The most recent meta-analysis of available data, published in the British Medical Journal in December 2011, supports the concept on which the Train Midwives Save Lives project is based: While providing a skilled birth attendant at every birth is the ultimate goal (as stated by WHO, UNFPA, etc.), the reality is that incorporating traditional birth attendants in order to reduce perinatal and maternal mortality is crucial and the evidence supports this approach.
The full article is available through this link: Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis BMJ 2011;343:d7102
I really appreciate the following succinct pictorial of what it looks like to incorporate TBAs. If I could have drawn the end-goal of Train Midwives Save Lives, this is what it would look like. Note that neonatal resuscitation, newborn care, and clean delivery kits are the key elements of training and education.
Conclusions and policy implications from the BMJ article
Use of traditional birth attendants without an appropriate package of training, support, linkage with healthcare institutions, and resource supply is unlikely to be effective. Potentially important components that support strategies incorporating traditional birth attendants and that have been proved to be beneficial10 include training and support, as well as linkage with healthcare professionals, continued skill development, access to resources such as clean birth kits and resuscitation equipment, and effective referral pathways (fig 5).
The most effective intervention to improve perinatal and maternal outcomes is the use of skilled birth attendants. Although this intervention is a central goal, the economic, geographical, political, and social realities have limited the ability of national and international efforts to ensure the presence of skilled attendants at all births. This limited coverage has resulted in critical gaps, with 52 million women giving birth without skilled attendance every year.3 Therefore, other cadres of health workers might need to be considered to extend the coverage of maternal and neonatal care. Traditional birth attendants can improve the coverage of maternal and neonatal care, and evidence from this meta-analysis suggests that they can be a component of the strategies to improve perinatal outcomes. Traditional birth attendants often represent a more feasible, culturally acceptable, and accessible option for women in developing countries.11