The numbers of home births are reducing in the Sunder Nagri area due to home visits and health education by the ANMs and CHVs. Presently around 50% of deliveries still take place at home by a traditional birth attendant (Dai). There are many complex social, educational and financial reasons for this. Unhygienic conditions of the rooms and faulty practices increase the risk of complications. Improvement in perinatal care requires a multi pronged approach. The community health department organizes the training of Dais based on the government’s prescribed 4-day training programmes. The trainers are the Doctors and Nurses of our Health Centre. The four-day workshop includes the following education:

Steps to improve the Domiciliary Delivery Support System:

• Organizing one day refresher training once a year for Dais.

• Six-monthly Dai workshop.

• Issuing identity cards to trained birth attendants in the area.

• Interactive programs with labor room staff of nearby major hospitals and local Dais.

• Improved health education to pregnant women and their family members.

• Social marketing of ‘Government provided delivery kits’ (2002).

• Starting Dai clinics in the beneficiary area (It is felt that providing clean area, clean bed and clean bathroom will reduce peri-natal mortality.

• Involvement of CHVs in home based intensive peri-natal care (ANMs will prepare a list of non compliers, negligent/neglected and high-risk pregnant women. CHVs will target them for health education).

• Involvement of Apna-Pariwar members in early reporting of all deliveries in order to give home based intensive peri-natal care (2004)