 The results of this study suggest that global efforts to increase births at healthcare facilities may not be effective in reducing maternal and neonatal mortality unless quality of care is improved. This study found that the quality of basic maternal care functions were significantly lower in primary care facilities compared to secondary care facilities, even when adjusting for other factors such as volume of deliveries and presence of skilled staff. Additionally, facilities with caesarean section capacity, especially those with high birth volumes, had better quality of care. These findings highlight the need for increased investment in improving the quality of care in health facilities in order to reduce maternal and neonatal mortality. This article was authored by Dr. Marguerite Cruck, M.D., Hannah H. Leslie, Ph.D., Staphan Bergett, Ph.D., and others.