Globally, the rate of skilled care during childbirth has increased from 58% in 1990 to 73% in 2013, mostly due to increases in facility-based births. But giving birth in a health facility with a ‘skilled’ attendant is not sufficient to reduce maternal and newborn deaths and severe morbidity. Many women and their babies die from poor care practices, even after reaching a health facility. Health facilities often struggle to provide the rapid emergency care needed to manage maternal complications and care for small and sick newborns. Common causes include inadequate or unhygienic infrastructure; lack of competent, motivated staff; lack of availability or poor quality of medicines; poor compliance to evidence-based clinical interventions and practices; and poor documentation and use of information. Improving quality of care and patient safety are therefore critical if we want to accelerate reductions in maternal and newborn mortality.