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Why So Many Newborns and Mothers Still Die

To improve quality of care before, during, and after childbirth, the global health community must develop new, evidence-backed interventions that address the underlying – often hidden – reasons why health-care providers fail to take the necessary steps. The first step is to identify what those reasons are.

WASHINGTON, DC – Wash hands? Check. Monitor heart rate? Check. Prepare essential supplies? Check. These might seem like obvious steps for medical professionals to take while delivering a child. But lapses in care remain one of the leading causes of preventable patient deaths in low- and middle-income countries, and initiatives aimed at addressing the problem are not working.

One such initiative focuses on creating a checklist for birth attendants to consult. But in a multiyear, multimillion-dollar randomized controlled trial conducted in northern India in 2017, the use of the World Health Organization’s Safe Childbirth Checklist, together with coaching on its implementation, did not improve outcomes for babies or their mothers.

Even if a childbirth checklist has some potential benefits, it amounts to an insufficient basis for efforts to address the scourge of high infant and maternal mortality. And yet, as a report in the British medical journal The Lancet shows, such micro-level interventions – including direct mentoring of providers – constitute 72% of all strategies for improving the quality of primary care globally. Although such micro-level interventions can help to improve local commitment to quality, “people tend to revert to entrenched ways of doing things, especially when surrounding systems do not support transformation.” The focus on micro-level interventions alone can even be detrimental, as such measures consume limited time and resources.

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