BackgroundThe majority of births in Mexico take place in a health facility and are attended by a skilled birth attendant, yet maternal mortality has not declined to anticipated levels. Coverage estimates of skilled attendance and other maternal and newborn interventions often rely on women’s self-report through a population-based survey, the accuracy of which is not well established.MethodsWe used a facility-based design to validate women’s report of skilled birth attendance, as well as other key elements of maternal, newborn intrapartum, and immediate postnatal care. Women’s reports of labor and delivery care were collected by exit interview prior to hospital discharge and were compared against direct observation by a trained third party in a Mexican public hospital (n = 597). For each indicator, validity was assessed at the individual level using the area under the receiver operating curve (AUC) and at the population level using the inflation factor (IF).ResultsFive of 47 indicators met both validation criteria (AUC > 0.60 and 0.75 < IF < 1.25): urine sample screen, injection or IV medication received during labor, before the birth of the baby (i.e., uterotonic for either induction or augmentation of labor), episiotomy, excessive bleeding, and receipt of blood products. An additional 9 indicators met criteria for the AUC and 18 met criteria for the IF. A skilled attendant indicator had high sensitivity (90.1 %: 95 % CI: 87.1–92.5 %), low specificity (14.0 %: 95 % CI: 5.8–26.7 %) and was suitable for population-level estimation only.ConclusionWomen are able to give valid reports on some aspects of the content of care, although questions regarding the indication for interventions are less likely to be known. Questions that include technical terms or refer to specific time periods tended to have lower response levels. A key aspect of efforts to improve maternal and newborn health requires valid measurement of women’s access to maternal and newborn health interventions and the quality of such services. Additional work on improving measurement of population coverage indicators is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1047-0) contains supplementary material, which is available to authorized users.

Maternal mortality among indigenous women in Guatemala is high. To reduce deaths during transport from far-away rural communities to the hospital, maternity waiting homes (MWH) were established near to hospitals where women with high-risk pregnancies await their delivery before being transferred for labour to the hospital. However, the homes are under-utilised. We conducted a qualitative study with 48 stakeholders (MWH users, family members, community leaders, MWH staff, Mayan midwives and health centre and hospital medical staff) in Huehuetenango and Cuilco to identify barriers before, during and after the women's stay in the homes. The women most in need - indigenous women from remote areas - seemed to have least access to the MWHs. Service users' lack of knowledge about the existence of the homes, limited provision of culturally appropriate care and a lack of sustainable funding were the most important problems identified. While the strategy of MWHs has the potential to contribute to the prevention of maternal (as well as newborn) deaths in rural Guatemala, they can only function effectively if they are planned and implemented with community involvement and support, through a participatory approach.

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We conducted a qualitative study to explore responses to a low-technology first-aid device for management of life-threatening obstetric hemorrhage in rural health facilities in Mexico. This entailed in-depth, semistructured interviews with clinical and administrative staff (n = 70) involved in pilot studies of the nonpneumatic antishock garment (NASG) at primary health care facilities and rural hospitals. We found that staffs' response fell into four categories: owning, doubting, resisting, and rejecting. Overall, there were positive reactions to the garment as a relevant technology for saving women's lives. Findings will be used for future implementation of the garment and other new technologies.

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