Open Access Research article

Home birth attendants in low income countries: who are they and what do they do?

Ana Garces1, Elizabeth M McClure2, Elwyn Chomba3, Archana Patel4, Omrana Pasha5, Antoinette Tshefu6, Fabian Esamai7, Shivaprasad Goudar8, Adrien Lokangaka6, K Michael Hambidge9, Linda L Wright10, Marion Koso-Thomas10, Carl Bose11, Waldemar A Carlo12, Edward A Liechty13, Patricia L Hibberd14, Sherri Bucher13, Ryan Whitworth2 and Robert L Goldenberg15*

Author Affiliations

1 IMSALUD, Guatemala City, Guatemala

2 Research Triangle Institute, Durham, NC, USA

3 Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia

4 Indira Ghandi College of Medicine, Nagpur, India

5 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

6 Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo

7 Department of Pediatrics, Moi University, Eldoret, Kenya

8 Department of Medical Education, Jawaharlal Nehru Medical College, Belgaum, India

9 Department of Pediatric Nutrition, Denver University School of Public Health, Denver, CO, USA

10 Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

11 Department of Pediatrics University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

12 University of Alabama at Birmingham, Birmingham, AL, USA

13 Department of Pediatrics, Indiana University, Indianapolis, IN, USA

14 Massachusetts General Hospital, Boston, MA, USA

15 Department Obstetrics and Gynecology, Columbia University, NY, USA

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BMC Pregnancy and Childbirth 2012, 12:34  doi:10.1186/1471-2393-12-34

Published: 14 May 2012



Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites.


Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia).


A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home.


Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality.

Home births; Traditional birth attendants; Perinatal mortality