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Length-of-stay in health facilities after childbirth is too short in many low- and middle-income countries

Length-of-stay in health facilities following childbirth is highly variable across 92 countries and inadequate for a substantial proportion of women, according to a study published by Oona Campbell and colleagues from the London School of Hygiene & Tropical Medicine, United Kingdom, in this week’s PLOS Medicine.

The researchers compiled data on length-of-stay after facility births from databases and recent health surveys covering 92 countries. Data were obtained from Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), the US Centers for Disease Control and Prevention Reproductive Health Survey (CDC-RHS), and databases compiled by the Organisation for Economic Co-operation and Development (OECD). Across countries, they estimated that the mean length-of-stay ranged from 0.5 days (in Egypt) to 6.2 days (in Ukraine) for singleton (i.e. single baby, not twins or multiplets) vaginal births (data available for 71 countries) and from 2.5 days to 9.3 days for caesarean-section deliveries (data available for 30 countries). The United Kingdom was the high-income country with the shortest length-of-stay for singleton vaginal births (mean 1.5 days). Across the 30 low- and middle-income countries with data from DHS, the proportion of women with vaginal deliveries who stayed too short (<24 h) ranged from 0.1% to 83.2%, while the proportion with cesarean-section deliveries who stayed too short (<72 h) ranged from 1.0% to 75.3%.

While the findings suggest that many women and their newborns are not receiving adequate postnatal care, there are several limitations to the analysis. For many countries, the researchers were unable to find information on postnatal length-of-stay, and additional research is warranted. The postnatal lengths-of stay reported vary widely between countries and are likely influenced by national norms and health system features in addition to specific needs of mothers and newborns. Moreover, in several countries, the percentage of births in health facilities is low, suggesting that many countries still need to increase facility births.

The authors say: “Substantial proportions of women stay too short to receive adequate postnatal care. We need to ensure that facilities have skilled birth attendants and effective elements of care, but also that women stay long enough to benefit from these.”