258437 Increasing access to reproductive health care in Chiapas, Mexico by improving capacity of traditional and skilled birth attendants

Monday, October 29, 2012

May Lynn Tan, MHS , Global Pediatric Alliance, San Francisco, CA
Alejandra Alvarez , Global Pediatric Alliance, San Francisco, CA
Martha Moreno, PhD , Training Program, Global Pediatric Alliance, San Francisco, CA
Scott Cohen, MD , Global Pediatric Alliance, San Francisco, CA
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.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
1. Name the logistical and cultural barriers to increasing access to skilled birth attendants in Chiapas, Mexico. 2. Differentiate between the skill sets of traditional versus skilled birth attendants. 3. Describe a community-based model for increasing skilled attendance at birth, and discuss ways in which the model can be adapted to other settings.

Keywords: Midwifery, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The organization of which I am executive director offers maternal and child public health services in Latin America. I have worked on issues affecting maternal and child health and nutrition for 12 years.
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.