ISSUE 11: MATERNAL HEALTH IN URBAN SETTINGS 

The MHTF Quarterly shares resources, research and news in key maternal health areas. This quarter, we’re focusing on maternal health in urban settings.

Many studies examining maternal health care around the world have found urban residence to be a protective factor, suggesting that women who live in cities are better off than those in rural areas. Researchers have observed that health services are often more easily accessible to women in cities due to higher density of health care workers and facilities. But this discourse oversimplifies the complexity of health care in urban settings, where women still experience barriers related to transportation, socioeconomic status and quality.

Despite the relatively short distance to health facilities in cities compared to rural areas, getting to a facility in time for delivery remains an issue for many women. Limited access to financial and material resources can also delay women from receiving timely care. Inequities in socioeconomic status within cities are a major contributor to maternal and newborn health disparities. Hospital fees can result in catastrophic expenditures for women seeking maternity care in urban settings, and poor women are sometimes at greater risk of incurring the costs of bribes or informal payments. In addition to low socioeconomic status as a barrier to health care access and utilization, the effects of urban poverty on maternal health are far-reaching and extend well beyond common obstetric indicators such as antenatal care attendance and facility-based delivery.

For women who manage to reach a health facility, poor quality of maternal health care remains a challenge in many urban areas—particularly in slums and informal settlements. For example, less than 30% of the health facilities in the slums of Nairobi, Kenya have magnesium sulfate readily available, only 20% can perform cesarean section surgeries and a mere 8% offer assisted vaginal delivery. Another study on the urban poor in Nairobi found that while 70% of women reported delivering in a health facility, only 48% did so with a skilled birth attendant. Whether a facility is private or public can also influence the quality of maternal health care provided. In a study from urban India, 86% of women surveyed who delivered in a private hospital reported that the bed was clean, compared to 43% of women who delivered in a public hospital. Women delivering in urban facilities have also reported experiences of disrespect and abuse, even in the presence of a skilled birth attendant, likely related to severe overcrowding and a limited health workforce.

Fifteen years ago, 39% of births occurred in urban areas, and by 2030, more than half of women will deliver in cities. Health care systems will need to adjust their resources, strategies and priorities in order to effectively respond to the impacts of urbanization and ensure high quality maternal health care for all women.
Back to Top

KEY REPORTS AND PUBLICATIONS

Maternal newborn health and the urban poor: A global scoping 

Averting Maternal Death and Disability Program | July 2016 
 

The urban disadvantage: State of the world’s mothers 2015

Save the Children | 2015
 

Examining the “urban advantage” in maternal health care in developing countries 

PLOS Medicine | September 2010
 

The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania

BMC Pregnancy and Childbirth | August 2016
 

What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya 

Maternal and Child Health Journal | February 2008
 

Applying a framework for assessing the quality of maternal health services in urban India

Social Science & Medicine | May 2007
   

Beliefs and practices during pregnancy and childbirth in urban slums of Dhaka, Bangladesh 

BMC Public Health | September 2012
Back to Top

PRESENTATIONS FROM THE 2015 GLOBAL MATERNAL NEWBORN HEALTH CONFERENCE

A Scoping of the Status of Maternal Newborn Health for the Urban Poor

Shanon McNab | October 2015
 

Scaling Up Maternity Referral Systems in Three Cities of Maharashtra, India, to Promote Access to Quality Health Services for Poor Urban Communities

Sweety Pathak | October 2015
 

Reducing Cesarean Section Rate in an Urban Nonprofit Hospital in India

Abhishek Bhartia | October 2015
 

“She is My Neighbor”: The Persistence of Traditional Birth Attendants in Poor Urban Areas of Cairo

Diana Perez Buck | October 2015
 

What Determines Trust in Maternity Care? Cross-Perspective Findings From Peri-Urban Kenya

Pooja Sripad | October 2015
 

Maternal and Neonatal Health in the Urban Slums of Bangladesh: Approaches of the Manoshi Program

Kaosar Afsana | October 2015
Back to Top

VIDEOS FROM THE 2013 GLOBAL MATERNAL HEALTH CONFERENCE

Models for Providing Quality Maternal Care in Urban Slum Areas


Plenary Session 2: Maternal Health in Urban Settings
(Part 1) (Part 2) (Part 3) (Part 4)

Back to Top

FROM THE MHTF BLOG

The Urban Disadvantage: Rethinking Maternal and Newborn Health Priorities

Nancy Chong | February 2017
Back to Top

FROM THE ADVANCING DIALOGUE ON MATERNAL HEALTH SERIES

The Urban Disadvantage: Maternal and Newborn Inequalities Among the Urban Poor

Woodrow Wilson Center | January 2017
 

Accessing Maternal Health Care Services in Urban Slums: What Do We Know?

Woodrow Wilson Center | April 2011
Back to Top
ISSUE 11 CONTENTS

Key Reports and Publications

Presentations

Videos

MHTF Blog

MH Dialogues
 
CONTACT US

MHTF is always looking for new resources, research, perspectives and news. We invite your feedback as well as any resources you would like to share. Please email your comments, questions, suggestions and blog contributions.
 
Share
Tweet
Forward

Share your thoughts and ideas

Check out new posts from the MHTF blog

Join the conversation on social media


Copyright © 2017 Maternal Health Task Force at the Harvard T.H. Chan School of Public Health, All rights reserved.



Forward to a friend

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list