The global push for institutional childbirths—in unhygienic facilities

Increasing and regularly monitoring the number of women giving birth in institutions has been central to international strategies to improve the health of mothers and babies in the developing world. In India, the $200m (£141m; €184m) a year Janani Suraksha Yojana programme pays women to give birth in healthcare facilities rather than at home, as is tradition. Bangladesh and Nepal have similar conditional cash transfer programmes.

This push has largely neglected a sad irony: in much of the developing world, where 99% of maternal and newborn deaths occur, hospitals and other healthcare facilities are in a poor state.

In an unprecedented analysis of water, sanitation, and hygiene (WASH) in healthcare facilities in low income countries, the World Health Organisation recently reported that 38% have no decent water source.1 This leaves doctors, nurses, and midwives struggling to care for patients—and WHO “embarrassed.”2 One fifth of facilities surveyed in 54 countries had inadequate sanitation, and 35% lacked water and soap for healthcare providers and patients to wash their hands.