Re-examines the role that traditional birth attendants can be expected to play in efforts to reduce maternal morbidity and mortality. Addressed to policy-makers and planners, the booklet aims to encourage realistic decisions based on a firm understanding of what TBAs can and cannot do and the extent to which their strengths and limitations might be affected by training programmes. Throughout, the use of traditional birth attendants is regarded as an interim solution in pursuit of the greater goal of giving all women and children access to acceptable, professional, modern health care. The opening sections clarify the actual and potential role of TBAs in maternal and child health and family planning. Against this background, other sections offer practical advice that can help decision-makers select the best options for implementing or strengthening TBA programmes. An explanation of the goals and objectives of TBA programmes is followed by an outline of 12 steps which can be initiated in order to implement a programme with the greatest chance of achieving its objectives. Of particular practical value is a section explaining nine issues - whether concerning licensing and certification or the risk of HIV transmission - that invariably emerge when decisions about a particular programme are made. The remaining sections alert readers to the limitations of TBA training programmes, including their inability, when used as a single approach, to improve maternal and child health care, and discuss the future role of trained and supervised TBAs within the context of the drive to give women access to modern health care and the services of a professional midwife or physician. Despite the importance of this ultimate goal, the booklet concludes that there will always be a need to keep what is best in TBA care: the sense of caring, the human approach, and the response to cultural and spiritual needs.

eng fre spa.

hin swa.

WHODOC

WHO monograph

4