Promise unrealized: A birth checklist fails to reduce deaths in rural India

Dr. Atul Gawande's closely watched study, the BetterBirth Trial, was supposed to be a breakthrough moment in global health. But it has produced a disappointing result.
Vinita, 23, holds her baby girl a few hours after her birth at a Community Health Center in Mall, near the capital of Uttar Pradesh. Source: ROBERTO SCHMIDT/AFP/Getty Images

It was supposed to be a breakthrough moment in global health.

Atul Gawande, the physician and writer, was applying a simple tool he championed — the checklist — to improve birth outcomes in a rural part of India with some of the world’s highest infant mortality rates.

But his closely watched study, the BetterBirth Trial, has produced a disappointing result: Despite increased adherence to best practices, outcomes for babies and mothers did not improve with the use of a checklist and coaching on its implementation, according to data published Wednesday in the New England Journal of Medicine.

“The improvement in quality was part of the answer, but it was not enough,” Gawande said. “We need to understand what more needs to be added to get to the endpoint everyone wants.”

The idea of the checklist

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