Introduction:In Ethiopia, rural residence and limited access to skilled providers and health services pose challenges for maternal and newborn survival. The Maternal Health in Ethiopia Partnership (MaNHEP) developed a community-based model of maternal and newborn health focusing on birth and the early postnatal period and positioned it for scale-up. MaNHEP's 3-pronged intervention included community-and facility-based community maternal and newborn health training, continuous quality improvement, and behavior change communications.Methods: Evaluation included baseline and endline surveys conducted with random samples of health extension workers, community health development agents, traditional birth attendants (TBAs), and women who gave birth the year prior to the survey; pretraining, posttraining, and postintervention clinical skills assessments conducted with health extension workers, community health development agents, and traditional birth attendants; endline surveys conducted with quality improvement teams; and a perinatal verbal autopsy study.Results: There were significant improvements in the completeness of maternal and newborn health care provided by the team of health extension workers, community health development agents, and TBAs in their demonstrated capacity and confidence to provide care and a sense of being part of a maternal and newborn health care team. There were also significant improvements in women's awareness of and trust in the ability of these team members to provide maternal and newborn health care, in the completeness of care that women received, and in the use of skilled providers and health extension workers for antenatal and postnatal care. In addition, a shift occurred toward the use of providers with a higher level of skills for birth care. Successful local solutions for pregnancy identification, antenatal care registration, labor-birth notification, and postnatal follow-up were adopted across 51 project communities. The number of days between perinatal deaths increased over the duration of the project.Discussion: MaNHEP was associated with more, and more complete, coverage of maternal and newborn health care and improved perinatal outcomes.

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32% of estimated live births in the region may not be able to reach emergency obstetric and neonatal care (EmONC) services within 2 hours in dry season, regardless of the type of transportation available. However, bicycles, motorcycles, and cars provide a significant increase in geographic accessibility in some areas. Achieving good access may require upgrading non-EmONC facilities to EmONC facilities in some districts while incorporating bicycles and motorcycles into the health transportation strategy in others.

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Despite decades of policies and programs aimed at improving reproductive health worldwide, high maternal morbidity and mortality persist in many resource-poor settings, particularly in Sub-Saharan Africa. [1][2][3] The predominant approach to mitigating this problem has been to target the knowledge, attitudes and practices of women of reproductive age and to strengthen health service provision. Although educating and designing services for women is undoubtedly important, this focus assumes that women have control over their maternal health care decisions. Evidence from diverse settings, however, indicates that women often have only partial, if any, autonomy over their reproductive and sexual health. [4][5][6][7][8] Not only do husbands have a significant influence on the behavior and actions of their wife, 7,9,10 but other household members, especially mothers-in-law, also exert control over younger women. 5,[11][12][13] Maternal morbidity and mortality are largely preventable through the provision of antenatal care, institutional delivery and timely postnatal care. 8,[14][15][16][17] 7,12,23 in some settings, substantial gaps in coverage remain even after adjustment for the availability of services. Accordingly, researchers and program planners have begun to appreciate the complexity of contextual influences on maternal health practices, and have adopted an approach that recognizes that individual attitudes and behaviors are products of their social and cultural environments. 24,25 Still, most studies have focused exclusively on women as the target population, and have aimed to understand and influence barriers and facilitators from their perspective. This narrow focus is incongruent with a sociocultural context in which women hold low status and are subject to the preferences and beliefs of their husband and elder relatives. 26-28Interpersonal power, however, has proven difficult to measure, such that power dynamics within a household and how they influence decisions on maternal health are not fully understood. 6,[29][30][31] To address this gap, we explored the link between household power dynamics and the maternal health behaviors of married women in rural Mali. Specifically, this article examines the relative influence of the preferences and beliefs of women, their hus- METHODS Data and SettingData for this analysis were drawn from the Projet Espoir Baseline Survey (PEBS), which was conducted between June and July 2011 in Bandiagara and Bankass, two rural districts of central Mali's Mopti region. This article contributes to the project's larger goal of identifying and addressing underlying social determinants of poor maternal health in rural Mali. Ethical approval was obtained from the institutional review boards at Emory University and the Malian Ministry of Health. The Mopti region is predominantly rural and agricultural, and has the lowest levels of education in the country. 51Although men and women in the region have roughly equal educational profiles overall, among younger cohorts, educational attainm...