Increasing access to and utilization of health care services is not sufficient for improving maternal health outcomes. The quality of care a woman receives during pregnancy, delivery and postpartum affects her health, the health of her child and the likelihood that she will seek care in the future.
High quality care should be:
- Safe—delivering health care which minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors
- Effective—providing services based on scientific knowledge and evidence-based guidelines
- Timely—reducing delays in providing and receiving health care
- Efficient—delivering health care in a manner that maximizes resource use and avoids waste
- Equitable—delivering health care that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status
- People-centered—providing care which takes into account the preferences and aspirations of individual service users and the cultures of their communities
Measuring quality is the first step towards improving it, but measurement can be challenging given the complex and interconnected aspects of women’s experiences with the maternal health care system. The availability of infrastructure and supplies, the health care workers’ level of training, the provider-patient relationship and many other factors affect the quality of care a woman receives, and some of these elements are more easily measurable than others. Research teams have proposed different ways of capturing quality of antenatal, intrapartum and postpartum care. However, many indicators that researchers currently use to measure quality have not been validated in various global settings, begging the question: How much do we really know about the quality of maternal health care around the world?
Survey-based studies have demonstrated wide variation in health facilities’ capacity to deliver basic maternity services and manage obstetric complications: In sub-Saharan Africa, only one out of every ten health facilities providing maternity care is able to perform cesarean sections, and often times those facilities operate without essential infrastructure such as electricity or a safe water source. Qualitative studies have illustrated the high prevalence of disrespect and abuse during facility-based childbirth, including instances of women being scolded, abandoned and even physically beaten by health care staff. Numerous papers have discussed, measured and analyzed skilled birth attendance as an indicator of quality, contributing to an ongoing dialogue about who is capable of providing high quality maternity care and where those deliveries should take place. There have also been efforts to measure and improve the quality of antenatal and postnatal care.
Designing interventions to improve quality of care requires a better understanding of the factors that matter most to women and the ability to accurately measure those factors. Addressing the challenges faced by frontline providers, health policy makers and program implementers trying to improve maternal health is also key. Continuing the global dialogue on quality of maternal health care is crucial for answering some of the most pressing questions:
- What are the best strategies for accurately measuring quality of maternal health care?
- In what ways might high quality care look different across diverse sociocultural settings?
- How does the WHO definition of quality of care compare to the real-life experiences of women receiving maternity care services?
- What kind of programs, policy changes and other interventions are most effective for addressing issues of quality?
The Maternal Health Task Force (MHTF) strives to ensure that the global maternal health community is well-informed and equipped to tackle these difficult questions and work together to improve the health and wellbeing of women, mothers and newborns around the globe.
- Standards for improving quality of maternal and newborn care in health facilities
World Health Organization | August 2016
- Time for a quality revolution in global health
The Lancet | September 2016
- Quality of care for pregnant women and newborns—the WHO vision
BJOG | July 2015
- Approaches to improve the quality of maternal and newborn health care: An overview of the evidence
Reproductive Health | September 2014
- The quality–coverage gap in antenatal care: Toward better measurement of effective coverage
Global Health Science and Practice| May 2014
- Quality of basic maternal care functions in health facilities of five African countries: An analysis of national health system surveys
The Lancet Global Health | November 2016
- Consultation on improving measurement of the quality of maternal, newborn and child care in health facilities
World Health Organization | 2014
- Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross-sectional study
The Lancet | May 2013
- Quality care during labour and birth: A multi-country analysis of health system bottlenecks and potential solutions
BMC Pregnancy and Childbirth | September 2015
- What prevents quality midwifery care? A systematic mapping of barriers in low- and middle-income countries from the provider perspective
PLOS One | May 2016
- Crossing the quality chasm: A new health system for the 21st century
Institute of Medicine, U.S. | 2001
Documents & Reports
- COPE® Client-Oriented, Provider-Efficient Services | EngenderHealth
- Essential Obstetric and Newborn Care Toolkit | USAID Maternal and Child Health Integrated Program (MCHIP)
- Improving Quality of Postpartum Family Planning in Low-Resource Settings: A Framework for Policy Makers, Managers, and Medical Care Providers | USAID ASSIST Project
- Maternal Infant and Young Child Nutrition and Family Planning (MIYCN-FP) Integration Toolkit | MIYCN-FP Technical Working Group
- Needs Assessment of Emergency Obstetric and Newborn Care: Data Collector’s Manual | Averting Maternal Death and Disability
- Optimizing Health Worker Roles for Maternal and Newborn Health Through Task Shifting | Word Health Organization
- Private Maternity Care Quality Toolkit (PMC-QT) | Merck for Mothers
- WHO Safe Childbirth Checklist | World Health Organization
- Improving Care of Mothers and Babies: A Guide for Improvement Teams | American Academy of Pediatrics
In partnership with Argentina’s Institute for Clinical Effectiveness and Health Policy, the MHTF developed the Obstetric Emergency Drills Training Kit to help providers around the world prepare for and more effectively manage obstetric emergencies such as postpartum hemorrhage and pre-eclampsia/eclampsia.
In 2016, the MHTF supported the launch of The Lancet Maternal Health Series, which focuses on quality of maternal health care around the world.
In 2011, the MHTF partnered with the Public Library of Science (PLOS) to publish a collection of perspectives and original research on the quality of global maternal health care.
- Adding Content to Contact
- Addressing Maternal Health Disparities in India
- Hansen Project on Maternal and Child Health
- Quality of Antenatal Care in Nigeria
- Strengthening the Maternal Health Care System in Ethiopia
- Validation of the Skilled Birth Attendant (SBA) Indicator
Meetings & Events
In April 2017, as a part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted a panel discussion at the Woodrow Wilson Center that focused on over-intervention in maternity care, a key issue related to maternal health care quality.
In September 2014, the MHTF hosted a technical meeting to discuss maternal newborn health integration and quality.
In June 2014, as a part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted a panel discussion at the Woodrow Wilson Center to examine innovative models for delivering high quality antenatal care.
Blog series: Quality of Maternal Health Care