This report summarizes the findings of a study designed to answer the question: “Is it possible to significantly reduce maternal and neonatal morbidity-mortality if the major factors associated with these health problems are identified, and an action plan with the active participation of staff and community is developed and implemented.” The corollary question is: “In order to continue to decrease the number of deaths, what are the: 1) best practices that should continue; and 2) the challenges that must be addressed?” The current study uncovers the contributory factors to changes in health outcomes and best practices, as well as identifies factors contributing to continuing challenges. The current study builds upon insights gained from earlier research on maternal and neonatal mortality and morbidity at both the health facility and community levels in the Dominican Republic.

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