Evidence map›Paper›PMID 29236628›Full record

Trial reportThe New England journal of medicine2017

Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India.

Katherine E A Semrau, Lisa R Hirschhorn, Megan Marx Delaney, Vinay P Singh, Rajiv Saurastri, Narender Sharma, Danielle E Tuller, Rebecca Firestone, Stuart Lipsitz, Neelam Dhingra-Kumar and 4 more

Registry-linked trialAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02148952 (A Matched-pair, Cluster Randomized Trial to Measure the Efficacy of the WHO Safe Childbirth Checklist Program on Severe Maternal, Fetal and Newborn Harm), which is not on this map. Cited by 151 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
151citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02148952 nacompletednot on this map

A Matched-pair, Cluster Randomized Trial to Measure the Efficacy of the WHO Safe Childbirth Checklist Program on Severe Maternal, Fetal and Newborn Harm

TypeinterventionalSponsorHarvard School of Public Health (HSPH)Ran2014 to 2017Enrolled157,689ConditionsMaternal Death, Maternal Morbidity, Stillbirth, Neonatal DeathArmsWHO Safe Childbirth Checklist Program
3 · Its place in the literature

Who cites it

151 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Impact of the WHO safe childbirth checklist on birth attendant behavior and maternal-newborn outcomes: A systematic review and meta-analysis.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
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  14. Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2020
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91 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Katherine E A SemrauFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Lisa R HirschhornFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Megan Marx DelaneyFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Vinay P SinghFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Rajiv SaurastriFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Narender SharmaFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Danielle E TullerFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Rebecca FirestoneFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Stuart LipsitzFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Neelam Dhingra-KumarFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Bhalachandra S KodkanyFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Vishwajeet KumarFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
Atul A GawandeFrom Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Department of Medicine, Harvard Medical School (K.E.A.S.), and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health (A.A.G.) - all in Boston; Feinberg School of Medicine, Northwestern University, Chicago (L.R.H.); Population Services International (V.P.S., R.S., N.S.) and the Community Empowerment Lab (V.K.), Lucknow, and Jawaharlal Nehru Medical College, Belgaum (B.S.K.) - all in India; Population Services International, Washington, DC (R.F.); and the World Health Organization, Geneva (N.D.-K.).
BetterBirth Trial Group

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThe prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes.

methodsWe conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention.

resultsOf 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P<0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes.

conclusionsBirth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).

Indexed as

ChecklistMidwiferyAdultChi-Square DistributionDelivery, ObstetricFemaleGuideline AdherenceHumansIndiaInfant, NewbornIntention to Treat AnalysisMaternal MortalityOutcome Assessment, Health CarePerinatal MortalityPregnancyPuerperal Disorders

Identifiers

PMID29236628
PMCPMC5672590

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.