Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a glob...

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Bibliographic Details
Published in:PloS one 2020-06, Vol.15 (6), p.e0234252-e0234252
Main Authors: Goodarzi, Bahareh, Walker, Annika, Holten, Lianne, Schoonmade, Linda, Teunissen, Pim, Schellevis, François, de Jonge, Ank, Portela, Anayda, Kabir, Russell
Format: Article
Language:English
Subjects:
Agreements
Bibliographic data bases
Biology and Life Sciences
Care and treatment
Children
Evaluation
Health risk assessment
Infant care
Maternal health services
Medical libraries
Medical research
Medicine and Health Sciences
Methods
Midwifery
Morbidity
Mortality
Newborn babies
Newborn infants
Obstetrics
Pediatrics
People and Places
Pregnancy
Public health
Quality management
Research and Analysis Methods
Researchers
Setting (Literature)
Social Sciences
Studies
Time
Women
Womens health
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Summary:Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0234252