Increasing access to reproductive health care in Chiapas, Mexico by improving capacity of traditional and skilled birth attendants

Training traditional birth attendants (TBAs) as a strategy to improve maternal health in developing countries is controversial. Studies show that while TBA training alone has not had a significant impact on maternal mortality, TBAs have unique potential to provide a variety of beneficial health services in resource-poor settings. Increasing access to skilled birth attendants (SBAs) has been shown to effectively reduce maternal mortality. However, recruiting SBAs to work in areas of greatest need presents cultural and logistical challenges. Working with indigenous Mayan communities in the state of Chiapas, Mexico, Global Pediatric Alliance has established a program designed to accomplish two objectives: 1. to improve the capacity of the communities' TBAs in providing emergency referrals, prenatal and postpartum care, and family planning education; and 2. to prepare a subset of qualified participants to be trained as SBAs. The main goal of the program is to create a system that integrates the services of TBAs and SBAs to extend community access to essential and emergency obstetric care. Our presentation will describe evaluation data on the impact of training on TBA knowledge and practices, the process of selecting candidates for SBA training, the necessary linkages formed with existing healthcare infrastructure, and the cultural implications of building capacity within a community as an alternative to recruiting skilled midwives from outside. We will also discuss recommendations for adapting this model to other communities where a majority of births are attended by TBAs.