title: Towards universal access to skilled birth attendance: the process of transforming the role of traditional birth attendants in Rural China.
abstract: BACKGROUND
  Institution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. However, the question of how to engage traditional birth attendants (TBAs) in the advocacy campaign for SBA poses a number of challenges. This paper aims to demonstrate how TBAs in rural regions of China have been integrated into the health system under a policy of institutional delivery.
  
  
  METHODS
  Research was conducted through literature and document reviews and individual in-depth interviews with stakeholders of the safe motherhood program in rural Guangxi Zhuang Autonomous Region, China. A total of 33 individual interviews were conducted with regional and local politicians, policy makers, health managers, health providers, civil society members, village cadres for women affairs, former TBAs, village maternal health workers, mothers and their mother-in-laws.
  
  
  RESULTS
  Since 1998, TBA's traditional role of providing in-home care during childbirth has been restructured and their social role has been strengthened in rural Guangxi. TBAs were redesigned to function as the linkage between women and the health system. A new policy in 1999 shifted the role of TBAs to village maternal health workers whose responsibilities were mainly to promote perinatal care and institution-based delivery of pregnant women. This successful transformation involved engaging with government and other actors, training TBAs for their new role, and providing incentives and sanctions for human resources management.
  
  
  CONCLUSIONS
  The China experience of transforming the role of TBAs in Guangxi rural area is an example of successfully engaging TBAs in promoting institution-based childbirth.
authors.affiliation: Global Health Institute, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China.|School of Public Health, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, China.|Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Global Health Institute, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China. xqian@fudan.edu.cn.|School of Public Health, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, China. xqian@fudan.edu.cn.|Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, China. xqian@fudan.edu.cn.
authors.forename: Xu
authors.initials: X
authors.lastname: Qian
authors.affiliation: Maternal and Child Health Hospital, Guangxi Autonomous Region, 225 Xinyang Road, Nanning, 530003, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Chen
authors.affiliation: Shanghai Municipal Center for Disease Control and Prevention, 1380 Western Zhongshan Road, Shanghai, 200336, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Escobar
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Story
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
mesh_terms: D002681:China; D005260:Female; D006297:Health Services Accessibility; D006700:Home Childbirth; D006801:Humans; D008880:Midwifery; D024802:Nurse's Role; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D012424:Rural Population
keywords: Institution-based childbirth; Maternal mortality; Skilled birth attendance; Traditional birth attendant