Does Traditional Birth Attendant Training Increase Use of Antenatal Care? A Review of the Evidence


  • Lynn M. Sibley CNM, PhD,

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    • Lynn M. Sibley, CNM, PhD, is an Associate Clinical Professor and Academic Coordinator of the Lillian Carter Center for International Nursing, Nell Hodgson Woodruff School of Nursing. She holds a joint appointment in the Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia. At the time this research was conducted, she was Senior Technical Advisor for the Department of Global Outreach of the American College of Nurse-Midwives.

  • Theresa Ann Sipe CNM, PhD,

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    • Theresa Ann Sipe, CNM, PhD, is an Assistant Professor and Statistician for College of Health and Human Sciences at the Georgia State University and holds an adjunct appointment in the Rollins School of Public Health at Emory University, Atlanta, Georgia.

  • Marge Koblinsky PhD

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    • Marge Koblinsky, PhD, is Senior Scientist with the Department of Population and Family Health Science, Johns Hopkins Bloomberg School of Public Health and Coordinator of the North American Consortium, Initiative for Maternal Mortality Programme Assessment.

Lillian Carter Center for International Nursing, Emory University, 1520 Clifton Road, Suite 440, Atlanta, GA 30322. E-mail:


A combined narrative review and metanalytic review was conducted to summarize published and unpublished studies completed between 1970 and 2002 on the relationship between traditional birth attendant (TBA) training and increased use of professional antenatal care (ANC). Fifteen studies (n = 15) from 8 countries and 2 world regions were analyzed. There are, to varying degrees, positive associations between TBA training and TBA knowledge of the value and timing of ANC services, TBA behavior in offering advice or assistance to obtain ANC, and compliance and use of ANC services by women cared for by TBAs or living in areas served by TBAs. There is a serious lack of information about TBA training program characteristics. Although the findings cannot be causally attributed to TBA training, the results suggest that training may increase ANC attendance rates by about 38%. This magnitude of improvement could contribute to a reduction in maternal and perinatal mortality in areas where women have access to quality antenatal and emergency obstetric care. There is an urgent need to improve capacity for evaluation and research of the effect of TBA training programs and other factors that influence women's use of ANC services.