From Counting Contacts to Making Contacts Count: Analyses of Facility-Based Maternal and Newborn Care Quality

Abstract

Global commitment to the Sustainable Development Goals to improve maternal and newborn health is premised on and motivated by the understanding that universal health coverage of comprehensive, high quality maternal health services could be a path towards improved maternal and newborn health. This has propelled scientific inquiry towards understanding and improving the quality of facility-based maternal and newborn care globally. This dissertation assesses the trends in quality of maternal and newborn care across several low- and middle-income countries (LMICs), as well as the impact of poor quality of care on maternal health outcomes. This dissertation is guided by the World Health Organization (WHO) framework for quality of care for pregnant women and newborns and comprises of three distinct empirical studies on quality of facility-based maternal and newborn care. The first study uses a nationally representative sample of public health facilities at the district level across India to explore the public health system’s capacity for basic delivery and newborn services. The second study assesses socioeconomic disparities in access to high quality maternal care in Kenya by combining a nationally representative health system assessment with population-representative demographic data to describe and quantify the geographic distribution of poverty and maternal care quality. The third, and final, study examines the relationship between quality of care during childbirth and severe maternal outcomes using a large cross-sectional survey of over 300,000 births across 357 health facilities in 29 countries in Africa, Asia, Latin America and the Middle East. These studies use innovative approaches and underutilized data sources to extend empirical methods for studying quality of maternal and newborn care to ultimately monitor quality improvement and make progress towards meeting the global goals for reducing the burden of poor maternal and newborn health. The results underscore the need to generate context-specific evidence in LMICs to monitor and improve quality of care for mothers and newborns, and to target programs to reach health facilities with poor quality and health outcomes.