Table 3 Examples of recommendations emerging from maternal and perinatal death reviews of particular relevance in humanitarian settings, mentioned by interviewees
Recommendations to address delays in decisions to seek care | Recommendations to address delays in reaching care | Recommendations to address delays in receiving quality care |
|---|---|---|
Importance of community engagement, including in design of services + feedback Addressing marginalisation with representation of community members within services Culturally appropriate and respectful services paramount Communication with women regarding risk planning for unpredictable insecurity Information sharing with community on security situation and availability of safe transport routes Addressing misinformation regarding health service Improving public perception of humanitarian actors Improving trust in health facilities and staff, and communication of humanitarian principles of neutrality Ensuring right to healthcare access regardless of legal status De-linking of immigration enforcement from health care activity, including data separation | Addressing restrictions on movement due to military/camp security procedures for women in labor Negotiation of referral pathways dependent on negotiation with armed actors/military/security/camp management Birth planning in insecure settings (e.g. availability of maternity waiting homes in situations of unpredictable security) Availability of free/subsidised transport networks with actors with access to ‘humanitarian space’ Coordination and communication between health actors, and with non-health actors Decision-making on strategic placement of basic and comprehensive emergency obstetric and newborn care services to avoid exacerbating referral delays in times of insecurity | Recruitment and retention of adequate staff in insecure settings Remote support for improving quality of care Address cultural barriers to emergency interventions—e.g. advanced consent for caesarean section from women/family decision makers Blood bank strengthening and emergency community blood drive activities Strengthening triage procedures Strengthening coordination between actors Ensuring respectful maternal and newborn care |