Open Access Highly Accessed Open Badges Research article

Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Jonathan M Spector1, Jonathan Reisman2*, Stuart Lipsitz3, Priya Desai1 and Atul A Gawande1

Author Affiliations

1 Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

2 Department of Internal Medicine-Pediatrics, Harvard - Massachusetts General Hospital, Boston, MA, USA

3 Department of General Medicine, Brigham and Women’s Hospital, Boston, MA, USA

For all author emails, please log on.

BMC Pregnancy and Childbirth 2013, 13:43  doi:10.1186/1471-2393-13-43

Published: 20 February 2013



The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care.


Health workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics.


Health workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%).


Substantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority.

Neonatal mortality; Maternal mortality; Childbirth; Developing world; Health technology