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In nine chapters, this book considers the extent to which training programs can be utilized to improve midwifery practice and reduce the risks surrounding childbirth in rural populations. The book opens with a chapter reviewing the question of whether the availability of trained birth attendants can be linked to a reduced incidence of neonatal tetanus. The need for more rigorous field studies evaluating the long-term effectiveness of training programs is pointed out. Subsequent chapters communicate lessons learned from programs conducted in Andhra Pradesh, Sierra Leone, Burma, and Ghana. Details are provided on the design, content, duration, and results of these different programs, together with data on their immediate and long-term effectiveness. These accounts also serve to show where certain countries succeed or fail in the training of traditional birth attendants and where they have specific or common problems in evaluating or conducting training. Other chapters examine the folklore and rituals surrounding traditional birthing systems in the Philippines and Latin America and show how specific customs may influence the acceptance or rejection of new practices. The book concludes with chapters evaluating the importance of literacy instruction and supervision as components in a successful training program. (Author/RH)