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Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1middot84 [95% CI 1middot05-3middot22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2middot44 [1middot02-5middot85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development. Copyright (c) 2021 World Health Organization; licensee Elsevier. This is an Open Access article under the CC BY 3.0 IGO license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products, or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

The paper proposes a genealogy of the biomedical paradigm surrounding childbirth, with the aim of deconstructing the principles of rationalism that led to the objectification of the body and to the consequent commodification of birth. We intend to demonstrate how such a conception of the body and of sensibility determines the birth process, which leads us to consider it an event that is relational in nature. Methodologically, this deconstruction is carried out through a critical-descriptive genealogy of the theoretical assumptions of the rationalist conception of the body. By developing the concept of ecology of childbirth, we intend to call into question this relational nature of the body and to recover the value of corporeality and embodiment as a language of proximity, within a theoretical framework of the ethics of difference. This vindication of the ecological-relational nature of sensibility has the potential to establish a dynamic of responsibility and cooperation capable of subverting the rationalist logic of control and the dominion of the current biomedical paradigm.El presente artículo ofrece una genealogía del paradigma biomédico del parto, con el objetivo de deconstruir los principios del racionalismo que condujeron a la objetivación del cuerpo y la consecuente mercantilización del nacimiento. Se pretende demostrar cómo dicha concepción del cuerpo y de la sensibilidad determina el proceso del nacimiento, en tanto acontecimiento de carácter relacional. Metodológicamente, esta deconstrucción se lleva a cabo a través de una genealogía crítico-descriptiva de los presupuestos teóricos de la concepción racionalista del cuerpo. A través del desarrollo del concepto de ecología del parto se propone, a su vez, repensar dicho carácter relacional a partir de una propuesta valorativa de lo corporal, es decir del cuerpo entendido como lenguaje de proximidad tomando como marco de referencia teórico la ética de la diferencia. Esta reivindicación del carácter ecológico-relacional de la sensibilidad tiene potencial para instaurar una dinámica de cooperación y responsabilidad que subvierta la lógica racionalista del control y el dominio que rige el paradigma biomédico vigente.

RESUMEN El presente artículo ofrece una genealogía del paradigma biomédico del parto, con el objetivo de deconstruir los principios del racionalismo que condujeron a la objetivación del cuerpo y la consecuente mercantilización del nacimiento. Se pretende demostrar cómo dicha concepción del cuerpo y de la sensibilidad determina el proceso del nacimiento, en tanto acontecimiento de carácter relacional. Metodológicamente, esta deconstrucción se lleva a cabo a través de una genealogía crítico-descriptiva de los presupuestos teóricos de la concepción racionalista del cuerpo. A través del desarrollo del concepto de ecología del parto se propone, a su vez, repensar dicho carácter relacional a partir de una propuesta valorativa de lo corporal, es decir del cuerpo entendido como lenguaje de proximidad tomando como marco de referencia teórico la ética de la diferencia. Esta reivindicación del carácter ecológico-relacional de la sensibilidad tiene potencial para instaurar una dinámica de cooperación y responsabilidad que subvierta la lógica racionalista del control y el dominio que rige el paradigma biomédico vigente. ABSTRACT The paper proposes a genealogy of the biomedical paradigm surrounding childbirth, with the aim of deconstructing the principles of rationalism that led to the objectification of the body and to the consequent commodification of birth. We intend to demonstrate how such a conception of the body and of sensibility determines the birth process, which leads us to consider it an event that is relational in nature. Methodologically, this deconstruction is carried out through a critical-descriptive genealogy of the theoretical assumptions of the rationalist conception of the body. By developing the concept of ecology of childbirth, we intend to call into question this relational nature of the body and to recover the value of corporeality and embodiment as a language of proximity, within a theoretical framework of the ethics of difference. This vindication of the ecological-relational nature of sensibility has the potential to establish a dynamic of responsibility and cooperation capable of subverting the rationalist logic of control and the dominion of the current biomedical paradigm.