TY - JOUR T1 - Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … <em>at Scale</em>? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 1 LP - 3 DO - 10.9745/GHSP-D-16-00063 VL - 4 IS - 1 A2 - , Y1 - 2016/03/21 UR - http://www.ghspjournal.org/content/4/1/1.abstract N2 - Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.See related article by Stollak.In this issue of Global Health: Science and Practice, Stollak et al.1 report a positive experience with maternal-newborn services for remote, primarily indigenous communities in Guatemala. The work was done by an NGO and included an important focus on community outreach and cultural sensitivity. Services were made more accessible by establishing birthing centers (Casas Maternas) in communities where such services hadn’t previously been available. They were staffed by skilled birth attendants (SBAs)—locally hired auxiliary nurses—who spoke the local language. The project also cultivated relationships with traditional birth attendants, who were made welcome to support women giving birth in the Casas Maternas. In addition, the project facilitated reliable transfer of complicated cases to higher-level care.This case raises 2 important issues, one specific to maternal-newborn care and the other more broadly relevant to generalizability or transferability from small scale to large.Well into the 1990s, to the extent that the global health community gave attention to safe motherhood, the dominant model assumed that … ER -