On a rural road in Taxila, Pakistan, three USAID health trainers waited in their car for Taxila's traditional birth attendant, a woman named Naseem. Their meeting with Naseem should have begun two hours earlier but she was nowhere to be found. Should they take Naseem's absence as a hint that she didn't want to meet with them? They did not anticipate an easy visit, but this meeting was imperative to them, as well as to the community of Taxila.

As a traditional birth attendant, Naseem provides the only obstetric care in Taxila. She assists pregnant women during birth, and presides over deliveries. Most women in Pakistan deliver using a traditional birth attendant, but few attendants have been formally trained and almost all lack proper medical tools. Traditional delivery practices at times result in the death of a mother or newborn. While families continue to experience the anguish of losing a child, little has been done to deal with the country's high infant mortality rate.

In response, USAID established the Pakistan Initiative for Mothers and Newborns (PAIMAN) to address the country's lack of quality obstetric care. PAIMAN collaborates with community-based organizations all over the country to renovate and establish birthing clinics, distribute medical supplies, educate the public through various media, and train traditional birth attendants and community midwives. When Naseem finally arrived for the meeting, the USAID workers explained the contents of the upcoming workshop for traditional birth attendants and persuaded her to attend that. The workshop would provide her with much needed knowledge and skill in obstetric and prenatal care.

After 15 years of practice, Naseem was reluctant to change the way she practices midwifery. But, after the hour-long discussion she was persuaded to attend the workshop. Once the workshop got underway, Naseem's reluctance softened. During the eight-day workshop, she learned the client-centered approach, clean delivery practices, recognition of danger signs, and the importance of timely referrals for women who need hospital care.

By the end of the workshop, Naseem, along with the 20 other attendants, renounced their previous methods as dangerous for both mothers and newborns. "I will stop practicing all harmful practices while conducting deliveries," she said. "I will only observe and apply skills that have been taught to us in the training."

Naseem is one of over 250 traditional birth attendants and 2350 community midwives in rural Pakistan who have taken part in the USAID training and now implement safer medical care for expectant mothers.