Journal of Urban Health

, Volume 96, Issue 2, pp 208–218 | Cite as

Using a Birth Center Model of Care to Improve Reproductive Outcomes in Informal Settlements—a Case Study

  • Jacqueline WallaceEmail author


The world is becoming increasingly urban. For the first time in history, more than 50% of human beings live in cities (United Nations, Department of Economic and Social Affairs, Population Division, ed. (2015)). Rapid urbanization is often chaotic and unstructured, leading to the formation of informal settlements or slums. Informal settlements are frequently located in environmentally hazardous areas and typically lack adequate sanitation and clean water, leading to poor health outcomes for residents. In these difficult circumstances women and children fair the worst, and reproductive outcomes for women living in informal 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 response, a birth center model of maternity care is proposed for informal settlements. Birth centers have been shown to provide high quality, respectful, culturally appropriate 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.


birth center birth centers birth center, free standing maternal health maternal health services slum slums informal settlement informal settlements 



I would like to extend my sincere gratitude to Drs. Nauruj Jahan and Tamjida Hanfi Sohni of BRAC for their help in introducing me to the Manoshi Project and their continued generous support over the years. In addition, I am very grateful for the knowledge and assistance of Dr. Afsana Kaosar of BRAC. Lastly, I am indebted to Dr. Henry Perry, for his enthusiastic support and advice.


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Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  1. 1.Global Health ConsultantBaltimoreUSA

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