While coverage of maternal healthcare is on the rise in many low- and middle-income countries, studies conducted by colleagues including the evaluation of the JSY program in India and a meta-analysis of place of delivery in sub-Saharan Africa, illustrate that facility births are not always associated with lower maternal mortality. This gap between use of facilities and better health outcomes may be due to poor quality of care.

Therefore, measures of coverage that do not account for quality of care may be misleading. Taking advantage of a unique dataset that included both facility- and population-level data, we show that coverage quickly declines as we account for quality of care. Furthermore, we find that this poor level of quality is far worse for individuals in the lowest household wealth. Read more in the International Journal for Quality in Health Care.

Another way "use" falls short of improving health outcomes is in diagnosis and treatment of hypertension among postpartum women. In a survey of women in rural Tanzania who had delivered a baby in the past year, only 23.5% of women with hypertension were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. These poor outcomes were despite averging 5 visits to the health system for their own care in the past year. These findings indicate the importance of going beyond measuring use of health care, and a need to incorporate measures of quality of care and outcomes. Read more here.