In a recent address at the inauguration of Ministry of Health’s OSSYM program, Federal Minister of Health Dr. Mekdes Daba highlighted that in countries like the United States and the United Kingdom, maternal healthcare access has reached the homes of the mothers in the community. In such settings where access to high-quality healthcare is ubiquitous, home births are increasingly being recommended for women who are deemed low risk. Women can request a trained midwife or birth attendant to deliver in the comfort of their own homes, equipped with all the necessary medical tools one would find in a hospital labor ward. Should complications arise, prompt ambulance services ensure that they can be swiftly transported to specialized care.
At first glance, this trend may seem to contradict the World Health Organization’s strong recommendation for facility-based deliveries. However, the way to understand it is to look at it through a lens of improving access to healthcare. The call for facility-based deliveries is not an unconditional indictment of all home births, but rather a reflection of the disparities in healthcare infrastructure. In high-income countries, the availability of skilled care and rapid emergency response services enables home deliveries to be both safe and viable. The ultimate aim of recommending institutional births in lower-resource settings is to replicate the same level of care that women in wealthier countries can now access in their living rooms.
For nations like Ethiopia, where nearly four million births occur annually and the doctor-to-population ratio remains alarmingly low, home births often come at a dangerous cost. In these settings, the lack of access to life-saving interventions, such as emergency cesareans or blood transfusions, can lead to devastating outcomes when complications arise during labor. Even when health facilities are available, they may be too far for many mothers to reach in time. Furthermore, poor quality of care and lack of person-centeredness in some facilities means some local communities either lack awareness or do not have confidence in the services provided by health facilities. In such environments, a home birth is not a luxury or a personal choice but rather the only feasible option.
As we look to improve maternal healthcare globally, it’s crucial to recognize that the underlying issue is not simply the location of delivery or a lack of health education to mothers, but rather a question of access to comprehensive, and high-quality care. What makes home births in developed countries possible is the robust healthcare infrastructure that supports them — the very infrastructure that is still out of reach for millions of women in the Global South.
Improving access to healthcare requires a multi-component and holistic approach. There will not be a single intervention that will dramatically improve the health seeking behavior and facility-based delivery of a community. Not only do we need to work on increasing health literacy within communities and building infrastructure, but also on improving the quality of care of the health facilities, ensuring that they are well equipped to provide the services the community requires most, as well as ensuring that they are safe, comfortable, and person-centered.
The idea of bringing high-quality, safe, and person-centered care closer to the mothers who need it most is the guiding principle behind ACSIS’s Contain People Move Value (COPMOV) program. For the past few years, ACSIS has been actively working to equip health centers in rural areas to provide care that the community needs by optimizing the health system, to ensure person-centeredness in rural health facilities through improving process design, and to improve community health literacy through various community engagement activities. At ACSIS, we believe this holistic approach is crucial to improving access to and trust in healthcare facilities that will decrease dangerous, unattended home births and improve facility-based delivery.
Yet, there is still more work to do. If we are to improve facility-based delivery, and ultimately decrease maternal and neonatal death and morbidity, we need to expand this approach to hard-to-reach areas in a manner that is culturally and contextually appropriate. We also need to ensure that our health centers are not simply equipped to minimum capacity but are comfortable, welcoming, and designed around the community that uses them.