Trained clinical observers used a structured checklist at referral and district/regional hospitals in four developing countries to monitor care provided to 245 women during labor, delivery, and postpartum and their newborns during postpartum. The countries were Benin, Ecuador, Jamaica, and Rwanda. Observation periods were either continuous and lasted 72 hours or noncontinuous and lasted 12 hours over 4--6 days; all such periods included a weekend day and night. Observers marked the checklist to record the times when healthcare providers performed certain tasks and whether each had been done according to standard. Certain circumstances--such as a woman giving birth before arrival--required rigorous data cleaning. The quality of care for the different tasks is reported here by country, by hospital type, and overall. The frequency of labor monitoring was well below the rates recommended in all four countries, regardless of hospital type. Fetal heart rate (FHR) was monitored the most frequently at 1.3 times per hour, although its recommended rate in all countries is twice an hour. Other labor indicators recommended at twice per hour were checked less often: maternal pulse was taken 0.43 times per hour, contraction intervals 0.38 times per hour, and contraction duration 0.37 times per hour. The two indicators recommended at the rate of once every four hours (0.25 times per hour) were performed more frequently: maternal blood pressure at 0.63 times per hour and vaginal exam at 1.1 times per hour. On average, in 26% of the cases, no labor indicator was monitored at all. In the three study countries where partograph use is recommended, incorrect use was observed in more than half the case observations, varying substantially by country. Correct partograph use was associated with more frequent labor monitoring. (author's)