The goal of this observational study is to evaluate the implementation and impact of a comprehensive emergency obstetric and newborn care (CEmONC) program on maternal and perinatal health services and outcomes in Malawi. The study will include health facilities providing delivery care in Lilongwe and Blantyre districts, healthcare providers, and selected clients. The main questions it aims to answer are:

1. Does implementation of the program improve health facility readiness, availability and quality of CEmONC services, and maternal and perinatal death surveillance and response (MPDSR)?
2. Are improvements in facility readiness associated with changes in maternal and perinatal health outcomes over time?

Participants and facilities will:

• Participate in health facility assessments at baseline, midline, and endline.
• Provide routine facility registers and records for retrospective abstraction of pregnancy outcomes, obstetric complications, and maternal and perinatal deaths.
• Participate in interviews to describe provider training, clinical practices, and experiences with maternal and newborn care and MPDSR implementation.