The impact of maternal mortality interventions using traditional birth attendants and village midwives.

Traditional birth attendants (TBAs) and village midwives have been employed in many interventions to reduce maternal mortality in developing countries. This study reviews the results of 15 TBA- and midwife-based interventions that aim to improve skilled assistance in delivery and recognition and referral of complications. Outcome measures used to evaluate the impact of the programmes varied. Five of the five programmes reviewed that evaluated their impact on maternal mortality demonstrated a decline in maternal mortality ratios, two of three studies measuring morbidity-related indicators found improvement of some but not all morbidity outcomes, six of seven showed a trend of improved referral rates, and three of three found high levels of knowledge retention among trained TBAs. Programmes with the greatest impact utilised TBAs and village midwives within multisectoral interventions. These findings suggest that TBAs and village midwives contribute to positive programme outcomes. Further investigation is needed to determine the nature of their contribution within larger programmes.