Abstract
In low- and middle-income countries (LMICs), where the rates of maternal mortality continue to be inappropriately high, there has been recognition of the importance of training traditional birth attendants (TBAs) to help improve outcomes during pregnancy and childbirth. In Guatemala, there is no national comprehensive training program in place despite the fact that the majority of women rely on TBAs during pregnancy and childbirth. This community case study presents a unique education program led by TBAs for TBAs in rural Guatemala. Discussion of this training program focuses on programming implementation, curriculum development, sustainable methodology, and how an educational partnership with the current national health-care system can increase access to health care for women in LMICs. Recent modifications to this training model are also discussed including how a change in the clinical curriculum is further integrating TBAs into the national health infrastructure. The training program has demonstrated that Guatemalan TBAs are able to improve their basic obstetrical knowledge, are capable of identifying and referring early complications of pregnancy and labor, and can deliver basic prenatal care that would otherwise not be provided. This training model is helping transform the role of the TBA from a sole cultural practitioner to a validated health-care provider within the health-care infrastructure of Guatemala and has the potential to do the same in other LMICs.
Highlights
The majority of mothers from low- and middle-income countries (LMICs), in rural settings, continue to seek and prefer traditional birth attendants (TBAs) over clinics and hospitals for care during pregnancy and delivery [1]
The purpose of this community case study is to describe a training program for TBAs in rural Guatemala that is redefining their role as health-care providers, integrating them into the current health-care system, and increasing access to basic prenatal care for the women they serve via a collaborative and sustainable approach
Recent systematic reviews have identified that successful programs are those that can be integrated into an existing health-care system, continue skill development of its participants for at least a year, and provide access to birth kits and resuscitation equipment [3, 4, 31]. These factors of success reported by other programs are what makes the School of POWHER a success in rural Guatemala as evidenced by the increase in knowledge of the participants, increased prenatal visits performed in the region, and increased referrals of high-risk women
Summary
The majority of mothers from low- and middle-income countries (LMICs), in rural settings, continue to seek and prefer traditional birth attendants (TBAs) over clinics and hospitals for care during pregnancy and delivery [1]. Maternal mortality ratios (MMRs) in the developing world, especially in rural regions, continue to be unacceptably high [6]. This holds true in Guatemala where the national average MMR of 88 maternal deaths per 100,000 births [5] does not reflect the major disparities that exist between rural and city births and, more importantly, between indigenous and nonindigenous women (ladinas). The strong adherence to cultural practices, lack of access, and distrust of health facilities causes the majority of Mayan women to rely on a Guatemalan TBA (comadrona) during labor and pregnancy [10]
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