Taking advice from those they trust: Traditional Birth Attendants as family planning promoters and providers in rural Guatemala

Some 153/100,000 live births in Guatemala end with maternal mortality, caused in part by low contraceptive use and inadequate birth spacing. Traditional Birth Attendants (TBAs), or comadronas in Guatemala, are respected Mayan women who attend births but remain untapped resources for family planning (FP). Until now, Guatemala's Ministry of Health (MOH) believed training TBAs to offer FP was unfeasible due to their age, cultural taboos and logistics of offering FP outside health center settings. Georgetown University's Institute for Reproductive Health and the MOH designed and tested an intervention to: 1)train TBAs to provide and promote FP methods; 2)enable auxiliary nurses to supervise and support TBAs; and 3)supply TBAs with commodities through the creation of a reporting and procurement system. The intervention aims to enable TBAs to promote all FP methods; offer four methods: oral contraceptives, condoms, Standard Days Method (SDM) and Lactational Amenorrhea Method; and refer for other methods in two rural municipalities. Low-literacy pictorial job aides and training materials were developed for nurses to train TBAs. Fifty-three TBAs were trained by nurses that supervise them. The evaluation drew on data from a competency checklist administered to 48 TBAs by nurses, 10 in-depth interviews with TBAs and service statistics for six months. Results show an increase in new FP users, especially condom users. Data from interviews show TBAs identified many opportunities (e.g. home visits) to provide FP information and methods. Knowledge and counseling skills were strong for all methods. Results demonstrate feasibility of incorporating TBAs into FP service delivery systems.