476 J Health Popul Nutr Dec 2006 for maternal mortality. Empirical evidence nonetheless suggests that hydration, keeping the bladder empty dur- ing labour, and stimulating the uterus to contract after delivery reduces postpartum haemorrhage due to uter- ine atony. Thus, there is an urgent need for research on these and on other community-based interventions that may reduce postpartum haemorrhage, a leading cause of maternal death (Fig. 2). In settings characterized by high mortality and weak healthcare systems, family and community care Sibley LM and Sipe TA extent, their number, distribution, role, status, presence of other providers, and preference of women and fami- lies. Our analysis of the 1994-2004 Demographic and Health Survey data from 44 countries for the period of three years preceding the survey (17) showed that the proportion of deliveries assisted by TBAs is extremely variable within and across countries, being highest for the rural areas. The proportion, however, is relative- ly low on average and is comparable to that of deliver- ies assisted by family members and no one combined Fig. 2. Family and community interventions with potential to reduce maternal mortality due to postpartum haemorrhage: what trained TBAs could do Pregnancy Universal Promote Promote Birth-preparedness Care-seeking APH Postnatal >24 hours Labour, birth–1st 24 hours Universal Provide Safe delivery Hydration and empty bladder Physiologic management of third stage of labour Uterine massage Breastfeeding support Care-seeking for prolonged labour and PPH Extra Postpartum haemorrhage home-based care Simplified active management of third stage of labour (e.g. misoprostol, oxytocin) Anti-shock garment Tamponade APH=Antepartum haemorrhage; PPH=Postpartum haemorrhage; TBA=Traditional birth attendant providers often include a mix of women, family mem- bers, TBAs, and other semi-skilled or skilled health workers. In these circumstances, “Are TBAs the best choice, among others, for training in health promotion and delivery care?” There are a number of considera- tions. One important consideration is the proportion of deliveries assisted by TBAs since this reflects, to a large (Table 2). It is, thus, essential to assess healthcare use- patterns, existing infrastructure, and availability of providers in local, regional and national settings for inputs into policy decision-making. We suggest that, where coverage is high, training TBAs to provide key evidence-based interventions and first-aid care for se- lected complications is a viable short-term strategy. Table 2. Proportion of deliveries assisted by unskilled attendants Type of attendant Residence Average % (SD) Range (%) TBA RUurbraaln 1229 ((1220)) 0-50 2-79 Family + other RUurbraaln 279(1(87)) <1-33 <1-62 No one RUurbraaln 25 ((25)) 0-10 <1-22 Unknown RUurbraaln <1 (<1) 0-1 <1 (<1) 0-1 Data analyzed using DHS StatCompiler (17) for 1994-2004 n=44 countries representing three world regions Percentages based on 62,492 urban births and 144,924 rural births DHS=Demographic and Health Survey; SD=Standard deviation; TBA=Traditional birth attendant