Improving access to quality maternal health services.

The accessibility of maternal health care services depends on more than their mere existence. While access to routine prenatal care can be increased through use of mobile outreach clinics or peripheral health facilities, access to care for delivery is complicated by the unscheduled nature of labor, by women's other responsibilities, and by fears for women's safety during night travel. Current modes of service delivery must be changed to make care accessible. Physical barriers posed by lack of communication and transportation must be overcome. Possible strategies include establishment of maternity waiting homes, emergency transport and referral mechanisms, and enhanced communications systems. Another strategy is to authorize health care workers at the lowest level of the health care system to perform emergency obstetric services, such as Cesarean sections. Cost is also a barrier, and institution of user fees has prevented many women from seeking care. There are even hidden costs when services are provided free or for a nominal charge. Efforts to overcome these economic barriers include health insurance schemes. In the long term, communities must be educated to recognize and respond to obstetric emergencies, and the quality of health care offered to women must be improved. In addition, communication must be improved between formal and informal health care systems, between communities and health care facilities, and between women and providers.