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Christina Pagel - One of the best experts on this subject based on the ideXlab platform.
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How many Births in sub-Saharan Africa and South Asia will not be attended by a skilled Birth Attendant between 2011 and 2015?
BMC Pregnancy and Childbirth, 2012Co-Authors: Sonya Crowe, Martin Utley, Anthony Costello, Christina PagelAbstract:Background The fifth Millennium Development Goal target for 90% of Births in low and middle income countries to have a skilled Birth Attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving Birth unattended. We aimed to generate estimates of the absolute number of non-SBA Births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving Birth unattended. Methods For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of Births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA Births for 2011-2015 under a variety of scenarios. Results Conservative estimates are that there will be between 130 and 180 million non-SBA Births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA Births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA Births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths. Conclusions Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give Birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.
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how many Births in sub saharan africa and south asia will not be attended by a skilled Birth Attendant between 2011 and 2015
BMC Pregnancy and Childbirth, 2012Co-Authors: Sonya Crowe, Martin Utley, Anthony Costello, Christina PagelAbstract:The fifth Millennium Development Goal target for 90% of Births in low and middle income countries to have a skilled Birth Attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving Birth unattended. We aimed to generate estimates of the absolute number of non-SBA Births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving Birth unattended. For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of Births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA Births for 2011-2015 under a variety of scenarios. Conservative estimates are that there will be between 130 and 180 million non-SBA Births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA Births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA Births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths. Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give Birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.
Lynn M Sibley - One of the best experts on this subject based on the ideXlab platform.
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traditional Birth Attendant training for improving health behaviours and pregnancy outcomes
Cochrane Database of Systematic Reviews, 2012Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Danika BarryAbstract:Background Between the 1970s and 1990s, the World Health Organization promoted traditional Birth Attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training is limited but promising for some mortality outcomes. Objectives To assess the effects of TBA training on health behaviours and pregnancy outcomes. Search methods We searched the Cochrane Pregnancy and ChildBirth Group's Trials Register (18 June 2012), citation alerts from our work and reference lists of studies identified in the search. Selection criteria Published and unpublished randomised controlled trials (RCT), comparing trained versus untrained TBAs, additionally trained versus trained TBAs, or women cared for/living in areas served by TBAs. Data collection and analysis Three authors independently assessed study quality and extracted data in the original and first update review. Three authors and one external reviewer independently assessed study quality and two extracted data in this second update. Main results Six studies involving over 1345 TBAs, more than 32,000 women and approximately 57,000 Births that examined the effects of TBA training for trained versus untrained TBAs (one study) and additionally trained TBA training versus trained TBAs (five studies) are included in this review. These studies consist of individual randomised trials (two studies) and cluster-randomised trials (four studies). The primary outcomes across the sample of studies were perinatal deaths, stillBirths and neonatal deaths (early, late and overall). Trained TBAs versus untrained TBAs: one cluster-randomised trial found a significantly lower perinatal death rate in the trained versus untrained TBA clusters (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.59 to 0.83), lower stillBirth rate (adjusted OR 0.69, 95% CI 0.57 to 0.83) and lower neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82). This study also found the maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22). Additionally trained TBAs versus trained TBAs: three large cluster-randomised trials compared TBAs who received additional training in initial steps of resuscitation, including bag-valve-mask ventilation, with TBAs who had received basic training in safe, clean delivery and immediate newborn care. Basic training included mouth-to-mouth resuscitation (two studies) or bag-valve-mask resuscitation (one study). There was no significant difference in the perinatal death rate between the intervention and control clusters (one study, adjusted OR 0.79, 95% CI 0.61 to 1.02) and no significant difference in late neonatal death rate between intervention and control clusters (one study, adjusted risk ratio (RR) 0.47, 95% CI 0.20 to 1.11). The neonatal death rate, however, was 45% lower in intervention compared with the control clusters (one study, 22.8% versus 40.2%, adjusted RR 0.54, 95% CI 0.32 to 0.92). We conducted a meta-analysis on two outcomes: stillBirths and early neonatal death. There was no significant difference between the additionally trained TBAs versus trained TBAs for stillBirths (two studies, mean weighted adjusted RR 0.99, 95% CI 0.76 to 1.28) or early neonatal death rate (three studies, mean weighted adjusted RR 0.83, 95% CI 0.68 to 1.01). Authors' conclusions The results are promising for some outcomes (perinatal death, stillBirth and neonatal death). However, most outcomes are reported in only one study. A lack of contrast in training in the intervention and control clusters may have contributed to the null result for stillBirths and an insufficient number of studies may have contributed to the failure to achieve significance for early neonatal deaths. Despite the additional studies included in this updated systematic review, there remains insufficient evidence to establish the potential of TBA training to improve peri-neonatal mortality.
