A woman's worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa

BMC Emerg Med. 2020 Jan 13;20(1):3. doi: 10.1186/s12873-020-0300-z.


Background: Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for "timely access to emergency obstetric care." This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region. Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness. Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile.

Main text: In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control.

Conclusions: The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent.

Keywords: Africa; African Federation of Emergency Medicine (AFEM); Community; Emergency obstetric care; Gender; Healthcare access; Maternal mortality; Norms; Pregnancy; Sustainable development goals; Three delays; World Health Organization (WHO).

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Developing Countries
  • Emergency Medical Services / organization & administration*
  • Female
  • Health Services Accessibility / organization & administration
  • Humans
  • Maternal Health Services / organization & administration*
  • Maternal Mortality / trends*
  • Patient Acceptance of Health Care / psychology
  • Pregnancy
  • Quality Indicators, Health Care
  • Quality of Health Care / organization & administration*
  • Time Factors