More than 40 percent of health facility births in five African countries are taking place in poor-quality facilities with crucial deficiencies in staffing, infrastructure, referral systems, and routine and emergency care practices, according to a new study from Harvard T.H. Chan School of Public Health.

“Our findings suggest that the current strategy of ‘birth at any clinic’ is likely wrong, and that poor quality is undermining the goal of reducing maternal and newborn mortality around the world,” said Margaret Kruk, associate professor of global health at Harvard Chan School and lead author of the study.

Since 2000, when world leaders established eight “Millennium Development Goals” (MDGs) at a United Nations Summit—one of which was to improve maternal health and another to reduce child mortality—low-income countries with high maternal mortality rates have been encouraging women to give birth in nearby health facilities rather than at home. The thinking was that giving birth in a health facility designated to handle deliveries would save women’s and newborns’ lives because birth complications are unpredictable. In practice, many delivery facilities are small primary care clinics offering only basic services.

But preliminary evidence from countries that have dramatically increased facility deliveries, such as India, has suggested that this has not led to reduced maternal and infant mortality. Other evidence, from high-income countries, has suggested that facilities that handle a high volume of births (e.g., more than 500 a year) and that have the capacity to perform cesareans have the highest quality of neonatal and obstetric care.

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