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women s social networks and Birth Attendant decisions application of the network episode model
Social Science & Medicine, 2012Co-Authors: Joyce K Edmonds, Daniel J Hruschka, Russell H Bernard, Lynn M SibleyAbstract:Abstract This paper examines the association of women’s social networks with the use of skilled Birth Attendants in uncomplicated pregnancy and childBirth in Matlab, Bangladesh. The Network-Episode Model was applied to determine if network structure variables (density/kinship homogeneity/strength of ties) together with network content (endorsement for or against a particular type of Birth Attendant) explain the type of Birth Attendant used by women above and beyond the variance explained by women’s individual attributes. Data were collected by interviewing a representative sample of 246 women, 18–45 years of age, using survey and social network methods between October and December 2008. Logistic regression models were used to examine the associations. Results suggest that the structural properties of networks did not add to explanatory value but instead network content or the perceived advice of network members add significantly to the explanation of variation in service use. Testing aggregate network variables at the individual level extends the ability of the individual profile matrix to explain outcomes. Community health education and mobilization interventions attempting to increase demand for skilled Attendants need to reflect the centrality of kinship networks to women in Bangladesh and the likelihood of women to heed the advice of their network of advisors with regard to place of Birth.
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does traditional Birth Attendant training improve referral of women with obstetric complications a review of the evidence
Social Science & Medicine, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:This narrative and meta-analytic review of the effectiveness of traditional Birth Attendant (TBA) training to improve access to skilled Birth attendance for obstetric emergencies produced mixed results. Among 16 studies that fit the inclusion criteria, there is a medium, positive, non-significant association between training and TBA knowledge of risk factors and conditions requiring referral; and small, positive, significant associations between TBA referral behavior and maternal service use. These results cannot be causally attributed to TBA training because of the overall quality of studies; moreover, in several studies TBA training was a component of integrated intervention packages. The effort and expense of more rigorous research focusing on TBA training to improve access to emergency obstetric care are difficult to justify. The referral process is complex; the real effects of TBA training on TBA and maternal behavior are likely to be small; and while the proportion of TBA-attended Births worldwide varies, it is, on average, quite low. The behavioral determinants and logistical barriers to care seeking for emergency obstetric care are generally well known. We suggest a more promising research agenda would reposition the questions surrounding referral into a broader ecological perspective.
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does traditional Birth Attendant training increase use of antenatal care a review of the evidence
Journal of Midwifery & Women's Health, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:A combined narrative review and metanalytic review was conducted to summarize published and unpublished studies completed between 1970 and 2002 on the relationship between traditional Birth Attendant (TBA) training and increased use of professional antenatal care (ANC). Fifteen studies (n = 15) from 8 countries and 2 world regions were analyzed. There are, to varying degrees, positive associations between TBA training and TBA knowledge of the value and timing of ANC services, TBA behavior in offering advice or assistance to obtain ANC, and compliance and use of ANC services by women cared for by TBAs or living in areas served by TBAs. There is a serious lack of information about TBA training program characteristics. Although the findings cannot be causally attributed to TBA training, the results suggest that training may increase ANC attendance rates by about 38%. This magnitude of improvement could contribute to a reduction in maternal and perinatal mortality in areas where women have access to quality antenatal and emergency obstetric care. There is an urgent need to improve capacity for evaluation and research of the effect of TBA training programs and other factors that influence women's use of ANC services.
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what can a meta analysis tell us about traditional Birth Attendant training and pregnancy outcomes
Midwifery, 2004Co-Authors: Lynn M Sibley, Theresa Ann SipeAbstract:Abstract Objective: to summarise the available published and unpublished studies on traditional Birth Attendant (TBA) training effectiveness. Design: a meta-analysis. Study sample: sixty studies ( n =60) spanning 1971–1999 from 24 countries and three regions. Measurements: the effect size index, Cohen's h for each outcome; the variance-weighted mean effect size and 95% confidence interval for sub-group of outcomes; homogeneity tests on the distribution of the weighted mean effect sizes; and sensitivity analysis to detect the presence of publication bias. Findings: TBA training was associated with significant increases in attributes such as TBA ‘knowledge' (90%), ‘attitude' (74%), ‘behaviour' (63%) and ‘advice' (90%) over the untrained TBA baseline. Results for ‘behaviour' and ‘advice' in specific content areas related to peri-neonatal health outcome, however, reveal sources of variability and underscore the conflicting evidence on TBA training. TBA training was also associated with small but significant decreases in peri-neonatal mortality (8%) and Birth asphyxia mortality (11%). Incomplete reporting limited the assessment of neonatal mortality due to tetanus and acute respiratory infection, maternal mortality, as well as assessment of the relationship between intervention characteristics and outcomes. The quality of studies included in the meta-analysis lack sufficient rigour to address the question of causality. Thus, while the data suggest that TBA training is effective in terms of the outcomes measured, we are unable to demonstrate that it is a cost-effective intervention. Implications: skilled attendance at Birth is a distant reality in many developing countries and effective community-based strategies are needed to help reduce high levels of mortality. Given the magnitude of peri-neonatal mortality, the associations observed between TBA training peri-neonatal and Birth asphyxia mortality, and TBA attributes in content relevant to peri-neonatal survival, we suggest that these strategies may usefully include TBA training in appropriate settings. If TBAs are to be trained, however, it is imperative that their training be adequately evaluated in order to develop the strong evidence base that is lacking to-date and that is necessary for sound policy and programming.
