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This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement Number HRN-A-00-98-00012-00 and In-house project 5800 53111. The contents are the responsibility of FRONTIERS and do not necessarily reflect the views of USAID or the United States Government. i SUMMARY Increasing access to safe delivery and family planning services within rural communities increases the opportunities for women to have positive outcomes for their pregnancies as well as to plan and achieve their desired family size. With support from USAID, the Population Council " s Frontiers in Reproductive Health (FRONTIERS) project supported the scaling up of a community-based model in Kenya that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. Originally piloted through a demonstration project implemented by the Population Council with DFID support in Western Province, FRONTIERS assisted the Kenyan Ministry of Health (MOH) to identify an expanded package of safe motherhood services, including postpartum family planning, which could be provided routinely by these " community midwives " living and working from home with minimal supervision and supply of commodities from the MOH. Guidelines and training materials for community midwives were developed and mechanisms for linkages with existing MOH systems at district level strengthened. Four districts (Mount Elgon, Bungoma, Lugari and Butere Mumias) in Western province were selected for scale up of the approach. Sixty community midwives (CMs) were oriented in May 2007 in essential obstetric and newborn care skills as well as family planning; recognition and management of complications were also covered. Cross-cutting topics included infection prevention, interpersonal communication, community involvement and record keeping. All CMs completed a two-three week residential assignment in a busy maternity unit where they were observed carrying out a number of essential procedures, the outcomes of which were recorded in a log book and certified by the facility " s senior midwife. They then received a certificate jointly signed by the Head of Division of Reproductive Health and the Registrar of the Nursing Council of Kenya, and were given a delivery kit and essential supplies to enable them to start providing antenatal, delivery, postpartum and family planning services in their community. To strengthen the sustainability of this approach FRONTIERS engaged a microfinance NGO to develop a training curriculum on …

Taking critical services to the home: Scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya