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Behavior Change Following Implementation of Home-Based Life-Saving Skills in Liberia, West Africa


  • Jody R. Lori CNM, PhD,

  • Elikem E. Amable CNM, MS,

  • Sara G. Mertz CNM, MS,

  • Kathleen Moriarty CNM, PhD

Jody R. Lori, CNM, PhD, FACNM, University of Michigan, School of Nursing, Director of Global Outreach, Deputy Director of WHO Collaborating Center, 400 N. Ingalls Building, Room 4320, Ann Arbor, MI 48109. E-mail:


Introduction: Home-Based Life-Saving Skills (HBLSS) has been fully integrated into Liberia's long-term plan to decrease maternal and newborn mortality and morbidity, coordinated through the Ministry of Health and Social Welfare. The objective of this article is to disseminate evaluation data from project monitoring and documentation on translation of knowledge and skills obtained through HBLSS into behavior change at the community level.

Methods: One year after completion of HBLSS training, complication audits were conducted with 434 postpartum women in 1 rural county in Liberia.

Results: Sixty-two percent (n = 269) of the women were attended during birth by an HBLSS-trained traditional midwife or family member, while 38% (n = 165) were attended by a traditional midwife or family member who did not receive HBLSS training. Home-Based Life-Saving Skills–trained birth attendants performed significantly more first actions (life-saving actions taught to be performed after every birth) than the attendants not HBLSS trained. Fourteen percent of our sample (n = 62) reported too much bleeding following the birth. Of these women, approximately half (n = 29) were attended by an HBLSS-trained traditional midwife or family member. There was a significant difference in secondary actions (those actions taught to be performed when a woman experiences too much bleeding following childbirth) that were reported to have been performed by HBLSS-trained attendants (mean 5.26, standard deviation [SD] 1.88) and untrained attendants (mean 2.73, SD 1.97; P < .0001).

Discussion: Our findings suggest that HBLSS knowledge is being transferred into behavior change and used at the community level by traditional midwives and family members.