1. Traditional Birth attendant in rural Haiti Agathe Jn Baptiste, MD

2. Indicators 8.5 million people; 65% in extreme poverty Life expectancy at birth: 52 25 doctors and 11 nurses/100,000 people Under-5 mortality rate, 2005 : 120 Infant mortality rate (under 1), 2005 : 84 Annual no. of births (thousands), 2005: 255 Skilled attendant at delivery (%), 1997-2005: 24 Maternal mortality ratio†, 1990-2005, 520 Maternal mortality ratio†, 2000, Lifetime risk of maternal death. 1 in: 29

3. Who and How  Assists the mother during childbirth  Have acquired skills by delivering babies herself, or through apprenticeship of other TBAs.  Self attendance of birth  Have cut the umbilical cord once

4. More than that Like in other developing countries they are primary pregnancy and childbirth care provider Traditional healers Herbalists

5. Characteristics Most traditional midwives live in rural and often isolated communities Illiterate Women / Men Mostly Elders

9. Role of the TBA and why home deliveries preferred  Emotional support  Traditional delivery care  Post partum care  Health advice and education  Long distance from health facilities

10. Role (cont.) Baby care Umbilical cord Bath (Taboo) Lock (special beverage given to the baby facilitating the first feces or meconium) Mother Hip bath (Herbs) Medicines Corporal massage Nutrition

11. Lack of referral TBA Seen as incompetent Not been paid Pregnant Women Fear Pregnant women usually praise TBA to do everything they can to avoid Hospital (expenses, travel, clothes, food) Considered mistreated by Health professional Episiotomy (considered not normal) Would not be able to get the placenta

13. The major emphasis of training Increased safety in the TBAs practice, such as cleanliness, especially washing of the hands and clean or sterile cord-cutting procedures Non-interference during labor Identification and referrals of mother at risk Doing away with traditional harmful practices and leaving alone or supporting those that contribute to psychosocial support

14. Other topics Human anatomy focusing upon the reproductive system reproduction And pregnancy from fecundation to delivery Family planning Nutrition Breastfeeding

25. Some problems to be addressed Lack of an organized system to supervise trained TBAs Provide continued training for them Availability of basic supplies, such as cord care kits Bridge between the community and the formal health system