Equity and intrapartum care by skilled birth attendant globally: protocol for a systematic review.

Introduction: Equity is a cross-cutting theme within the Sustainable Development Goals (SDGs) and central to the effort to improve maternal and child health globally. One key strategy to prevent maternal death set out in SDG 3 is assistance by a skilled birth attendant (SBA) at childbirth (indicator 3.1.2). However, the increased coverage of SBAs globally has not been reflected by the same degree of decrease in maternal mortality and has been reported to have higher levels of inequality than other maternal health interventions. There is a need to evaluate the extent of inequity in intrapartum care by SBAs and evaluate themes in determinants of inequity across regions and specific country characteristics.

Methods And Analysis: The protocol for this review follows The Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses with equity extension 2012 guidelines. Studies of all languages and from all countries from 2004, the year when the WHO/ICM/FIGO joint statement on SBAs was published, and onwards will be included. PubMed/MEDLINE, CINAHL Complete, the Cochrane Library, POPLINE, the World Health Organization (WHO) Global Index Medicus, and grey literature will be searched. Our primary outcome is intrapartum care by SBA. Studies will be included if they evaluate equity and its determinants adapted from the Progress-Plus grouping of characteristics affecting health outcomes. Results will be stratified based on WHO, World Bank Group income and SDG regional groupings.

Ethics And Dissemination: This review is a secondary analysis of published literature and does not require ethics review. Results will provide information regarding equity in intrapartum care by SBAs globally and will inform development of indicators for monitoring of inequity as well as global policy related to intrapartum care and maternal mortality. Results will be disseminated via peer-reviewed manuscript, international conferences and stakeholder websites.

Prospero Registration Number: CRD42017069021.