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Within a complex package of interventions, we would not be able separate the effect of enhanced support for traditional birth attendants and linkage with healthcare institutions, from that of other components in achieving these observed improvements.
The second, community-based interventions with traditional birth attendants (TBAs), better linkages to referral networks, and better informed home-birth partners, has a weaker evidence base [36], although some pilots have had positive results [37].
The primary question for our review was whether strategies incorporating training, support, and linkage of traditional birth attendants, within the complex interventions as a whole, resulted in an improvement in perinatal, neonatal, and maternal outcomes (fig 5).
The intervention in Nepal was focussed on facilitator-led women's groups [ 17, 18] and the intervention in Pakistan on linkage and training of traditional birth attendants [ 15].
Use of traditional birth attendants without an appropriate package of training, support, linkage with healthcare institutions, and resource supply is unlikely to be effective.
Our meta-analysis of cluster randomised controlled trials showed that perinatal and neonatal deaths were significantly reduced with interventions incorporating the training, linkage, and support of traditional birth attendants.
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