The START team was asked to identify existing data on differential mortality outcomes among mothers and their babies when delivered at home versus in a facility in Ethiopia, India, and Nigeria. They were also asked to evaluate the evidence for interventions that can be delivered at home in the intrapartum or immediate postpartum period. Additionally, the team was asked to research and describe who delivers at home and what influences that decision. START was also asked to review several key databases currently being funded by BMGF, including how and where data is collected, limitations to their usefulness, and how they are being analyzed.
The START Team conducted a literature review of both observational studies and interventions. The review expanded beyond the three countries of interest when it became clear that there were only a limited number of relevant studies from those places; ultimately, the team reviewed studies, interventions, and meta-analyses from sub-Saharan Africa and Asia. START then began to examine the datasets of interest, describing their methods for data collection and the geographic and conceptual domains covered by each, as well as limitations to their use. START conducted three key informant interviews with practitioners in India and Nigeria, whose valuable input helped to contextualize the literature and data, and who gave deep insights into the challenges in this field. Finally, the team synthesized results and developed several suggested recommendation for developing practices to assist parents, babies, and their caregivers.