Mobile Community Childbirth Checklist (mCommCC) for mothers and layperson referral gatekeepers: danger sign recognition, emergency preparedness, and linkages to skilled care

In Bangladesh, 77% of births occur outside a facility and 72% without a skilled attendant. When maternal or neonatal complications occur, <40% of women seek care, mainly due to misunderstanding of complication severity and/or necessity for referral; relatives or neighbours are the primary referral sources. Antenatal care coverage and logistical preparation for childbirth emergencies are also poor. An intervention to empower mothers and layperson referral gatekeepers to overcome these logistical, knowledge, communication gaps is urgently needed.

Our proposed approach is the Mobile Community Childbirth Checklist (mCommCC), which mothers and layperson birth companions will access in the intrapartum and early neonatal periods. Checklist tasks are drawn from WHO Mother Baby mCheck tool and Home-Based Lifesaving Skills Take Action Cards. The mobile phone system (technology) employs text and audio reminders to encourage progress-specific safety checks, Interactive Voice Response for danger sign recognition and corresponding action steps (creating demand), and direct communication linkages with live skilled care guidance (improving service delivery).

The mCommCC intervention will actively increase timely and appropriate skilled care seeking in the event of suspected maternal or neonatal complications. This will, in turn, reduce preventable serious maternal and neonatal morbidity and mortality.

Most standard practices to increase skilled care utilization focus on mobilizing skilled healthcare workers to reach all delivering mothers, which is expensive and difficult in resource-poor settings. The mCommCC empowers mothers and layperson birth companions themselves to seek and link with skilled care, using a cheap, familiar and accessible technology.