Program effects on skilled attendance at birth in Jharkhand, India

Background: The ACCESS program implemented a competency-based training for auxiliary nurse midwives (ANMs) and posted them to rural communities in Jharkhand state. Trained community health workers educated women to use skilled birth attendants and practice birth preparedness/complication readiness (BP/CR). The effectiveness of the program was evaluated.

Methods: A posttest-only design was employed to assess the quality of MNH services provided by ANMs using quarterly interviews with ANMs in intervention and comparison areas, and the collection of service statistics from trained ANMs. A pre/post quasi- experimental design was employed to assess changes in recent mothers' and pregnant women's knowledge and use of MNH services and practices using interviews.

Results: A total of 37ANMs and over 2600 community health workers covering 223 villages were trained. At baseline, ANMs only provided outpatient services but at endline, the majority was conducting deliveries using evidence-based practices such as active management of the third stage of labor and partograph. The proportion of women who delivered with an ANM in the experimental group increased significantly —from 6% at baseline (n=799) to 13% at endline (n=701). The practice of BP/CR increased significantly for pregnant women and recent mothers in the experimental groups. Knowledge of postpartum care increased significantly for these groups, and the practice of essential newborn care increased among recent mothers.

Conclusions: Skilled birth attendance increased. The intervention should be scaled up to other districts in Jharkhand with minor modifications. The improved ANM training approach should be integrated into preservice education for ANMs at the national level.