Obstetric first aid in the community--partners in safe motherhood. A strategy for reducing maternal mortality.

The unacceptably high levels of maternal mortality that are prevalent throughout the developing world are a product of many factors; most notably, these include nonexistent, inaccessible or inadequate facility-based emergency care, poorly developed referral linkages, predominance of home-based care by attendants and family members who are poorly equipped to respond to emergencies, and the complexities of problem recognition and decision making during emergencies leading to inappropriate or delayed action. This paper describes an innovative community-oriented strategy that has been designed to reduce maternal mortality and that targets women, families, and traditional birth attendants (TBAs) using two complimentary training interventions. The strategy reflects the authors' conviction that the training of professional and paraprofessional health workers in emergency care is essential, but that it must be complemented by the education and mobilization of families, communities, and TBAs who must, in turn, come to common perceptions on the need for and means of intervening to prevent a maternal death. Collaborating with partners in the US Agency for International Development-funded Primary Providers Training and Education in Reproductive Health Project. Special Project staff of the American College of Nurse-Midwives will lead development and testing of the strategy through operations research activities in selected countries.