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A protocol for a systematic review of birth preparedness and complication readiness programs

Andrea Solnes Miltenburg1*, Yadira Roggeveen1, Marianne van Elteren2, Laura Shields1, Joske Bunders1, Jos van Roosmalen2 and Jelle Stekelenburg3

Author Affiliations

1 Athena Institute for Research on Innovation and Communication in Health and Life sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands

2 Department of Medical Humanities (EMGO) Institute for Health and Care Research VU, University Medical Center (VUmc), Van der Boechorststraat 7, 1081, BT Amsterdam, the Netherlands

3 Department of Obstetrics & Gynaecology, Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD Leeuwarden, The Netherlands

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Systematic Reviews 2013, 2:11  doi:10.1186/2046-4053-2-11

Published: 8 February 2013



One of the effective strategies for reducing the number of maternal deaths is delivery by a skilled birth attendant. Low utilization of skilled birth attendants has been attributed to delay in seeking care, delay in reaching a health facility and delay in receiving adequate care. Health workers could play a role in helping women prepare for birth and anticipate complications, in order to reduce delays. There is little evidence to support these birth preparedness and complication readiness (BP/CR) programs; however, BP/CR programs are frequently implemented. The objective of this review is to assess the effect of BP/CR programs on increasing skilled birth attendance in low-resource settings.


Due to the complexity of BP/CR programs and the need to understand why certain programs are more effective than others, we will combine both quantitative and qualitative studies in this systematic review. Search terms were selected with the assistance of a health information specialist. Three reviewers will independently select and assess studies for quality. Data will be extracted by one reviewer and checked for accuracy and completeness by a second reviewer. Discussion between the reviewers will resolve disagreements. If disagreements remain, a third party will be consulted. Data analysis will be carried out in accordance with the BP/CR matrix, developed by the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO). Study data will be grouped and analyzed by quality and study design and regrouped according to type of intervention strategy.


This review will provide: 1) an insight into existing BP/CR programs, 2) recommendations on effective elements of the different approaches, 3) proposals for concrete action plans for health professionals in the field of reproductive health in resource-poor settings and 4) an overview of existing knowledge gaps requiring further research.

Systematic review registration

PROSPERO registration no.: CRD42012003124

Birth preparedness and complication readiness; Birth plan; Maternal mortality; Utilization; Skilled birth attendant; Safe motherhood; Health education