The global met need for emergency obstetric care: a systematic review

Background: Of the 287,000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as 'Met need for EmOC'.

Objective: To estimate the global met need for EmOC and to examine the correlation between met need, maternal mortality ratio and other indicators.

Search strategy: A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and Google Scholar.

Selection criteria: Studies containing data on met need in EmOC were selected.

Data collection and analysis: Analysis was performed with data extracted from 62 studies representing 51 countries. World Bank data were used for univariate and multiple linear regression.

Main results: Global met need for EmOC was 45% (IQR: 28-57%), with significant disparity between low- (21% [12-31%]), middle- (32% [15-56%]), and high-income countries (99% [99-99%]), (P = 0.041). This corresponds to 11.4 million (8.8-14.8) untreated complications yearly and 951 million (645-1174 million) women without access to EmOC. We found an inverse correlation between met need and maternal mortality ratio (r = -0.42, P < 0.001). Met need was significantly correlated with the proportion of births attended by skilled birth attendants (β = 0.53 [95% CI 0.41-0.65], P < 0.001).

Authors' conclusions: The results suggest a considerable inadequacy in global met need for EmOC, with vast disparities between countries of different income levels. Met need is a powerful indicator of the response to maternal mortality and strategies to improve EmOC act in synergy with the expansion of skilled birth attendance.