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Matern Child Health J. 2018 Nov 14. doi: 10.1007/s10995-018-2642-7. [Epub ahead of print]

Availability of Safe Childbirth Supplies in 284 Facilities in Uttar Pradesh, India.

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Ariadne Labs | Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA, 02118, USA.
Northwestern Feinberg School of Medicine, Chicago, IL, USA.
IKS Health, Mumbai, Maharashtra, India.
Population Services International, Delhi, India.
Population Services International, Washington, D.C., USA.
Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India.
Community Empowerment Lab, Lucknow, Uttar Pradesh, India.
Ariadne Labs | Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor East, Boston, MA, 02118, USA.
Harvard Medical School, Boston, MA, USA.
Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA.


Objectives Vital to implementation of the World Health Organization (WHO) Safe Childbirth Checklist (SCC), designed to improve delivery of 28 essential birth practices (EBPs), is the availability of safe birth supplies: 22 EBPs on the SCC require one or more supplies. Mapping availability of these supplies can determine the scope of shortages and need for supply chain strengthening. Methods A cross-sectional survey on the availability of functional and/or unexpired supplies was assessed in 284 public-sector facilities in 38 districts in Uttar Pradesh, India. The twenty-three supplies were categorized into three non-mutually exclusive groups: maternal (8), newborn (9), and infection control (6). Proportions and mean number of supplies available were calculated; means were compared across facility types using t-tests and across districts using a one-way ANOVA. Log-linear regression was used to evaluate facility characteristics associated with supply availability. Results Across 284 sites, an average of 16.9 (73.5%) of 23 basic childbirth supplies were available: 63.4% of maternal supplies, 79.1% of newborn supplies, and 78.7% of infection control supplies. No facility had all 23 supplies available and only 8.5% had all four medicines assessed. Significant variability was observed by facility type and district. In the linear model, facility type and distance from district hospital were significant predictors of higher supply availability. Conclusions for Practice In Uttar Pradesh, more remote sites, and primary and community health centers, were at higher risk of supply shortages. Supply chain management must be improved for facility-based delivery and quality of care initiatives to reduce maternal and neonatal harm.


Childbirth; Commodities; Equipment; Essential birth practices; Quality improvement; Supply


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