Remarkable reductions in newborn and maternal deaths
The New England Journal of Medicine has just published a game changing paper showing the impact of the Safer Births Bundle of Care program, in Tanzania.
27th February 2025: Researchers have published a study in the New England Journal of Medicine showing a 40% reduction in early newborn death* and a 75% reduction in maternal death after implementation of the Safer Births Bundle of Care program, in Tanzania.
These results demonstrate the impact of the large-scale intervention, which supports birth attendants to better manage the most common causes of maternal and newborn mortality and is currently implemented across 5 regions in Tanzania.
The Safer Births Bundle of Care program was designed and developed as a result of 10+ years of global research from the Safer Births Research Consortium and collaboration between key partners, including Laerdal Global Health. Building on the globally deployed Helping Babies Breathe initiative, the program combines low-dose, high-frequency simulation training using innovative training simulators, the adoption of specially designed clinical tools, along with continuous quality improvement initiatives and supportive mentorship.
The program is now in over 150 health facilities across Tanzania, reaching over 280,000+ births annually, with plans for national expansion in 2025.
Image: A team simulation takes place, practicing the key steps in managing bleeding after birth.
The study
The data for this ground-breaking study, published in the New England Journal of Medicine, was taken from March 2021 through December 2023, with approximately 300,000 mother-baby pairs recorded during the study period.
Newborn results
The study demonstrates that after implementation of the program, there was a decrease is the risk of newborn deaths within the first 24 hours after birth by 40%. Remarkably, regions such as Geita and Manyara, witnessed an even more significant 60-70% reduction. For perinatal deaths, combining intrapartum stillbirths and 1-day newborn deaths, there was an overall 18% reduction.
Frequent newborn resuscitation training and access to specially designed clinical tools (NeoBeat and Upright resuscitator) is attributed to the substantial decline in newborn deaths.
Remarkable maternal outcomes
Despite not being a primary outcome for the study, what emerged was a staggering reduction of in-hospital maternal deaths within 7 days of birth by 75%.
The reduction represents a change from around 240 deaths per 100,000 births in the baseline to approx. 60 deaths for every 100,000 births.
Another study into the program highlights that healthcare workers indicated improved confidence and competence in managing bleeding after birth, the leading cause of maternal death worldwide. Participants attributed this improvement to frequent facilitator-led team simulations with reflective debriefing, which improved skills, confidence and competence in their clinical practice. Participants also recognized a reduction in the "blame and shame" culture in Safer Births Bundle of Care sites, which enhanced self-confidence and a feeling of safety, meaning healthcare workers were more willing and likely to take action.
Image: A debriefing session underway, following a team simulation training
Team-based simulations and reflective debriefing have provided rich learning opportunities for healthcare workers who have been part of SBBC, and that is thanks to the well-trained facilitators – a key reason for the success of SBBC so far.
Built on evidence
The Safer Births program is an iterative program built on over 10 years of research. Through this period the University of Stavanger has been the central research partner, with several completed and on-going PhDs enrolled at the university. So far, the Safer Births Research Consortium has published 150 papers, with 40 on-going or completed PhDs.
Partnership and collaboration
Supported by partners including Norwegian aid, and the Global Financing Facility (a trust fund hosted at The World Bank), 13 million USD has been provided in funding for the Safer Births Bundle of Care program since 2020.
Through the private-public partnership, Haydom Lutheran Hospital has led the implementation of the Safer Births Bundle of Care program in Tanzania under the leadership of the Ministry of Health, President’s Office-Regional Authority, and Local Government (PO-RALG) and in partnership with SAFER, Laerdal Global Health, and Stavanger University Hospital. Local professional associations, including the Tanzanian Midwives Association (TAMA), the Pediatric Association of Tanzania (PAT), and the Association for Gynaecologists and Obstetricians (AGOTA), have also been essential partners in supporting the adoption of the program.
These results with the leadership of the Government of Tanzania and Safer Birth partners show the transformative advances that can be made to crash maternal and neonatal mortality if such highly cost-effective, and relatively simple innovations are taken to scale. This shows the power of countries, private sector, development and global heath partners joining forces to improve health outcomes.
The Safer Births Bundle of Care program has received interest from other countries with a high maternal and newborn mortality burden, including Nigeria and Ethiopia.
For more information visit: www.saferbirths.com