Implementing the World Health Organization Labour Care Guide in a selected hospital of Bangladesh: A mixed-methods evaluation
Study Period: May 2026-June 2027
Donor: The ARPAN Centre for Research Excellence, Burnet Institute, Australia
Partners: The ARPAN/GMP network of Barnet Institute, The Bangladesh Ministry of Health and Family Welfare, The Obstetrical and Gynaecological Society of Bangladesh (OGSB), Institute of Woman and Child Health (IWCH) and Ashulia Women and Children Hospital (AWCH)
Project Description:
Background: Improving intrapartum care is a key priority in Bangladesh to reduce preventable maternal and newborn deaths. While the number of facility-based deliveries has risen significantly, challenges remain in areas such as consistent labour monitoring, early identification of complications, and ensuring woman-centred care. The WHO Labour Care Guide (LCG) considered the “next generation partograph,” is designed to reflect WHO’s recommendations for a positive childbirth experience. It enables accurate clinical monitoring, encourages critical decision-making, supports timely interventions, and promotes supportive care for women. Findings from the Global Maternal and Newborn Health Platform (GMP) study reveal that partographs were used in 44% of labour monitoring cases in Bangladesh, with the LCG applied in 20% of those. Among the 10 GMP countries, Bangladesh reported the highest stillbirth rate, at 30.2 per 1,000 births.
Objective:
Method: The study will be conducted in four phases. First, baseline data will be collected on labour monitoring practices (LCG/partograph), caesarean section rates, stillbirths, APGAR scores, early neonatal mortality, and maternal mortality. In the second phase, a co-design workshop with stakeholders, academicians, and the Ministry of Health and Family Welfare will be held to develop an implementation strategy, followed by structured training for all labour ward providers on LCG use and WHO intrapartum care standards. The third phase will implement routine use of the LCG in place of the partograph, supported by on the job mentoring, with prospective data collection on the same indicators and practitioner feedback gathered via a short Likert-scale tool after each birth. Finally, qualitative data will be collected through one focus group discussions with doctors and another with nurses/midwives, and four in-depth interviews with key personnel including the Head of Department, Resident Surgeon/Registrar, Nursing Supervisor, and Senior Obstetrician/Trainer, focusing on usability, acceptability, and feasibility.
Significance: Implementing the WHO Labour Care Guide (LCG) in Bangladesh will strengthen the quality and consistency of labour monitoring, enable earlier recognition and management of maternal and fetal complications. By reducing unnecessary obstetric interventions, particularly caesarean sections, the LCG supports safer, evidence-based practices. It will also enhance provider skills, confidence, and motivation to deliver woman-centred care aligned with global standards. Ultimately, this will contribute to improved maternal and neonatal outcomes, including optimum caesarian section, fewer intrapartum stillbirths and better newborn health indicators such as APGAR scores.