Background: Although maternal and newborn mortality have decreased 44
and 46% respectively between 1990 and 2015, achievement of ambitious
Sustainable Development Goal targets requires accelerated progress.
Mortality reduction requires a renewed focus on the continuum of
maternal and newborn care from the household to the health facility.
Although barriers to accessing skilled care are documented for specific
contexts, there is a lack of systematic evidence on how women and
families identify maternal and newborn illness and make decisions and
subsequent care-seeking patterns. The focus of this multi-country study
was to identify and describe illness recognition, decision-making, and
care-seeking patterns across various contexts among women and newborns
who survived and died to ultimately inform programmatic priorities
moving forward. Methods: This study was conducted in seven
countries\u2014Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia,
and Nepal. Mixed-methods were utilized including event narratives
(group interviews), in-depth interviews (IDIs), focus group discussions
(FDGs), rapid facility assessments, and secondary analyses of existing
program data. A common protocol and tools were developed in
collaboration with study teams and adapted for each site, as needed.
Sample size was a minimum of five cases of each type (e.g., perceived
postpartum hemorrhage, maternal death, newborn illness, and newborn
death) for each study site, with a total of 84 perceived PPH, 45
maternal deaths, 83 newborn illness, 55 newborn deaths, 64 IDIs/FGDs,
and 99 health facility assessments across all sites. Analysis included
coding within and across cases, identifying broad themes on recognition
of illness, decision-making, and patterns of care seeking, and
corresponding contextual factors. Technical support was provided
throughout the process for capacity building, quality assurance, and
consistency across sites. Conclusion: This study provides rigorous
evidence on how women and families recognize and respond to maternal
and newborn illness. By using a common methodology and tools, findings
not only were site-specific but also allow for comparison across
contexts