Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunity

The proportion of women and children receiving health care in the poorest countries is increasing [1]. Unfortunately, markers of improved health outcomes, such as falling maternal or newborn mortality, have not matched expectations from the gains in the coverage of care. Robust evidence exists for one explanatory factor: the poor–rich gaps in coverage found along the continuum of care for women and children, and particularly for the crucial period around childbirth [2]. The more-neglected explanation for the mismatch between coverage and health outcomes is the quality of the care provided to women and children, which is the focus of Year 1 of the Maternal Health Task Force (MHTF)-PLOS Collection on Maternal Health (http://www. ploscollections.org/maternalhealth_year1) and our short commentary. Although inadequacies in care have long been noted across the world and for many health problems [3], a focus on the magnitude, costs, and consequences specifically for women and children in lowincome countries is relatively new, and still has not achieved the status of a political priority [4]. This contrasts markedly with the attention paid to the coverage of care. Here we seek to highlight the synergies between inequalities in coverage and quality. The inverse care law [5] proposes that quality of care varies inversely with need, and we extend this to emphasize that poor quality care is disproportionately borne by the poorest groups of women and children. Our commentary is structured around a key cause and a consequence of the neglect of quality—weak measurement and poor evidence for action—and concludes with priorities for seizing the quality care opportunity.