Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America

South Africa is classified as a low-and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia prac-titioners in resource-limited environments.In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future.In China, improvements in women's reproductive, maternal, neonatal, child, and adolescent health are crit-ical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented atten-tion. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues.The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world's regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia.Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American health-care. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.

Automated summary

South Africa is a low- and middle-income country with a mix of resource-rich and resource-limited settings. The skill level of anaesthesia practitioners varies, with major referral hospitals having higher skill levels compared to resource-limited environments.