Mother−baby friendly birthing facilities

Although the global maternal mortality ratio (MMR) is declining, few lowand middle-income countries (LMICs) are on track to meet Millennium Development Goal 5 by 2015. An unacceptable inequity exists for birthing women related to where they give birth, with women in LMICs dying at far higher rates than women in more developed settings. Themajority ofmaternalmortality reduction programs encourage facility birthwith skilled providers [1], including conditional cash transfers and othermethods/strategies to improve facility-based delivery rates [2]. However, many facilities, particularly in LMICs are overcrowded, understaffed, and have few resources. Women often choose to avoid facilities because of abuse, coercion, or neglect [3]. Recently there has been increasing focus among international and national organizations on examining the quality of care, abuse/neglect of women in facilities during childbirth, and the lack of professional and social accountability among facility-based providers of care [4–8]. Evidence collected in a variety of settings has documented that the quality of care is related to the quality of maternal and newborn health outcomes, including mortality [4,9,10]. Miller et al. [11] noted that paradoxically high rates ofmaternalmortality persisted in the Dominican Republic, despite 98% facility delivery by skilled attendants. The results of the study demonstrated that the lack of quality care and accountability was at the root of unnecessary maternal deaths [11]. A recent review series on quality of maternal and newborn care found that improving access to facilities did not guarantee improved maternal outcomes, and posited that poor quality of care was the most likely explanatory factor [12]. A 2013 publication explored a study protocol to promote respectful maternity care and reduce disrespect and abuse [13], while Althabe et al. [14] demonstrated, in a systematic review, strategies for improving quality of care in maternal and child health. International agencies such as the World Health Organization (WHO), White Ribbon Alliance (WRA), and the International MotherBaby Childbirth Initiative