Setting
We conducted this trial at the Arba Minch HDSS site in Ethiopia from 2019 to 2021. This site has been operating in 2 districts and 10 kebeles (smallest administrative units) in total. Owing to the scattered distribution of the population coupled with the mountainous topography and the absence of proper roads, access to health services, especially EmOC facilities, was extremely limited in these districts. Additionally, the vast majority of females in the districts were uneducated and had low socioeconomic status. These districts had one of the lowest maternal health indicators in the country, with only 18.5% of births attended by skilled birth attendants [Study areaIn the study area, different types of health facilities were in operation, including two public hospitals, six health centers, 32 health posts and private health facilities. At the health centres, basic EmOC is provided and when there is a need of comprehensive EmOC, the women/clients are referred to Arba Minch hospitals. Each health centre is expected to supervise five satellite health posts (the lowest community-level primary healthcare in Ethiopia) staffed with two salaried female health extension workers (HEWs) who provide promotive and preventive services for each kebele. All HEWs completed high school and one year of health extension programme training. A team of up to 30 households from the community formed the Women's Development Army (WDA), which was then divided into six smaller groups of one-to-five networks that made it easy to communicate with the community.