Awareness and Utilization of the WHO Safe Childbirth Checklist in Facility-Based Public Health Institutions of Khordha District, Odisha: An Observational Study

Introduction: The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool designed to help healthcare professionals enhance childbirth practices. We assessed the level of awareness, utilization, and barriers to utilization of the WHO SCC among obstetric health workers. Methods: An observational cross-sectional analytical study was conducted in facility-based public health institutions of Khordha district, Odisha, India. These were primary and secondary-level public health facilities providing 24-hour maternity services to low- and middle-income women from urban and nearby rural areas. The participants comprised all obstetric care providers working in maternity units and parturient women admitted to the labor unit of public health institutions in Khordha district. These included doctors, midwives, nurses, and community health officers. The primary outcome was to assess the level of knowledge and utilization of the WHO SCC among obstetric care providers at different public health institutions. The secondary outcomes were to identify the factors associated with knowledge and utilization of the WHO SCC and perceived barriers to non-utilization of the WHO SCC. Results: The overall mean knowledge score of obstetric care providers regarding the WHO SCC was 14.40 ± 4.91, corresponding to a mean percentage score of 48.0%, indicating suboptimal knowledge. Bivariate logistic regression analysis demonstrated that higher age (OR = 2.51; 95% CI: 1.15-5.47), professional category, i.e., midwives (OR = 2.61; 95% CI: 0.98-6.94) and nursing officers (OR = 5.00; 95% CI: 1.10-22.82), previous formal training (OR = 2.55; 95% CI: 1.05-6.16), and more clinical experience (OR = 0.37; 95% CI: 0.16-0.90) were significantly associated with higher level of knowledge. The study further demonstrated moderate adherence (>70%) to recommended childbirth practices among providers who utilized the WHO SCC in routine labor room practice. Higher adherence was observed for key practices such as allowing a birth companion, maternal blood loss assessment after delivery, infection and eclampsia management, and discharge counseling when the SCC was used. In contrast, several essential practices, including infection and eclampsia management, delivery preparedness, breastfeeding support, and family planning counseling, showed suboptimal adherence (<70%). Healthcare providers working in hospital settings and those who had received prior training were more likely to use the SCC (p < 0.05). The predominant perceived barriers to SCC utilization included time constraints, heavy workload, staff shortages, and inadequate supervision and training. Conclusion: Our study showed suboptimal awareness and a moderate level of adherence to recommended child birth practices. Strengthening knowledge of obstetric healthcare workers is essential to ensure consistent and effective utilization of the WHO SCC, and addressing organizational and system-level challenges may therefore be essential for improving its adherence.