Every Second Matters ‐ uterine balloon tamponade implementation across ten medical colleges in Maharashtra and Madhya Pradesh in India: A qualitative study

OBJECTIVE: To understand facilitators, barriers, and perceptions of the Every Second Matters uterine balloon tamponade (ESM‐UBT) package implemented across 10 medical colleges in India, 3 years after the program was introduced. METHODS: Semi‐structured interviews were conducted until thematic saturation in March 2020. Multiple provider cadres, including nurses, Obstetrics/Gynecology residents, professors, and program leads, were eligible. Interviews were transcribed and thematically coded using an inductive method. RESULTS: Sixty‐two obstetric providers were interviewed. Facilitators of implementation included recurrent training, improved teamwork and communication, strong program leadership, and involvement of lower‐level facilities. Barriers to implementation included administrative hurdles, high staff turnover, language barriers, and resources required to reach and train lower‐level facilities. Overall, the majority of clinicians viewed the ESM‐UBT package as a useful intervention in aiding efforts to reduce maternal deaths from postpartum hemorrhage. CONCLUSIONS: Among 10 medical colleges in India the ESM‐UBT package is seen as a beneficial intervention for managing refractory atonic postpartum hemorrhage, and for reducing maternal morbidity and mortality. Identified facilitators of and barriers to implementation of the ESM‐UBT package in India should be used to guide future implementation efforts.