Paper short abstract:

Macro-level policy goals on maternal and infant health such as the MDGs remain out of reach in many places. This paper will discuss and review our research in the context of wealthy, middle income and resource constrained countries to question received wisdom about the benefits of global MCH policies.

Paper long abstract:

Macro-level policies on maternal and infant health, from WHO's global level to national health policies at state level have been intended to bring about improvements in maternal and infant morbidity and mortality and to promote better health. However, big policy goals such as the MDGs remain out of reach in many places.

There has been a consistent bias in such policies towards top-down planning following a largely technocratic imperative. Assumptions were made about risk, safety and wellbeing that were not always well founded or evidence-based. Among these policies has been the exclusion of traditional midwives, and even an overlooking and undervaluing of formally qualified midwives in many countries, together with an emphasis on hospital birth. These policies are not affordable in many countries and further to this, there is a lack of evidence for the greater safety of hospital birth for healthy pregnant women. Additionally, the problem of disrespect and abuse of mothers in maternity facilities is increasingly being discussed, while many healthcare professionals suffer stress and burnout relating to over-stretched services.

Recently, robust research evidence has begun to emerge on three fronts: the safety of well-organised out of hospital birth; the safety of midwife led care and services and the potential value of traditional midwives and other categories of maternity supporters or workers. This paper will discuss and review our research in the context of wealthy (UK), middle income (Brazil) and resource constrained countries (Malawi & Sudan), to question received wisdom about the benefits of global MCH policies. Macro-level policy goals on maternal and infant health such as the MDGs remain out of reach in many places. This paper will discuss and review our research in the context of wealthy, middle income and resource-constrained countries to question received wisdom about the benefits of global MCH policies.