The WHO ACTION-I trial makes clear that there are many areas in low- and middle-income countries where antenatal glucocorticoids can be prescribed safely and effectively. Facilities that meet the clinical standards of the trial sites (or to which resources could be provided to meet these standards) should use them.
The investigators of ACT, which was conducted in sub-Saharan Africa, South Asia, and Latin America, used a pragmatic, cluster-randomized design to assess whether antenatal dexamethasone could be safely and effectively administered in community and primary care settings where access to obstetricians and neonatal intensive care was limited.