I often seem to have babies on the brain these days, most likely because many of my college friends who got married a year or two ago are beginning to have children. For my generation, this of course means that pictures of a now-pregnant friends or new babies wrapped tightly in blankets are constantly popping up on my Facebook feed. One particular friend’s experience caught my eye, however, because she impressed (or shocked) most of us by delivering her first child, a baby girl named Evelyn, at home. While thinking about it, it struck me that while home births are so unusual (and often frowned upon) in the U.S., they are much more supported in Europe – and they are often the only option for mothers in developing countries.
According to the WHO, skilled attendance at births is considered to be the single most important intervention for ensuring safe motherhood – this means both the presence of a accredited health professional (doctor, nurse, or midwife) and an environment that allows for access to emergency obstetric care. Increasing the number of births with skilled attendance is crucial to reducing the 536,000 maternal deaths and 3.7 million newborn deaths that occur globally each year. Unfortunately, only about 62% of births in the developing world are attended by a skilled practitioner; in some countries, this figure is less than 20%. Additionally, there are regional disparities: while improvement in the proportion of assisted births has increased worldwide, sub-Saharan Africa and southern Asia lag behind other areas, and rural and impoverished women are less likely to receive skilled care.
Many of communities in rural or resource-poor areas already have traditional birth attendants who, though they have no formal medical training, are respected by the residents. While some countries, such as Kenya, have banned these women from practicing to try to encourage women to go to the hospital, others argue that this will only marginalize women who cannot afford medical care (or the transportation to get there). A more constructive approach, utilized by the MOM Project (mobile obstetric medics) on the Thai-Burma border, mobilized the traditional birth attendants in the area to improve health outcomes and could serve as a model for other resource-poor areas. Burma (Myanmar), which spends about 50 cents per capita (about 3% of its budget) on healthcare, has some of the worst health indicators in the world, and the ethnic groups along the borders are even worse off than the rest of the country. This intervention, designed by researchers at Johns Hopkins, incorporated traditional birth attendants into a three-tiered provider network designed to improve access to skilled care. Traditional birth attendants improved antenatal care services, health workers provided supplies and worked to prevent post-birth complications, and maternal health workers provided oversight, training, and emergency care. The intervention increased prenatal care and postnatal visits within seven days, malaria testing and ITN use, de-worming, and vitamin use. Other studies have shown similar improvements in mortality and referral rates after training traditional birth attendants. This underscores the importance of mobilizing traditional birth attendants to improve maternal and newborn health, particularly in areas where medical facilities and trained personnel may not become available any time soon.
MDG 5, which focuses on maternal health, aims to reduce maternal mortality rates by 75%. As countries strive toward this goal, traditional birth attendants could serve as a valuable resource to bridge the gap to skilled maternal care until the capacity of health systems can be built up to provide skilled attendance for every birth.