We developed and tested the framework using a range of
sources of evidence. It incorporates the need to balance
community-based preventive and supportive services for
all childbearing women and newborn infants with the
elective and emergency services needed by those with
compli cations. Our fi ndings are supported by recent
empirical data from a multicountry WHO study,6
suggesting that women need a health system that helps
them to stay healthy and care for their families and
provides a timely transition to elective and emergency care
for those who develop complications.179 The framework
diff erentiates between what care is provided, how it is
provided, and who should provide it, in all settings. As well
as off ering a context for debate about the care and services
that childbearing women and infants need, the framework
might have other uses, such as structuring analyses of
health system provision, planning new services, or
develop ing an education curriculum, and it can be tested,
debated, and further refi ned for diff erent settings and
population groups. It could similarly be analysed using
appropriate evidence to describe the scope and eff ect of
obstetrics, family practice, nursing, skilled birth
attendance, and community and public health systems.
Specifi cally, our analyses suggest that midwifery has a
particular contribution to make to the quality care
identifi ed in the framework in regard to education,
information and health promotion; assessment,
screening, and care planning; and promoting normal
processes and preventing complications in the context of
respectful care that is tailored to need and works to
strengthen women’s capabilities.