In this paper, authors study the quality of care in maternal health using data from health facilities in five of the countries that have the highest maternal mortality ratio: DRC, Cameroon, Central African Republic, Nigeria, and the Republic of Congo. Poor outcomes may arise due to low clinical quality, which in turn may stem from at least three reasons: first, structural constraints may continue to bind. Second, inadequate training may result in doctors not knowing what they should do. Third, doctors may not put their knowledge to use in their clinical practice. In this paper, we document, for different components of ANC, the share of consultations in which the providers know that they should perform an action, have all the equipment and supplies needed, and yet do not perform the action. Results show that, despite considerable heterogeneity in contexts, sizeable effort gaps exist along all dimensions of antenatal care. At least ten percent and as much as 65 percent of non-compliance to ANC protocol can be explained by know-do gaps. Finally, the authors explore the characteristics of facilities, providers and patients that correlate with the different gaps in provision of high-quality care. The authors show that despite unusually rich data on potential correlates, no clear patterns emerge, suggesting that more work is needed to understand low effort provision in healthcare in developing country contexts. Light lunch will be served.