New Study: how expanded emergency services impacts Maternal and Newborn Health

The WHO has identified increased access to skilled birth attendants and comprehensive emergency obstetric care as key facilitators in achieving the infant and maternal health Sustainable Development Goals, but many women in developing countries lack access of quality emergency services.

gvk-ambulenceCEGA affiliate Grant Miller (Stanford) has recently co-authored a paper in Health Affairs evaluating the impact of the first centralized ambulance service (GVK EMRI) in India on maternal and infant health outcomes. GVK Emergency Management and Research Institute (GVK EMRI) is a public private partnership providing 911-like, free of charge emergency response services, and operates a fleet of over 10,000 ambulances across 15 Indian states and 2 territories. Prior to the launch of GVK EMRI in 2005, private hospitals provided an ad-hoc network emergency response services, which in many areas were notorious for slow response times and under-trained staff.

The authors employ a difference-in-differences approach to estimate the impact of GVK EMRI services on the probability of neonatal and infant mortality, institutional and attended deliveries, and the mother experiencing complications during childbirth in the states of Gujarat and Andhra Pradesh. The results show statistically significant and meaningful reductions in the probability of both neonatal and infant mortality throughout Andhra Pradesh, but only in the areas of Gujarat with the highest pre-intervention mortality rates. It is very interesting that while the benefits of the improved emergency services appears to have been spread evenly across the residents of Andhra Pradesh, the benefits were isolated to the presumably most disadvantaged in Gujarat.

Additionally, there is an overall null effect of GVK EMRI on all 3 maternal delivery variables in both Andhra Pradesh & Gujarat, but a very small positive effect in the high mortality areas of Gujarat. Therefore, the authors posit the mechanism for the reduction of neonatal and infant mortality is not increases in the quantity of institutionalized deliveries, but instead improvements in the quality of care that at-risk mothers’ received. This implies that the benefits for this program could be even greater in the future, if the increased supply of emergency medical services was combined with a behavioral intervention to increase the demand for institutionalized delivery (such as the ongoing, BERI funded projects on pre-commitment devices in Kenya and social signaling in Sierra Leone).