A Good Idea or an Expensive Diversion? Workshop on the Evidence Base for Clean Birth Kits
Last week, I attended a workshop in London convened by Immpact/University of Aberdeen and Saving Newborn Lives/Save the Children. The workshop – the first in a planned series – was on Assessing and Advancing the Evidence Base For Birth Kits. The objectives included: reviewing the current evidence on the effectiveness of clean birth kits and experience around their implementation, making recommendations for policy, programs and advocacy, and identifying gaps in knowledge. Presentations given at the workshop showed that approximately 1.1 million mothers and newborns die annually from infections linked to unhygienic birth practices. Reviews of the evidence suggest that clean birth practices can reduce the risk of neonatal morbidity and mortality from infection related causes, but the evidence of their effectiveness in reducing maternal sepsis is much weaker. There are only a few studies (and only one randomized controlled trial) showing that clean birth kits support clean birth practices.
It seems that clean birth kits in one form or another are currently in use in at least 50 countries. In addition, there are plans underway to expand the use of birth kits in various countries, and to invoke them in advocacy messages around a recommended set of maternal and newborn health interventions. We learned from the presentations given at the workshop that the specific contents of clean birth kits varies as does their distribution method, intended users, and implementation in combination with other interventions, such as training of birth attendants. Many questions were raised by participants about whether clean birth kits represent a good investment for maternal and newborn health. There was some concern expressed about the potential for birth kits to be an ‘expensive diversion’ away from much needed work on strengthening health systems, although some could also imagine ways in which birth kits could be used as a strategy for improving the quality of care in health facilities. There were also questions raised about potential adverse effects, such as whether the use of birth kits in home births would discourage women from delivering in health facilities or with a skilled attendant. In addition, participants discussed the possible effect of birth kits on either increasing or reducing inequities in access to clean birth supplies.
A policy brief summarizing the evidence and the many gaps in knowledge surrounding birth kits is being prepared for distribution at the Women Deliver Conference in June.
For more information on clean birth kits, visit www.birthingkitfoundation.org.au.