171782 Skilled birth attendance and maternal mortality: The Conundrum

Tuesday, October 28, 2008: 10:30 AM

Ndola Prata, MD, MSc , The Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, Berkeley, CA
Paige Passano, MPH , Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California Berkeley, Berkeley, CA
Tami Rowen, MS, MD , Department of Obstetrics Gynecology and REproductive Sciences, University of California, San Francisco, San Francisco, CA
Julia Walsh, MD DrPH , UC Berkeley School of Public Health, Berkeley, CA
Malcolm Potts, MB, PhD, FRCOG , University of California, Berkeley, Berkeley, CA
     
Background: The current global strategy to reduce the maternal mortality rate in developing countries focuses on training skilled birth attendants (SBAs) and upgrading existing emergency obstetric facilities. Since the early 1990s, the WHO, UNFPA, UNICEF, and other leaders in maternal and child health have withdrawn support both for training and for establishing linkages with traditional birth attendants. Unfortunately, this policy doesn't address the fact that women in remote rural settings have very poor access to skilled attendants at birth. Methods: A Demographic and Health Survey (DHS) analysis of trends in skilled birth attendance was conducted. The percentage of maternal deaths from each region was calculated to determine what proportion of the burden of regional maternal deaths can be attributed to specific countries with low usage of SBAs.

Results: Less than 50% of births were attended by SBAs in the most recent DHS in 35 countries in the world and over the last 20 years, the increase has been negligible. Nearly three-quarters of the 532,000 annual maternal deaths in Subsaharan Africa, Asia & the Pacific, and Latin America & the Caribbean can be attributed to these 35 countries. The current strategy to promote SBAs and improve facilities is inappropriate for conditions on the ground in these 35 countries. Conclusion: Short and medium term goals, which will enable the creation of locally-appropriate solutions and utilize existing cadres of health workers, are required in underserved rural regions of Africa, Asia and Latin America to supplement the long term goal of offering all women professional support in childbirth.

Learning Objectives:
1. State the general direction of the trend of changes in skilled birth attendance in the countries with the highest maternal mortality rates. 2. Discuss two arguments for excluding TBAs from safe motherhood training programs, and list two counter-arguments for why they should be included. 3. The current policy of training skilled birth attendants and upgrading facilities aims to increase the proportion of women in all regions who experience safe childbirth. Name 3 major barriers to the potential for success of this policy in rural areas.

Keywords: Maternal and Child Health, Community-Based Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was one of the authors who had the idea for this paper and I wrote it.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: The Reality: The Role of TBAs in Communities
See more of: Maternal and Child Health