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Skilled Birth Attendants: The Last Mile Link


Safe Delivery Safe Mother aims to address high fertility and reduce maternal mortality in Pakistan. Recently, the group implemented a pilot project that trained over 160 government-deployed Skilled Birth Attendants (SBAs) in the Multan district of the Punjab province. The six-month pilot project concluded in February. The Safe Delivery Safe Mother team is in the process of sharing recommendations on how to increase the use and acceptance of post-partum family planning with the Pakistani government and other partners.

Safe Delivery Safe Mother

Saima Faiz, from Jalalpur Khaki, Pakistan, says that women in her community have an average of 12 to 14 children. She works in her community’s Basic Health Unit but has felt uncertain about how to help women who want to have safe and affordable family planning choices. After attending a recent training on post-partum family planning methods presented by Safe Delivery Safe Mother, her confidence has increased. She found learning how to use the Medical Eligibility Criteria for Contraceptive Use (MEC), a tool created by the World Health Organization to prescribe suitable family planning methods, particularly helpful. Safe Delivery Safe Mother translated it into her native Urdu, which enabled her to easily incorporate it into her daily clinical practice. The MEC is now an integral part of her counseling toolkit.

Watch the video to view Safe Delivery Safe Mother’s field trainings. Credit: Safe Delivery Safe Mother.

Pakistan has the highest fertility rate in the South Asian region, with 3.6 children per woman and an annual population growth rate of 2.4%. While Safe Delivery Safe Mother believes strongly that women must be able to choose the size of their families, we also know that women and their families are healthier when births are spaced. However, in some rural areas, such as Jalalpur Khaki, people believe that family planning prevents births altogether.

Training Accomplishments

To address high fertility and maternal death rates, Safe Delivery Safe Mother implemented a pilot project funded through The Pitch regional competition, a knowledge management innovation created by Knowledge SUCCESS and sponsored by USAID. The project trained over 160 government-deployed Skilled Birth Attendants (SBAs) in the Multan district, located in the Punjab province (the most populous in Pakistan, with a population of over 110 million). SBAs are often a community’s only source of skilled care, seeing women at a time in their lives when they are most focused on childbearing and health.

Training photo from Safe Delivery Safe Mother
Credit: Safe Delivery Safe Mother

The six-month activity concluded in February; now, the Safe Delivery Safe Mother team is in the process of sharing recommendations on how to increase the use and acceptance of post-partum family planning with the Pakistani government and our partners. We learned many valuable lessons during this project, including:

  • Skilled Birth Attendants are eager to learn about long-acting reversible contraceptive methods and how to administer various forms of post-partum family planning within 48 hours of birth.
  • It is integral to develop and translate training curricula, materials, and tools into local languages. This increases acceptance by both SBAs and their patients at primary health care facilities. As our materials are in the local language, they serve a dual purpose: training SBAs and being used for counseling and raising awareness for patients at primary health care facilities and community clinics.
  • It is challenging to do this work in rural environments with low literacy levels and limited accessibility. It is particularly difficult to conduct outreach and follow-up monitoring. In order to address these challenges, we collected data by visiting health facilities and received manual reporting on the tracking tools—which were regularly checked, corrected, and updated. While it isn’t easy to do in these settings, we worked to ensure the most thorough data reporting from SBAs, with the highest quality and accuracy.

“It is integral to develop and translate training curricula, materials, and tools into local languages. This increases acceptance by both SBAs and their patients at primary health care facilities.”

Looking to the Future

Despite challenges, it is clear that SBAs and women who give birth are interested in the benefits of postpartum family planning. Developing materials for specific stakeholders—including pictorial guides in local languages—increases the uptake of various family planning methods.

The Safe Delivery Safe Mother approach is easily replicated in other regions and provinces, and we hope that our partners will seek out more information on our website or by contacting us. Women must have the ability to plan their families, space their children, and ensure healthier births. Data is not the story—people are.

Tamar Abrams contributed to the development of this post.

Mehreen Shahid

Founder and Chairperson, Safe Delivery Safe Mother NGO, Pakistan

Mehreen is the founder of the Safe Delivery Safe Mother (SDSM) NGO, which provides essential and life-saving maternal and reproductive healthcare in Pakistan. She strengthens the public health system through data-driven solutions and building the capacity of frontline Community Health Workers. SDSM has trained over 1,000 Skilled Birth Attendants, who positively impact more than 300,000 annual pregnancies and deliveries across Punjab and Gilgit-Baltistan. Her vision is to provide affordable and accessible maternal and reproductive healthcare to the remotest and most underserved areas of Pakistan. She has extensive experience in health, education, social protection, and public-private partnerships, among other sectors. Previously, she has worked at the Clinton Foundation, the World Bank, and McKinsey & Company, in Pakistan, the US, the UK, and the Middle East. She has a Master of Public Policy (MPP) from the University of Oxford, and is the recipient of the prestigious Annemarie Schimmel Scholarship Award. She is an alumna of the Global Health Corps and Forbes Ignite Fellowship programs. She enjoys outdoor sports, poetry, and travel.