# Methods for Understanding the Cesarean Birth Surgical Disparity in Rural Ethiopia and Considering a Mobile Cesarean Birth Center as a Solution

> **NIH NIH R21** · UNIVERSITY OF COLORADO DENVER · 2021 · $187,915

## Abstract

Project Summary/Abstract
 When medically indicated, cesarean birth saves maternal, fetal, and neonatal lives. Historically, the World
Health Organization (WHO) recommends a 10 – 15% population cesarean birth rate, among all global
populations; some authors suggest 9 – 19% is more appropriate. Therefore, as an evidence-based intervention
to prevent adverse pregnancy outcomes, cesarean birth rates of under 2%, which is the case in rural Southwest
Ethiopia, is an unacceptable public health problem. Low cesarean birth rates plague many regions of sub-
Saharan Africa, so the context of rural Southwest Ethiopia is likely generalizable to many other settings that
experience unacceptably low cesarean birth rates. Barriers to proper use of cesarean birth as an intervention to
prevent morbidity and mortality in sub-Saharan Africa include those described by the Three Delays Model: 1) the
delay in the decision to seek care, 2) the delay in reaching appropriate emergency obstetrical care, and 3)
receiving adequate care when the facility is reached. Preliminary data from our target community in Southwest
Ethiopia found that the Three Delays is representative of barriers to accessing cesarean birth, which make it
“virtually impossible” for many women to reach essential emergency obstetric care.
 No intervention has yet determined the most effective way of delivering cesarean birth to rural underserved
and low-resource regions of sub-Saharan Africa, even though the Three Delays model was published 25 years
ago. As such, there is an implementation gap in determining how best to provide cesarean birth in the face of the
Three Delays in vast regions of the African continent. Mobile surgical units have been successfully used in Latin
America to deliver gynecologic surgery and Médecins Sans Frontières provides cesarean birth in surgically
equipped tents in low-resource and war-torn settings. Our overarching hypotheses are: 1) the cesarean birth
surgical disparity in rural Ethiopia can be addressed by the implementation of a novel, mobile community-based
cesarean birth center staffed by mid-level providers, and 2) the pre-implementation methods we will use to
explore (AIM 1), prepare (AIM 2), and design (AIM 2) the center for eventual implementation, dissemination, and
adaptation will be generalizable to other settings and/or surgical disparities in sub-Saharan Africa and potentially
globally. This proposed work will have impact because it studies how best to deliver cesarean birth to regions of
the world that have not ever had access to this life-saving surgery. It will advance knowledge in the field of
implementation science because it studies the pre-implementation of a novel and innovative clinical solution to a
cesarean birth disparity using Exploration and Preparation aspects of the EPIS framework, and implementation
methods that will be generalizable to other settings and conditions where highly innovative, decentralized,
pragmatic solutions may be necessary.

## Key facts

- **NIH application ID:** 10214860
- **Project number:** 1R21HD102720-01A1
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** margo Shawn harrison
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $187,915
- **Award type:** 1
- **Project period:** 2021-03-06 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10214860

## Citation

> US National Institutes of Health, RePORTER application 10214860, Methods for Understanding the Cesarean Birth Surgical Disparity in Rural Ethiopia and Considering a Mobile Cesarean Birth Center as a Solution (1R21HD102720-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10214860. Licensed CC0.

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