Beyond the numbers

WHO/Alberta Bacci

Maternity team discussing near-miss cases in Uzbekistan with WHO experts

BTN is a practical guide that describes five proven approaches for reviewing cases of maternal death or morbidity. The philosophy of BTN is simple: maternal death can be avoided in resource-poor countries and effective interventions can be designed and implemented if information on factors that led to the death are understood and known.

Since its publication in 2004, considerable experience has been accumulating in European region in the implementation of two BTN approaches: "confidential enquiries into maternal deaths" (CEMD) and the "reviews of severe maternal morbidity - near-miss case reviews" (NMCR).

WHO/Europe provides support in introduction and implementation of the BTN approaches through organizing national workshops, assistance in piloting, and scaling up, as well as exchange of experience during multi-countries review meetings.
The benefits of CEMD are now being recognized more widely and many countries in the WHO European Region are introducing the methods with the aim of making pregnancy safer.

Severe maternal morbidity or "near-misses" including severe hemorrhage, sepsis and hypertensive disorders of pregnancy are a major concern in maternal health not only for low resource countries but also in developed and high resource countries like Norway.  

BTN tool presents the near-miss concept is an action-oriented approach: 

  1. Identification of opportunities and obstacles for improving quality of care; 
  2. Recommendations and implementation of tailored and multifaceted interventions; 
  3. Reassessment, situation analysis, adjustment and further actions