Contribution of Trained Traditional Midwives in Reducing Rural Maternal and Neonatal Mortality and Morbidity in Liberia

Liberia suffers appalling maternal mortality (994). The Liberia Ministry of Health and Social Welfare has sanctioned the training and deploying of traditional birth attendants (TBAs) as Trained Traditional Midwives (TTMs). Using curricula and instructors of the American College of Nurse Midwives, certified Liberian nurse-midwives receive Training of Trainers (TOT) to train TBAs to be TTMs. The nurse-midwives of the Nehnwaa Child Survival Project – a partnership of Curamericas Global and Ganta United Methodist Hospital (GUMH) – received this TOT training. and have begun training TBAs in villages in the Project's catchment. The first cohort of 30 TTMs has completed training. TTMs have begun doing deliveries and now do 100% of the home deliveries in the project's 30 participating villages. Important lessons have already been learned: 1) TBAs are receptive to learning new methods, exhibiting a sense of professional pride; 2) fears of inciting competition between TBAs and the village TTM proved unfounded as they traditionally work cooperatively and share fees; 3) this has already resulted in an unplanned “training cascade” as TTMs teach the other TBAs– this will have to be controlled, and may indicate the need to train the entire team; 4) TTMs are receptive to women electing a health facility delivery and readily counsel women accordingly; 5) both women and TTMs are receptive to the TTM accompanying the woman to the health facility to assist as appropriate and provide support. When implemented with full community participation, local culture and TBA tradition are proving very amenable to this strategy.