Objectives: To compare obstetrical knowledge, referral practice, and integration into the public health system among trained and untrained traditional birth attendants (TBAs) in rural Honduras, an area of high maternal mortality.

Methods: Eighteen practicing TBAs in rural Honduras completed traditional lay midwife training in 2000, and 26 months later, a randomly selected six of these and six untrained "control" TBAs from a nearby village were interviewed to assess maternal mortality process indicators including obstetrical knowledge, referral practices, and monthly training meeting attendance.

Results: At 26 months post- training, the trained TBAs demonstrated uneven but persisting achievement of curricular learning goals relating to identification of high-risk pregnancies and management of obstetrical emergencies, increased and appropriate referrals to the government health system, and increased meeting attendance compared with the control group of TBAs.

Conclusions: These outcomes support this model of training TBAs as a component of programs to decrease maternal mortality in geographically isolated and impoverished regions.

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