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Operations Research Studies Examine Determinants of Quality Maternal and Newborn Care
by Lani Marquez


Although deaths during labor, delivery, and the post-partum period represent a large proportion of maternal and infant deaths in developing countries, surprisingly little is known about the multitude of factors that support or hinder the quality of care provided to mothers and newborns during birth. For example, a wide variety of factors can affect the performance of health workers attending births, be they doctors, nurses, or midwives. These factors include provider competence and motivation, training, compliance with evidence-based standards, supervision, patient characteristics, and availability of equipment, drugs, and supplies. 

In support of the U.S. Agency for International Development’s Strategic Objective for maternal and newborn mortality reduction, the QA Project recently completed data collection in a multi-country research effort to analyze the factors that support or hinder the quality of care given during labor, delivery and postpartum in health facilities. The study was carried out in Benin, Ecuador, Jamaica, and Rwanda.

The maternal and newborn care research encompassed three studies. The first study measured the competence of skilled birth attendants, using mannequins to verify skills in critical patient care procedures and a written test (derived from internationally recognized sources, such as the World Health Organization) to measure knowledge

Key study findings highlighted at the conference were:

o  The quality of postpartum maternal care is much lower  than quality in other phases of birth and is also more highly variant across countries.

o  Certain delivery and postpartum tasks are rarely performed to standard, including hand washing, active management of the third stage of labor, checking mother’s postpartum temperature, and putting baby in skin-to-skin contact with mother.

o  Monitoring during labor and of newborns is erratic and in need of improvement.

o  Delays in diagnosis and treatment once a woman arrived at a facility were due to many factors, including personnel not available, missed or incorrect diagnosis, and lack of drugs or equipment.

o  Certain simple lifesaving skills for managing obstetric emergencies are rarely taught and rarely performed. Many lives might be saved if these procedures were more widely used.

The second study examined the relationships between enabling environmental factors––elements other than knowledge and skills that influence how a trained birth attendant provides care––and performance during labor, delivery, and immediate postpartum care. The enabling factors studied included availability of supplies, drugs, and equipment; existence of appropriate standards and policies; supervision; availability of job aids; and the way services were organized to facilitate or impede the delivery of good care.

The third study developed and tested a method for measuring delays in the treatment of selected obstetrical emergencies within health care facilities. Emergencies addressed included eclampsia/pre-eclampsia, sepsis, obstructed labor, postpartum hemorrhage, and post-abortion complications. The study gathered data through observations in obstetrical wards and emergency rooms and review of records on obstetrical emergencies.

While data analysis is still underway, preliminary results from the three studies were presented at the international conference on maternal health best practices, “Saving Mothers Lives: What Works,” held October 3-5, 2002, in New Delhi, India. Presenters included Dr. Affette McCaw-Binns, study collaborator from the University of the West Indies in Mona, Jamaica; Dr. Sourou Gbangbade, an Obstetrician/Maternal Health specialist from Benin; and Steven Harvey of the QA Project.

The conference was sponsored by the White Ribbon Alliance for Safe Motherhood, a group of organizations and individuals dedicated to raising international awareness about the need to make pregnancy and childbirth safe for all women and infants. 

For more information on the maternal and neonatal care studies, contact the QA Project’s Director of Operations Research, Bart Burkhalter. For more information on the New Delhi conference, link to the conference website at: http://www.whiteribbonalliance-india.org/confhome.htm.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.