{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T04:06:32Z","timestamp":1750392392717,"version":"3.41.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006661","name":"United Nations Population Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>We examined the impact of a codesigned multicomponent implementation strategy on adherence to evidence\u2010based intrapartum care, respectful maternity care, and newborn care practices in 11 medical schools across two states and a union territory in India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted pre\u2010post implementation research using the reach, effectiveness, adoption, implementation, and maintenance (RE\u2010AIM) framework from July 2019 to October 2021. The implementation strategy was codesigned by researchers and medical school faculty. At baseline and endline, we recruited intranatal (<jats:italic>n<\/jats:italic>\u2009=\u2009175, 158) and postnatal women (<jats:italic>n<\/jats:italic>\u2009=\u2009158, 167) with uncomplicated vaginal delivery for observation and interview, respectively. The primary outcome was proportion of uncomplicated deliveries with a composite of avoiding augmentation, avoiding episiotomy, and using alternate birthing positions. We used generalized estimating equations to compare baseline and endline findings and estimated adjusted prevalence odds ratios (APORs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The primary outcome increased from 5.4% at baseline to 17.4% at endline with APOR 3.55 (95% CI: 1.08, 11.66). A decline was observed in not\u2010recommended practices, namely pubic shaving (APOR 0.05, 95% CI: 0.01, 0.18), enema (APOR 0.07, 95% CI: 0.02, 0.22), fundal pressure (APOR 0.05, 95% CI: 0.02, 0.14), episiotomy (APOR 0.75, 95% CI: 0.38, 1.48). Newborn care practices showed the greatest improvements in early initiation of breastfeeding (APOR 42.35, 95% CI: 5.70, 314.61) and delayed cord clamping (APOR 21.28, 95% CI: 6.00, 75.43). Results from postnatal interviews corroborated those from direct observation in the labor room.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A codesigned multi\u2010component implementation strategy can improve adherence to evidence\u2010based intrapartum and newborn care practices in medical schools.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.70008","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T08:08:23Z","timestamp":1739261303000},"page":"378-387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Strengthening evidence\u2010based intrapartum and newborn care practices in medical schools: Subnational implementation research from India"],"prefix":"10.1002","volume":"170","author":[{"given":"Madhu","family":"Gupta","sequence":"first","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirti","family":"Iyengar","sequence":"additional","affiliation":[{"name":"Children's Investment Fund Foundation  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neena","family":"Singla","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3021-9663","authenticated-orcid":false,"given":"Kiranjit","family":"Kaur","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1787-8392","authenticated-orcid":false,"given":"Madhur","family":"Verma","sequence":"additional","affiliation":[{"name":"All India Institute Medical Science  Bathinda Punjab India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7488-5134","authenticated-orcid":false,"given":"Adhish Kumar","family":"Sethi","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rimpi","family":"Singla","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minakshi","family":"Rohilla","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanita","family":"Suri","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neelam","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarundeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swarnika","family":"Pal","sequence":"additional","affiliation":[{"name":"National Health System Resource Center  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anchal","family":"Dhiman","sequence":"additional","affiliation":[{"name":"National Health System Resource Center  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Poonam","family":"Goel","sequence":"additional","affiliation":[{"name":"Government Medical College and Hospital  Chandigarh India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. 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