Supplementary Material for: The effectiveness of regionalization of perinatal care and specific facility-based interventions: A systematic review

Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal(SDG)-3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource limited settings. Methods: A systematic review on effectiveness of perinatal care regionalization was updated and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity-building and incentive packages. We conducted sub-group analysis for evidence from low-and-middle-income countries (LMICs). Results: Implementation of regionalization programs significantly decreased maternal and perinatal mortality. Transport-related interventions significantly decreased overall maternal mortality, neonatal mortality, perinatal mortality, and improved postnatal care coverage in LMICs. Adding maternity homes/units significantly decreased stillbirth in LMICs. Incentives for postnatal care significantly improved infant mortality, stillbirth, and postnatal care coverage in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs and decreased maternal mortality and infant mortality in LMICs. Maternal education significantly decreased neonatal mortality, perinatal mortality, infant mortality and stillbirth. Capacity-building interventions significantly decreased maternal mortality in LMICs, neonatal mortality overall, and in LMICs, perinatal mortality, infant mortality, under-5 mortality and stillbirth in LMICs, and preterm birth overall. Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high-burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.