Marge Koblinsky - One of the best experts on this subject based on the ideXlab platform.
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inequity in maternal health care services evidence from home based skilled Birth Attendant programmes in bangladesh
Bulletin of The World Health Organization, 2008Co-Authors: I Anwar, M Sami, N Akhtar, Mahbub Elahi Chowdhury, U Salma, M Rahman, Marge KoblinskyAbstract:OBJECTIVE: To explore use-inequity in maternal health-care services in home-based skilled-Birth-Attendant (SBA) programme areas in Bangladesh. METHODS: Data from a community survey, conducted from February to May 2006, were analysed to examine inequities in use of SBAs, caesarean sections for deliveries and postnatal care services according to key socioeconomic factors. FINDINGS: Of 2164 deliveries, 35% had an SBA, 22.8% were in health facilities and 10.8% were by caesarean section. Rates of uptake of antenatal and postnatal care were 93% and 28%, respectively. There were substantial use-inequities in maternal health by asset quintiles, distance, and area of residence, and education of both the woman and her husband. However, not all inequities were the same. After adjusting for other determinants, the differences in the use of maternal health-care services for poor and rich people remained substantial [adjusted odds ratio (OR) 2.51 (95% confidence interval, CI: 1.68-3.76) for skilled attendance; OR 2.58 (95% CI: 1.28-5.19) for use of caesarean sections and OR 1.53 (95% CI: 1.05-2.25) for use of postnatal care services]. Complications during pregnancy influenced use of SBAs, caesarean-section delivery and postnatal care services. The number of antenatal carevisits was a significant predictor for use of SBAs and postnatal care, but not for caesarean sections. CONCLUSION: Use of maternity care services was higher in the study areas than national averages, but a tremendous use-inequity persists. Interventions to overcome financial barriers are recommended to address inequity in maternal health. A greater focus is needed on the implementation and evaluation of maternal-health interventions for poor people.
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does traditional Birth Attendant training improve referral of women with obstetric complications a review of the evidence
Social Science & Medicine, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:This narrative and meta-analytic review of the effectiveness of traditional Birth Attendant (TBA) training to improve access to skilled Birth attendance for obstetric emergencies produced mixed results. Among 16 studies that fit the inclusion criteria, there is a medium, positive, non-significant association between training and TBA knowledge of risk factors and conditions requiring referral; and small, positive, significant associations between TBA referral behavior and maternal service use. These results cannot be causally attributed to TBA training because of the overall quality of studies; moreover, in several studies TBA training was a component of integrated intervention packages. The effort and expense of more rigorous research focusing on TBA training to improve access to emergency obstetric care are difficult to justify. The referral process is complex; the real effects of TBA training on TBA and maternal behavior are likely to be small; and while the proportion of TBA-attended Births worldwide varies, it is, on average, quite low. The behavioral determinants and logistical barriers to care seeking for emergency obstetric care are generally well known. We suggest a more promising research agenda would reposition the questions surrounding referral into a broader ecological perspective.
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does traditional Birth Attendant training increase use of antenatal care a review of the evidence
Journal of Midwifery & Women's Health, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:A combined narrative review and metanalytic review was conducted to summarize published and unpublished studies completed between 1970 and 2002 on the relationship between traditional Birth Attendant (TBA) training and increased use of professional antenatal care (ANC). Fifteen studies (n = 15) from 8 countries and 2 world regions were analyzed. There are, to varying degrees, positive associations between TBA training and TBA knowledge of the value and timing of ANC services, TBA behavior in offering advice or assistance to obtain ANC, and compliance and use of ANC services by women cared for by TBAs or living in areas served by TBAs. There is a serious lack of information about TBA training program characteristics. Although the findings cannot be causally attributed to TBA training, the results suggest that training may increase ANC attendance rates by about 38%. This magnitude of improvement could contribute to a reduction in maternal and perinatal mortality in areas where women have access to quality antenatal and emergency obstetric care. There is an urgent need to improve capacity for evaluation and research of the effect of TBA training programs and other factors that influence women's use of ANC services.
