An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

This cluster-randomized trial in rural Pakistan compared perinatal and maternal outcomes in control districts with the outcomes in districts in which traditional birth attendants were trained and were issued disposable delivery kits and in which obstetrical teams provided outreach clinics for antenatal care. Perinatal mortality was reduced significantly in the intervention districts. This trial in rural Pakistan compared perinatal and maternal outcomes in control districts with the outcomes in districts in which traditional birth attendants were trained and integrated into an improved health care system. Perinatal mortality was reduced significantly in the intervention districts. There are an estimated 4 million neonatal deaths and 500,000 maternal deaths worldwide each year. 1 , 2 The vast majority of these deaths occur in developing countries, where 43 percent of births are attended by traditional birth attendants, the proportion generally being higher in rural areas. Training traditional birth attendants was a central component of the Safe Motherhood Initiative launched by the World Health Organization, the United Nations Children's Fund (also known as UNICEF), the United Nations Population Fund, the World Bank, and other organizations, but the lack of evidence from randomized, controlled trials to inform decision making has prohibited widespread . . .