Good outcomes during pregnancy and childbirth are related to availability, utilization and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth.
This article describes the findings of an analysis in 12 countries in Africa and Asia to synthesize and grade health system “bottlenecks”, or factors that hinder the scale up, of maternal-newborn intervention packages. Health financing and health workforce were critical bottlenecks for skilled birth attendance. Health service delivery bottlenecks were the most critical for both basic and comprehensive emergency obstetric care. Health financing was a critical bottleneck for comprehensive emergency obstetric care. Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, solutions included improving quality of care and establishing public private partnerships.