Does training traditional birth attendants improve health behaviours and pregnancy outcomes?

A traditional birth attendant (TBA) is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs. TBAs are found widely in low and middle-income countries. Although the proportion of births assisted by TBAs varies widely within a given country and across countries, it is estimated that they assist an average 24% of all births in these settings.

Key messages

• It is unclear how providing additional training to TBAs impacts on maternal mortality
• There is some evidence that providing additional training to TBAs may reduce perinatal and neonatal deaths and stillbirths
• There is mixed evidence of the impacts of additional TBA training on:
  • maternal morbidity, including from hemorrhage; puerperal sepsis; and obstructed labour;
  • advice-giving regarding infant feeding;
  • the referral of mothers with complications of pregnancy and child birth.
• Factors that should be considered when assessing whether this evidence is likely to be transferable to other settings include:
  • if there is an existing network of TBAs that can be targeted for further training and provided with support;
  • acceptance of non-professional providers within the formal health system;
  • cultural norms and values regarding pregnancy, childbirth and child rearing;
  • local causes of maternal and perinatal ill-health and death;
  • women’s ability to access health care.