Que Vivan las Madres: An impact evaluation for a novel package of interventions targeting maternal and perinatal health in rural Guatemala

Background: Guatemala has one of the highest maternal mortality ratios in Latin America. While evidence supports a skilled birth attendant at delivery for improving pregnancy outcomes, only 52% of births are attended by skilled health personnel. Despite investment in 24-hour labor and delivery units, improvements in maternal and perinatal outcomes remain slow. The objective of this study is to measure the impact of a package of three interventions on perinatal mortality and maternal morbidity in Northern Guatemala.

Methods: We conducted a matched-pair cluster randomized control trial in four rural districts. Inclusion criteria was: 24-hour staffing, no operating room, at least 7 births per month, TBA in the community, and less than six-hours from the district commercial center.   Thirty clinics were matched on district, perinatal mortality, and delivery volume, and then randomized to the intervention or control group. The interventions included: PRONTO training course, a social marketing campaign, and the introduction of a professional midwife liaison between clinics and TBAs. Data was collected at baseline, during implementation, and for one-year follow-up. The primary outcomes were: change in perinatal mortality; change in maternal morbidity; and change in proportion of institutional births.

Results: Outcome data from 17,302 obstetric events were collected over eighteen-months of the study.  Using a difference-in-difference approach, a 9.4% increase in births was recorded at intervention facilities compared with control facilities (95% CI: 1.3, 18.3; p: 0.022).

Discussion: Improving maternal and perinatal outcomes requires complex approaches.  This project developed a package of diverse, innovative interventions and preliminary evidence shows impact.