TY - JOUR
T1 - Does traditional birth attendant training improve referral of women with obstetric complications
T2 - A review of the evidence
AU - Sibley, Lynn
AU - Sipe, Theresa Ann
AU - Koblinsky, Marge
N1 - Funding Information:
We thank G.J. Armelagos, K.S. Barrett, E.P. Finley, V. Kamat, K. Liese, P.J. Long, S. Morreale and C. Quimby for their contribution to the meta-analysis of TBA training effectiveness. This study was conducted as part of IMMPACT (Initiative for Maternal Mortality Programme Assessment). IMMPACT is coordinated by the University of Aberdeen and funded by the Bill and Melinda Gates Foundation, United Kingdom Department for International Development, and the United States Agency for International Development. The views expressed in IMMPACT documents by named authors are solely the responsibility of those authors and in no way reflect the official opinions of the funding bodies.
PY - 2004/10
Y1 - 2004/10
N2 - This narrative and meta-analytic review of the effectiveness of traditional birth attendant (TBA) training to improve access to skilled birth attendance for obstetric emergencies produced mixed results. Among 16 studies that fit the inclusion criteria, there is a medium, positive, non-significant association between training and TBA knowledge of risk factors and conditions requiring referral; and small, positive, significant associations between TBA referral behavior and maternal service use. These results cannot be causally attributed to TBA training because of the overall quality of studies; moreover, in several studies TBA training was a component of integrated intervention packages. The effort and expense of more rigorous research focusing on TBA training to improve access to emergency obstetric care are difficult to justify. The referral process is complex; the real effects of TBA training on TBA and maternal behavior are likely to be small; and while the proportion of TBA-attended births worldwide varies, it is, on average, quite low. The behavioral determinants and logistical barriers to care seeking for emergency obstetric care are generally well known. We suggest a more promising research agenda would reposition the questions surrounding referral into a broader ecological perspective.
AB - This narrative and meta-analytic review of the effectiveness of traditional birth attendant (TBA) training to improve access to skilled birth attendance for obstetric emergencies produced mixed results. Among 16 studies that fit the inclusion criteria, there is a medium, positive, non-significant association between training and TBA knowledge of risk factors and conditions requiring referral; and small, positive, significant associations between TBA referral behavior and maternal service use. These results cannot be causally attributed to TBA training because of the overall quality of studies; moreover, in several studies TBA training was a component of integrated intervention packages. The effort and expense of more rigorous research focusing on TBA training to improve access to emergency obstetric care are difficult to justify. The referral process is complex; the real effects of TBA training on TBA and maternal behavior are likely to be small; and while the proportion of TBA-attended births worldwide varies, it is, on average, quite low. The behavioral determinants and logistical barriers to care seeking for emergency obstetric care are generally well known. We suggest a more promising research agenda would reposition the questions surrounding referral into a broader ecological perspective.
KW - Emergency obstetric care
KW - Meta-analysis
KW - Obstetric complications
KW - Referral system
KW - Safe motherhood
KW - Traditional birth attendant training
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U2 - 10.1016/j.socscimed.2004.02.009
DO - 10.1016/j.socscimed.2004.02.009
M3 - Article
C2 - 15279931
AN - SCOPUS:3242764464
SN - 0277-9536
VL - 59
SP - 1757
EP - 1768
JO - Ethics in Science and Medicine
JF - Ethics in Science and Medicine
IS - 8
ER -