Sonya Crowe - One of the best experts on this subject based on the ideXlab platform.
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How many Births in sub-Saharan Africa and South Asia will not be attended by a skilled Birth Attendant between 2011 and 2015?
BMC Pregnancy and Childbirth, 2012Co-Authors: Sonya Crowe, Martin Utley, Anthony Costello, Christina PagelAbstract:Background The fifth Millennium Development Goal target for 90% of Births in low and middle income countries to have a skilled Birth Attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving Birth unattended. We aimed to generate estimates of the absolute number of non-SBA Births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving Birth unattended. Methods For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of Births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA Births for 2011-2015 under a variety of scenarios. Results Conservative estimates are that there will be between 130 and 180 million non-SBA Births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA Births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA Births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths. Conclusions Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give Birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.
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how many Births in sub saharan africa and south asia will not be attended by a skilled Birth Attendant between 2011 and 2015
BMC Pregnancy and Childbirth, 2012Co-Authors: Sonya Crowe, Martin Utley, Anthony Costello, Christina PagelAbstract:The fifth Millennium Development Goal target for 90% of Births in low and middle income countries to have a skilled Birth Attendant (SBA) by 2015 will not be met. In response to this, policy has focused on increasing SBA access. However, reducing maternal mortality also requires policies to prevent deaths among women giving Birth unattended. We aimed to generate estimates of the absolute number of non-SBA Births between 2011 and 2015 in South Asia and sub-Saharan Africa, given optimistic assumptions of future trends in SBA attendance. These estimates could be used by decision makers to inform the extent to which reductions in maternal mortality will depend on policies aimed specifically at those women giving Birth unattended. For each country within South Asia and sub-Saharan Africa we estimated recent trends in SBA attendance and used these as the basis for three increasingly optimistic projections for future changes in SBA attendance. For each country we obtained estimates for the current SBA attendance in rural and urban settings and forecasts for the number of Births and changes in rural/urban population over 2011-2015. Based on these, we calculated estimates for the number of non-SBA Births for 2011-2015 under a variety of scenarios. Conservative estimates are that there will be between 130 and 180 million non-SBA Births in South Asia and sub-Saharan Africa from 2011 to 2015 (90% of these in rural areas). Currently, there are more non-SBA Births per year in South Asia than sub-Saharan Africa, but our projections suggest that the regions will have approximately the same number of non-SBA Births by 2015. We also present results for each of the six countries currently accounting for more than 50% of global maternal deaths. Over the next five years, many millions of women within South Asia and sub-Saharan Africa will give Birth without an SBA. Efforts to improve access to skilled attendance should be accompanied by interventions to improve the safety of non-attended deliveries.
Rose L. Molina - One of the best experts on this subject based on the ideXlab platform.
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Nurses' and auxiliary nurse midwives' adherence to essential Birth practices with peer coaching in Uttar Pradesh, India: a secondary analysis of the BetterBirth trial
Implementation Science, 2020Co-Authors: Rose L. Molina, Brandon J. Neal, Lauren Bobanski, Vinay Pratap Singh, Bridget A. Neville, Megan Marx Delaney, Stuart Lipsitz, Ami Karlage, Mrunal Shetye, Katherine E. A. SemrauAbstract:Background The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe ChildBirth Checklist for Birth Attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential Birth practices between two different cadres of Birth Attendants—nurses and auxiliary nurse midwives (ANMs)—during and after a peer coaching intervention for the WHO Safe ChildBirth Checklist. Methods This is a secondary analysis of Birth Attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through Birth Attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). Results Of the 570 Birth Attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential Birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended ( p = 0.68). Conclusions Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential Birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of Birth Attendant competency, the structure, content, and frequency of coaching may need to be customized according to the Birth Attendant training and competency. Trial registration ClinicalTrials.gov: NCT2148952 ; Universal Trial Number: U1111–1131-5647.
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nurses and auxiliary nurse midwives adherence to essential Birth practices with peer coaching in uttar pradesh india a secondary analysis of the betterBirth trial
Implementation Science, 2020Co-Authors: Rose L. Molina, Brandon J. Neal, Lauren Bobanski, Vinay Pratap Singh, Bridget A. Neville, Megan Marx Delaney, Ami Karlage, Stuart R Lipsitz, Mrunal ShetyeAbstract:The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe ChildBirth Checklist for Birth Attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential Birth practices between two different cadres of Birth Attendants—nurses and auxiliary nurse midwives (ANMs)—during and after a peer coaching intervention for the WHO Safe ChildBirth Checklist. This is a secondary analysis of Birth Attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through Birth Attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). Of the 570 Birth Attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential Birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential Birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of Birth Attendant competency, the structure, content, and frequency of coaching may need to be customized according to the Birth Attendant training and competency. ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111–1131-5647.