Boston, MA Harvard School of Public Health (HSPH) has been awarded a $14.1 million, four-year grant from the Bill & Melinda Gates Foundation to test the effectiveness of an innovative checklist-based childbirth safety program in reducing deaths and improving outcomes of mothers and infants in 120 hospitals in India. The program was developed by the World Health Organization (WHO) and HSPH.
Atul Gawande, associate professor in health policy and management at HSPH and a surgeon at Brigham and Women's Hospital, Boston, and co-principal investigator Jonathan Spector, research associate in health policy and management at HSPH and a neonatologist at Massachusetts General Hospital, Boston, are leading the BetterBirth clinical trial. The study will evaluate the impact of the WHO Safe Childbirth Checklist program at hospitals in Uttar Pradesh, India.
Of 130 million births annually in the world, nearly 350,000 result in the mother's death, 1 million in intrapartum stillbirth, and another 3.1 million in infant death during the neonatal period. Most deaths occur within 24 hours of delivery. In Uttar Pradesh the mortality rate for women giving birth is estimated at 440 per 100,000 births, vs. 254 per 100,000 births in the country as a whole. (By comparison, the maternal mortality ratio in the United States is 13 per 100,000 births.) Uttar Pradesh is one of India's least developed states, with 31% of its 190 million people living in poverty.
"To reduce these deaths, pregnant women are increasingly encouraged to deliver in health facilities instead of at home. But success requires a basic standard of care that is often missing," Gawande said. "At times, the problem is inadequate resources, but often the issue is a lack of handwashing or screening for use of available antibiotics. We designed a simple strategy to help facilities upgrade their performance."
The HSPH team worked with the WHO Departments of Patient Safety, Reproductive Health and Research, a
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Harvard School of Public Health