Making childbirth safer in Indonesia

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Indonesian Community Health Center providing maternal and neonatal care (image p
Indonesian Community Health Center providing maternal and neonatal care (image predates pandemic) Photo: Masyitah Saifuddin
Study led by Göttingen and Syiah Kuala Universities finds Safe Childbirth Checklist contributes to improved maternal and neonatal healthcare Every year, 295,000 maternal deaths, 2 million stillbirths, and 2.5 million neonatal deaths occur worldwide. Improved quality of care could prevent the majority of those deaths. For this reason, the World Health Organization (WHO) introduced a Safe Childbirth Checklist (SCC), targeting ways to improve the quality of care. An international research team from Göttingen University, Syiah Kuala University, Indonesia, and Heidelberg University adapted the intervention to meet local needs, collected data and analysed the Checklist’s effects on quality of care and mortality in 32 health facilities in Indonesia. Their results were published in JAMA Network Open.

The researchers found that using the Safe Childbirth Checklist (SCC) increased the communication of danger signs, improved the way that babies were fed, and increased the number of times temperature was measured in neonates. In particular, midwives carried out adequate measurement of temperature in less than half of the births in health facilities without the Checklist. Most noticeably, the results suggest that in facilities where staff use the SCC more frequently, stillbirth rates decreased.

To assess the SCC’s effectiveness, the WHO invited practitioners and academics to evaluate it in different contexts. Thirty-five countries around the globe are now using the tool. The international research team led by the University of Göttingen and Syiah Kuala University joined this worldwide collaboration to examine the effects of the SCC in Indonesia.

Joint first author Farah Diba, Syiah Kuala University, emphasizes: -Using the Safe Childbirth Checklist increases the communication in the ward with the mothers and other healthcare providers, leading to an improvement in the quality of care.- Yet, ensuring long-term adherence to the quality improvement tool remains a challenge. "While results are promising, future research is needed to understand what factors can support midwives in using the Safe Childbirth Checklist and what barriers remain to ensuring a healthy pregnancy and birth," says Dr Lennart Kaplan, postdoctoral researcher at the University of Göttingen and joint first author of the study.

Original publication: Kaplan et al, -Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia. A Cluster-Randomized Clinical Trial-, JAMA Network Open, 2021.