Anna Maria Special, May 20, 2013
In collaboration with our WHO colleagues, our rapid literature review on obstetric complications provided the opportunity to understand the nature of the current literature available to inform decisions on midwifery workforce planning. The current benchmarks are widely accepted global estimates that we´ve utilized in country-specific workforce planning exercises. So it was interesting to appreciate the data from a different perspective; taking individual data sources, country examples and contexts and looking to merge and align them for the creation of global figures, that would in turn be applied to specific countries and contexts for planning.
However, looking from the top of the cascade if you will, the findings were more complex than originally (innocently) anticipated. Following a strict search protocol is key for scientific integrity, yet it also limits you to the articles that fit the criteria, thus leaving you without the opportunity to incorporate that great report created by a trusted colleague which falls just out of the search criteria. Nonetheless, as data was extracted it became clear that there is a gap in the published literature for examining the prevalence of complications (as defined by UNFPA/WHO/UNICEF) as a percentage of total pregnancies/live births at a population level. Many studies focused on measuring the incidence of one or more of these complications within a specific clinical setting. Likewise, some complications were much more prominent in the literature than others. Diagnostic criteria varied across studies and at times was not fully explained.
What´s more, the exercise lead us to question whether our question truly matched our intention. This was not to be a purely academic endeavour; the findings were to have a purpose. Through the rapid review we were able to get the sought data- rates at which various complication affected the studied populations. However, even in the presence of perfect science, human judgement/common sense would dictate that perhaps we did not just want to know the rates of complications – as expressed in our research question. In truth, we sought data that would inform guidelines regarding what percentage of women would need emergency care. These are similar concepts, but different questions.
Nonetheless, the analysis of the data extracted and this experience prompts us to query whether it is possible to set a universal benchmark for the health workforce based on a global figure of incidence rates of complications. Throughout the current literature, including literature that was not included in our data review, definitions of complications vary, as does information regarding the impact of health, genetic and societal and sociocultural factors on incidence rates. It becomes clear that context is important. To that end, it may be more appropriate to focus on workforce planning based on models of “typical” populations at a sub-national level. While standardization of methods and models is necessary for the achievement of global health standards, a one-size fits all approach to meeting the maternal health needs across contexts and countries may come short of truly appreciating and addressing the diverse realities that women are living.