Table 1 Conceptualising and developing the negotiated standards of intrapartum care

The negotiated standards of intrapartum care

A critical aspect of BOLD formative research is the identification of intrapartum practices that are evidence-based, feasible to deliver by the health system and yet align with the values and preferences of pregnant women and their families. These practices, termed the ‘negotiated standards of care’, are intended to underscore the importance of providing humane and respectful care while maintaining high ethical and safety standards in clinical practice. Within this context, the ‘negotiated standards of care’ implies a level of quality of care that is acceptable and achievable within the health facilities based on consensus between health managers and community groups. The development of these standards and the potential benefits when implemented in practice are entrenched in the concept of service co-design by both health service providers and users. The process will create an atmosphere of collaboration between communities and health professionals, motivate health professionals to subscribe to these ‘negotiated standards’ and at the same time increase demand for these services by the communities.

Development process

The development of the negotiated standards will occur after the completion of the formative research phase of the BOLD project. The starting points will be the compilation by WHO of existing internationally recognized evidence-based clinical principles and practices for intrapartum care. These principles and practices will be drawn from existing WHO and other international guidelines (e.g. NICE guidelines, midwifery care standards by the International Confederation of Midwives) that are related to the management of normal labour, with due consideration for local contexts. Values, preferences and expectations of potential health service users as they relate to intrapartum care practices will be extracted from the qualitative studies involving health managers, health providers and the community. Similarly, intrapartum clinical practices that are practicable and achievable within the limits of available health resources will be explored through qualitative studies involving health managers and providers of the selected institutions. WHO will process the information from qualitative studies against the background of established evidence-based standards to develop a final list of intrapartum practices or clinical policies where the negotiation between the health managers and providers and community members would start. WHO will mediate the discussion between the health managers, selected health providers, and representatives of the catchment communities to finalise the standards, provide guidance on implementation and encourage providers and users to subscribe to it. A common agreement on what is scientific, feasible and user-centred between health system and community members will lead to service improvement and ultimately better birth outcomes. The adherence to the standards will be assessed in the intervention phase of the project when SELMA and PSB are implemented to improve health outcomes. However, the implementation phase is not part of the current two-year tool development and validation