Competent and defcient provision of childbirth services: a descriptive observational study assessing the quality of intrapartum care in two provinces of the Democratic Republic of the Congo

Background: A majority of women in the Democratic Republic of the Congo (DRC) give birth in a health facility, but maternal and newborn mortality remains high. In rural areas, the quality of facility-based delivery care is often low. This study examines clinical quality of intrapartum care in two provinces of the DRC.

Methods: We observed process and input elements of delivery care provision at 29 facilities in Kwilu and Kwango provinces. Distinguishing non-performance attributable to provider behavior vs. input constraints, we compared both providers’ adherence to clinical standards (“competent care”) and non-adherence to processes for which required inputs were available (“defcient care”).

Results: Observing a total of 69 deliveries, care was most competent for partograph use (75% cases) and hemorrhage  revention (73%), but least for postpartum monitoring (4%). Competent care was signifcantly associated with higher case volumes (p=·03), skilled birth attendance (p=·05), and nulliparous women (p=·02). Care was most defcient for infection prevention (62%) and timely care (49%) and associated with cases observed at hospitals and lower delivery volume.

Conclusions: Low quality was commonly not a result of missing equipment or supplies but related to providers’ nonadherence to standard protocols. Low case volumes and the absence of skilled attendants seemed to be main factors for sub-standard quality care. Birth assistance during labor stage 2 was the only intrapartum stage heavily affected by the unavailability of essential equipment. Future interventions should strengthen links between birth attendants’ practice to clinical protocols.