Where there are (few) skilled birth attendants.

Area of Science:

• Global Health
• Maternal Health
• Public Health Policy

Background:

• Maternal mortality remains high in developing countries, with many births occurring at home without skilled attendants.
• Existing strategies focus on training skilled birth attendants and upgrading facilities, but these do not meet immediate needs for millions of women.
• A significant burden of maternal deaths is concentrated in 28 countries where less than half of births are attended by skilled personnel.

Purpose of the Study:

• To propose a complementary, cost-effective strategy to rapidly reduce maternal mortality in regions with high rates of home births without skilled attendants.
• To identify immediate interventions that can be implemented by existing community health workers.

Main Methods:

• Analysis of maternal mortality data and trends in countries with low skilled birth attendant rates.
• Proposal of training community-based birth attendants in primary and secondary prevention technologies.
• Focus on interventions such as misoprostol, family planning, blood loss measurement, and postpartum care.

Main Results:

• Current trends indicate slow progress in increasing skilled birth attendant rates in high-burden countries.
• Community-based training offers a rapid and cost-effective approach to supplement existing safe motherhood efforts.
• Targeting women in the lowest economic quintiles ensures equitable benefit distribution.

Conclusions:

• Training community birth attendants in essential preventive and immediate care skills is crucial for rapid maternal mortality reduction.
• This strategy addresses the immediate needs of women delivering at home without skilled attendants.
• Empowering community health workers enhances the reach and effectiveness of global safe motherhood initiatives.