility (GFF)
- The Human Reproduction Programme
- Partnership for Maternal Newborn Child Health
- H6 partnership of UN agencies
Looking ahead: The World Bank remains committed to improving outcomes through continued investments in service delivery health systems strengthening Universal Health Coverage implementation results-based financing For example Sahel Women’s Empowerment Demographic Dividend program GFF support leveraging IDA projects deliver sexual reproductive health