Thus there is an urgent need for training and retraining of these personnel. It is essential to detect abnormal conditions in mothers and children to be able to carry out emergency measures and know when referral is necessary. Traditional birth attendants are no real permanent substitutes for skilled attendants, although in some countries circumstances have forced a liaison between the two, as an interim measure, recognizing the need for referral to the trained professional. We have been able to identify the barriers that prevent women from having access to the quality health care they need. Surprisingly, these barriers turn out to be similar the world over.
Distance is one such barrier, but it is by no means the most serious.
Again, evidence is now accumulating from around the world about the kinds of interventions that can help overcome such barriers. They include community-based transport and insurance schemes, decentralization of care, establishing maternity waiting homes, and participatory workshops bringing women and health care providers together to discuss how services can be more in tune with women's needs and perceptions. Barriers such as these are by no means limited to the developing world. In developed countries, too, increased attention is currently focused on the need to humanize medical care during pregnancy and childbirth, as well as on the importance of ensuring access for all, including the most disadvantaged sectors of society. Cost should not be the major barrier to provision of services.