> For the complete documentation index, see [llms.txt](https://research.ambitiousimpact.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://research.ambitiousimpact.com/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/1-background.md).
# 1 Background
## 1.1 Context
**Ambitious Impact (AIM) exists to increase the number and quality of effective nonprofits working to improve human and animal wellbeing.** We connect talented individuals with high-impact ideas and give potential entrepreneurs intensive training and ongoing support to launch ideas to scale. Our research team focuses on finding impactful opportunities[^1].
As part of our 2026 research agenda, we reviewed ideas in the health systems strengthening (HSS) space. This report summarizes our findings on simulation-based training for basic emergency obstetric and newborn care (BEmONC).
## 1.2 Maternal and neonatal mortality remains disproportionately high in LMICs
**Maternal and neonatal outcomes differ starkly between low- and high-income countries.** A baby born in a high-income country has a 0.3% chance of dying in their first 28 days of life, compared with 2.6% for a baby born in a low-income country [(Our World in Data, 2026b, 2023 data)](https://ourworldindata.org/grapher/neonatal-mortality-wdi?tab=table\&tableFilter=incomeGroups). Mothers face similarly stark disparities: high-income countries experience around 11 maternal deaths per 100,000 live births, compared with 450 in low-income countries [(Our World in Data, 2026a, 2020 data)](https://ourworldindata.org/grapher/maternal-mortality-vs-fertility?tab=table\&country=AUS~RUS~USA~BRA~IND~OWID_WRL~NGA\&tableFilter=incomeGroups).
**Despite global progress, a substantial maternal and neonatal health (MNH) burden persists in sub-Saharan Africa (SSA) and South Asia.** In the past, almost every country had child mortality rates of around 50%. Today, since many countries have made significant progress in MNH, the burden of maternal and neonatal mortality falls most heavily on low- and middle-income countries (LMICs). Over 95% of maternal deaths in 2020 occurred in Africa and Asia [(Our World in Data, n.d.-b)](https://ourworldindata.org/grapher/number-of-maternal-deaths-by-region). In 2023, out of the 132 million births worldwide, there were approximately 1.4 million stillbirths and 2.4 million neonatal deaths ([Boerma et al., 2023](https://doi.org/10.1016/S2214-109X%2823%2900195-X); [Our World in Data, n.d.-a](https://ourworldindata.org/grapher/number-of-births-per-year)). Around two-thirds of neonatal deaths in 2022 happened in SSA [(World Health Organization, n.d.)](https://www.who.int/news-room/fact-sheets/detail/newborn-mortality).
## 1.3 Access to high-quality emergency obstetric and newborn care is limited
**In low-resource settings, mothers and babies often receive too little care, too late.** In some settings, timely access to well-equipped, evidence-based care maternal and neonatal care remains limited [(Miller et al., 2016)](https://doi.org/10.1016/S0140-6736%2816%2931472-6).
**The idea explored in this report aims to improve the quality of care by training skilled birth attendants (SBAs).** SBAs are accredited health professionals—midwives, doctors, or nurses—trained to manage uncomplicated pregnancies, childbirth, and the immediate postnatal period, as well as to identify, manage, and refer complications.
**Clinicians may lack the knowledge, support, tools, or infrastructure needed to recognize signs of distress and provide critical life-saving interventions.** These gaps contribute substantially to the MNH burden.
**Emergency obstetric and newborn care (EmONC) comprises a set of life-saving interventions, known as “signal functions,” that address major causes of obstetric and newborn morbidity and mortality.** The signal functions a facility can reliably deliver help determine its level of care, ranging from basic (BEmONC) to comprehensive (CEmONC) and intensive care.
**Availability of EmONC remains poor in low- and lower-middle-income countries (LLMICs).** A recent assessment of service provision assessments conducted between 2014 and 2022 in eight LLMICs (Afghanistan, Bangladesh, the Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Nepal, Senegal, and Tanzania) found average availability of BEmONC services of just 13%, ranging from 2% in Nepal to 47% in Ethiopia [(Sayeed et al., 2026)](https://doi.org/10.1136/bmjgh-2026-023672).
**Table 1: BEmONC signal functions (click for operational definitions)**
| Obstetric | Newborn |
| --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| [Administer medications to treat postpartum hemorrhage (PPH)](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Perform newborn resuscitation with bag and mask](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Administer parenteral antibiotics](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Initiate and support early and exclusive breastfeeding](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Administer magnesium sulfate](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Administer parenteral antibiotics](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Remove retained products of conception](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Practice immediate kangaroo mother care for preterm and low-birthweight (LBW) infants](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Perform manual removal of placenta](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Administer oxygen therapy with pulse oximetry for stabilization and transportation](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Arrange ambulance, with trained and equipped provider, to a facility that can provide definitive care](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | [Arrange ambulance, with trained and equipped provider, to a facility that can provide definitive care](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) |
| [Provide IV fluid replacement therapy](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | |
| [Administer first dose of antenatal corticosteroids prior to referral](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | |
| [Perform vacuum assisted vaginal birth](/bemonc/simulation-based-training-for-emergency-obstetric-and-newborn-care/appendix-operational-definitions-for-bemonc-signal-functions.md) | |
[^1]: To read more about our approach to selecting intervention ideas for our program, please see [this site](https://ambitious-impact.gitbook.io/ambitious-impact-docs).
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