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.