Title:
Assessing the Quality of Obstetric Care During Labor: A Literature Review of Tools in Low- and Middle-Income Countries
Authors:
Kumari, Versha
Place:
Amsterdam, The Netherlands
Publisher:
KIT - Royal Tropical Institute [etc.]
Year:
2025
PAGE:
vii, 39
Language:
En
Subject:
Maternal Health – Lessons Learned
Keywords:
Quality of Care, Labor Care, Obstetric Care, Quality Assessment Tools, LMICs
Abstract:
Despite significant gains in facility-based births and skilled birth attendance in low- and middle-income countries (LMICs), maternal mortality remains unacceptably high, with the majority of deaths occurring during labor and the immediate postpartum period. Quality gaps, both in clinical processes and women’s experiences of care persist as major contributors. This thesis presents a structured literature review of tools designed to assess the quality of obstetric care during labor in LMICs, using an adapted WHO Quality of Care framework for labor and childbirth. Five tools were analyzed: the WHO Safe Childbirth Checklist (SCC), WHO Labour Care Guide (LCG), Person-Centered Maternity Care (PCMC) scale, Every Mother Every Newborn (EMEN) tool, and the Quality of Process Indicators for Intrapartum and Immediate Postpartum Care (QoPIIPC) index. Each was evaluated for alignment with WHO standards and appraised for feasibility, adaptability, and acceptability, drawing on empirical implementation evidence. Findings revealed that SCC, EMEN, and QoPIIPC excelled in measuring clinical quality, whereas PCMC uniquely captured women’s perspectives on dignity, communication, and autonomy. The LCG attempted to bridge clinical and experiential domains, with promising results in improving decision-making and reducing unnecessary interventions, though sustained use depended on training and supportive supervision. Across tools, alignment with WHO standards was stronger for clinical than experiential care, with emotional support, continuous companionship, and shared decision-making often neglected in practice. No single tool provided a comprehensive assessment of both clinical and experiential quality. Integration of clinical process measures with respectful, person-centered care indicators supported by context-specific adaptation, provider engagement, and community involvement is essential for advancing maternal health outcomes. Policymakers and implementers in LMICs should prioritize development and institutionalization of holistic, feasible tools that can drive continuous quality improvement during labor.
Organization:
KIT - Royal Tropical Institute, VU - Vrije Universiteit Amsterdam
Institute:
KIT (Royal Tropical Institute)
Country:
Low-and Middle-Income Countries (LMICs)
Training:
Master of Science in Public Health and Health Equity
Category:
Research
Right:
@ 2025 Kumari
Document type:
Thesis/dissertation
File:
efQfy76koz_20251216131649711.pdf