Ghana’s slow progress towards attaining millennium development goal 5 has been associated with gaps in quality of care, particularly quality of clinical decision making for clients. This thesis reviews the relevance and effect of clinical decision making support tools on pregnancy outcomes. Relevance of three clinical decision making support tools available to frontline providers of care in the Greater Accra region is discussed. These are routine maternal health service delivery data population based reproductive data and clinical care guidelines. First, the quality of routine health system data, determined by the completeness and accuracy of transfer of routine antenatal and delivery service data in the Greater Accra Region of Ghana is assessed and found to be good and reliable for use for decision making. Secondly, predictors of skilled attendance at delivery were identified amongst women who attend antenatal clinic at least once during their pregnancy in Ghana, using the 2008 Ghana Demographic and Health Survey (DHS) data. These predictors were wealth status class, rural or urban residency, previous delivery complication and health insurance coverage. Finally, adherence to first antenatal care guidelines was assessed. Overall, complete adherence to guidelines was low and providers were more likely to completely adhere to guidelines when caring for women 20 years or older, employed and married women. Also, public health facility resource availability in relation to provider adherence to first antenatal visit guidelines was explored.It was evident that although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. Thus, availability of these resources do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Regarding effect, two clinical decision making support tools (first antenatal care guidelines and mobile health) on pregnancy outcomes were examined. Complete adherence to first antenatal care guidelines decreased risk of any neonatal complication and delivery complication. A systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in low- and middle-income countries (LMICs) was conducted. From this review, mHealth interventions were used as communication, data collection, or educational tool by health care providers in the provision of antenatal, delivery and postnatal care. None of the studies directly assessed effect of mHealth on maternal and neonatal mortality. We conclude that there is a gap in the knowledge of whether mHealth interventions directly affect maternal and neonatal outcomes and future research should address this gap. In conclusion I discuss the importance of reducing subjectivity of provider judgement by encouraging them to use available clinical decision making support tools. I also emphasize the need for them to be supported by the health system to be able to incorporate these tools in their daily practice to enhance the quality of care for mothers and improve pregnancy outcomes.