Using a Birth Center Model of Care to Improve Reproductive
Outcomes in Informal Settlements—a Case Study
Jacqueline Wallace
#
The New York Academy of Medicine 2018
Abstract The world is becoming increasingly ur-
ban. For the first time in history, more than 50%
of human beings live in cities (United Nations,
Department of Economic and Social Affairs, Pop-
ulation Division, ed. (2015)). Rapid urbanization is
often chaotic and unstructured, leading to the for-
mation of informal settlements or slums. Informal
settlements are frequently located in environmen-
tally hazardous areas and typically lack adequate
sanitation and clean water, leading to poor health
outcomes for residents. In these difficult circum-
stances women and children fair the worst, and
reproductive outcomes for women living in infor-
mal settlements are grim. Insufficient uptake of
antenatal care, lack of skilled birth attendants and
poor-quality care contribute to maternal mortality rates
in informal settlements that far outpace wealthier urban
neighborhoods (Chant and McIlwaine (2016)). In re-
sponse, a birth center model of maternity care is pro-
posed for informal settlements. Birth centers have been
shown to provide high quality, respectful, culturally ap-
propriate care in high resource settings (Stapleton et al. J
Midwifery Women’s Health 58(1):3–14, 2013; Hodnett
et al. Cochrane Database Syst Rev CD000012, 2012;
Brocklehurst et al. BMJ 343:d7400, 2011). In this paper,
three case studies are described that support the use of
this model in low resource, urban settings.
Keywords birth center
.
birth centers
.
birth center, free
standing
.
maternal health
.
maternal health services
.
slum
.
slums
.
informal settlement
.
informal settlements
Introduction
The world is undergoing a radical transformation. For the
first time in history, more than 50% of the world’spop-
ulation live in urban areas, and it is estimated that by the
year 2050 two thirds of human beings will live in cities
[1]. This trend is not occurring evenly, with the highest
rates of urbanization occurring in Africa and Asia. Nearly
90%ofnewurbangrowthisexpectedtooccurintheleast
developed nations [1, 6], and the urban population there
is expected to double every 35 years [7].
Not surprisingly, such rapid growth is often unman-
ageable. Concentrated settlements of impoverished res-
idents create chaotic, dangerous communities, often re-
ferred to as slums or informal settlements. As defined by
UN-Habitat, the United Nations program for human
settlements, a slum is a settlement that lacks one or more
of the following: access to clean water, access to im-
proved sanitation, sufficient living area that is not over-
crowded, durable housing and secure tenure [8]. How-
ever, there is considerable variation in the definition of
“slum”, and some cities and countries have no formal
definition at all [9, 10]. To some, the terms informal
settlement and slum are interchangeable, yet to others
the term “slum” is offensive, having a negative or pejo-
rative connotation [10
, 11].
In addition, there is marked
heterogeneity between informal settlements of different
J Urban Health
https://doi.org/10.1007/s11524-018-0257-3
J. Wallace (*)
Global Health Consultant, Baltimore, MD, USA
e-mail: jmgwallace@gmail.com
@Phil_Robichaud
@deepthiw
@JoseServera