Safe Motherhood and Quality of Care
This domain asks how systems, not only individuals, save mothers: emergency obstetric care, referral, audit and respectful treatment.
Emergency obstetric care
Basic EmONC has seven signal functions: parenteral antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products, assisted vaginal birth and newborn resuscitation. Comprehensive care adds caesarean section and blood transfusion. Readiness is judged by 24-hour availability, not by equipment standing in a cupboard.
Referral and the three delays
Delay in deciding to seek care, in reaching care, and in receiving care. In Mongolia's dispersed settlements, distance, weather and transport drive the second delay; maternity waiting homes, pre-booked transport and a written birth plan reduce it.
Quality and respectful care
Quality has two halves: provision, meaning safe evidence-based care, and experience, meaning dignity, privacy, companionship and clear communication. Mistreatment - shouting, slapping, neglect, detention for non-payment - is a quality failure and a rights violation, not a personality problem.
Audit and review
Maternal death surveillance and response, near-miss review and clinical audit identify avoidable factors. A good audit finds system causes, not a name to blame.
Worked example
An audit shows 40% of severe pre-eclampsia cases received no magnesium sulfate before referral. Reasoning: the remedy is not a lecture but a supply and protocol change - stock magnesium sulfate at soum level, add it to the referral checklist, train and drill staff, then re-audit the same indicator.
Traps
Equating quality with new buildings; blaming individuals for system gaps; and measuring only clinical outputs while ignoring how women were treated.