title: Home birth attendants in low income countries: who are they and what do they do?
abstract: BACKGROUND
  Nearly half the world's babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites.
  
  
  METHODS
  Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia).
  
  
  RESULTS
  A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home.
  
  
  CONCLUSIONS
  Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.
authors.affiliation: IMSALUD, Guatemala City, Guatemala.
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Goudar
authors.forename: Adrien
authors.initials: A
authors.lastname: Lokangaka
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Carl
authors.initials: C
authors.lastname: Bose
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: Sherri
authors.initials: S
authors.lastname: Bucher
authors.forename: Ryan
authors.initials: R
authors.lastname: Whitworth
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D003150:Community Health Workers; D003906:Developing Countries; D046689:Fetal Mortality; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008428:Maternal Mortality; D008880:Midwifery; D011203:Poverty; D011361:Professional Competence