Birth attendant training course may be global model for safer birth care in poor communities          

Skilled birth attendants
Skilled birth attendants encourage breast feeding with baby they delivered. © 2016 SMRU.

11 October 2016, Mae Sot (Thailand) – Training local Karen and Burman women as skilled birth attendants in refugee settings resulted in no adverse perinatal outcomes and many positive outcomes such as a drop in stillbirths and infant deaths and more babies being born in clinics rather than at home, says a new study published in the scientific journal PLOS ONE

Developed on the Thai-Myanmar border, the training programme may be a model that could be used in poor, remote or conflict-affected communities around the world, experts say.

“This is a prime example of helping to reduce perinatal mortality and maintain low rates of maternal mortality in childbirth in a very disadvantaged population. This model could be translated to other low-resource, low-income settings,” said Stephen Kennedy, Professor of Reproductive Medicine, University of Oxford, UK.

The study examined more than 15,000 births from 2008-2015, after the Shoklo Malaria Research Unit (SMRU) had begun giving accelerated skilled birth attendant training to provide safe maternity care when faced with a shortage of qualified midwives in its clinics on the Thai-Myanmar border. 

The training to migrant and refugee Karen and Burman women living in north-western Thailand near the Myanmar border resulted in no adverse perinatal outcomes and many positive outcomes such as a reduction in stillbirths and neonatal deaths, a 25% increase in clinic births, a 16.4% drop in the use of episotomies and 99% use of a partogram (a composite record of key maternal and fetal data) during labour.

In South-East Asia fewer than half of women giving birth have access to a skilled birth attendant, according to UN figures. Most maternal deaths and disability are preventable if the woman has access to care from a skilled birth attendant.

Faced with a predicted shortage of skilled birth attendants at Maela, the largest refugee camp on the Thai-Myanmar border, in 2008 the Shoklo Malaria Research Unit (SMRU) invited a registered midwife to develop a six-month, locally adapted skilled birth attendants curriculum using core guidelines from the International Confederation of Midwives (ICM), the International Federation of Obstetricians and Gynaecologists (FIGO) and the WHO.

“There is a shortage of qualified midwives worldwide and midwives and skilled birth attendants can play a central role in reducing maternal and new-born mortality and morbidity, particularly in neglected populations and resource-limited settings,” said Ms Adrienne White, the study’s author.

“In refugee settings, areas of conflict or where national systems have collapsed, evidence-based skilled birth attendant training adapted to local conditions should be accelerated to provide immediate care to vulnerable populations and ensure the continuation of practices that foster normal labour and birth,” said Ms. White.

Students at a small group workshop in Maela
Students at a small group workshop on family planning in the Maela Refugee Camp on the Thai-Myanmar border, part of their postnatal care core clinical skills training. © 2016 SMRU.

A unit of the Bangkok-based Mahidol Oxford Tropical Medicine Research Unit (MORU), SMRU is based in the refugee camps and migrant communities along the Thai-Myanmar border. The five SMRU clinics have provided free, basic humanitarian care to refugees since 1986 and in migrant communities since 1998.

“Pregnant women and new-borns are very vulnerable so a safe level of basic and emergency obstetric and new-born care is imperative,” said Oxford Prof Rose McGready, Deputy Director of SMRU. “Many countries are struggling to provide safe birth care. To bridge this gap we must trust and develop local people’s skills. This study should help international authorities and NGOs, and national health programmes in resource-limited settings consider their recommendations and training for birthing services.”

Led by researchers at the Shoklo Malaria Research Unit (SMRU) in Thailand, and the Midwifery Research and Education Unit, Hannover Medical School, Germany, among others, the study was funded by the Wellcome Trust (UK), StichtingMalariadokters (The Netherlands) and the Australian Volunteers for International Development (AVID).

Notes for editors

The Mahidol-Oxford Tropical Medicine Research Unit (MORU),,  is a research collaboration between Mahidol University in Thailand and Oxford University and the Wellcome Trust in the UK.  A unit of the Mahidol Oxford Tropical Medicine Research Unit (MORU), the Shoklo Malaria Research Unit (SMRU) is based in Mae Sot, Thailand, and works in the refugee camps and migrant communities along the Thai-Myanmar border.


White AL, Min TH, Gross MM, Kajeechiwa L, Thwin MM, Hanboonkunupakarn B, Than HH, Zin TW, Rijken MJ, Hoogenboom G, McGready R, Accelerated Training of Skilled Birth Attendants in a Marginalized Population on the Thai-Myanmar Border: A Multiple Methods Program Evaluation, PLoS ONE 11(10): e0164363. doi:10.1371/journal.pone.0164363.