title: Role of traditional birth attendants in improving reproductive health: lessons from the family health project, Sindh.
abstract: OBJECTIVE
  
  
  
  OBJECTIVE
  Despite strenuous efforts, the maternal mortality rate in Pakistan remains high. The national figure of 340 maternal deaths per 100,000 live births tends to hide the fact that in some rural areas it is as high as 700 per 100,000 live births. Not surprisingly, in Pakistan only 20% of births are attended by a trained health professional. In most rural areas, home to almost 70% of the population, traditional birth attendants (TBAs) deliver 90% of the births. TBAs, therefore, play a crucial role in the delivery of maternal health care in Pakistan. Realizing the importance of TBAs, the Family Health Project (FHP) of the Department of Health Sindh, financed by the World Bank, tried to enhance their knowledge and skills through comprehensive training programs. FHP provided training to 650 TBAs in 10 districts. The training was provided by the Department of Community Health Sciences (CHS) of the Aga Khan University (AKU) who acted as technical consultant to the project.
  
  
  METHODS
  A community-based qualitative post-intervention survey.
  
  
  RESULTS
  Post-intervention survey of this seven-year project (1992-1999) revealed that (a) the training enhanced the knowledge and skills of the TBAs, (b) the trained TBAs provide more broader health care services and (c) they enjoy greater community acceptance and provide greater consumer satisfaction. It also showed that the TBAs remain the most available and accessible health resource in most rural settings.
  
  
  CONCLUSIONS
  It is imperative that TBAs and their continuing training should remain central to any reproductive health intervention along with an effective referral system linking them to well-equipped emergency obstetric care facilities. However, the assessment clearly demonstrated that an integrated referral system backed by effective emergency obstetric care is essential to the success of the TBA training program.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi.
authors.forename: A
authors.initials: A
authors.lastname: Islam
authors.forename: F A
authors.initials: FA
authors.lastname: Malik
mesh_terms: D006801:Humans; D008428:Maternal Mortality; D008880:Midwifery / Q000193:education*; D010154:Pakistan