This report synthesizes lessons learned and offers global recommendations from the BetterBirth Study for policy makers, program designers, implementers, and health system leaders. BetterBirth, one of the largest studies ever conducted in maternal and newborn health, used a scalable intervention targeting the seven leading causes of maternal and newborn mortality during facility-based childbirth. The study, which took place from 2014 to 2017 in 120 frontline facilities in Uttar Pradesh, India, focused on an eight-month peer-coaching-based program to implement the World Health Organization (WHO) Safe Childbirth Checklist. Researchers found that the BetterBirth implementation of the Checklist, coupled with coaching and data feedback, improved adherence to essential birth practices. Yet, these improvements did not reduce overall maternal and perinatal mortality in primary-level facilities.
During 2018, more than 200 million data points from more than 157,000 women study participants and their newborns were analyzed. The goal was to discover ways to improve facility-based childbirth care to lower morbidity and mortality. Researchers found there is no magic bullet—no individual clinical practice correlated with better outcomes. Rather, lower mortality correlated with an increased number of completed essential birth practices, regardless of which practices were done.
However, they found even this was insufficient to drive the change required to save lives at scale. Improving individual birth attendant performance was not enough. To deliver the comprehensive bundle of essential birth practices and achieve sustained outcomes, birth attendants should be supported by a health system that is integrated, cohesive, and seamless.
The BetterBirth data provide an evidence base for key strategies needed at all levels of the facility-based childbirth ecosystem: birth attendants, facilities, health systems, and women and their communities. The following recommendations from the BetterBirth experience offer a path to high-quality, person-centered childbirth care around the world.