Meeting women’s needs at birth through companionship: Improving the implementation evidence on context, processes and effect in low and middle-income countries

Every day approximately 810 women die as a result of preventable causes related to pregnancy and childbirth and approximately 7,000 newborn deaths every day, about one third on the day of birth.

World Health Organization recommends women having a companion of their choice at birth to improve quality of care, improve birth outcomes and reduce unnecessary interventions including caesarean section.

Companionship also has the potential to reduce mistreatment during childbirth.Companionship is not universally implemented in Low- and Middle-income Countries.

Policies and institutional structures do not support implementation and understanding of different implementation models for different contexts and cost are limited.

We aim to:Evaluate the processes of implementing companionship models in eight hospitals and the effect of training health providers on the implementation of companionshipEstablish the readiness of 48 hospitals within eight countries to implement companionshipAssess the effects of companionships on the mode of delivery, experiences of care including mistreatment, and understand the perspectives of companionsEstimate the costs of implementation and potential scale-up of different models of companionshipWe will use a mixed-methods process evaluation to address aim 1, qualitative and quantitative data for aim 2, cross-sectional data for aim 3, and the ingredients approach and expenditure approach for aim 4.

We will also engage health providers and key stakeholders.