Ž . International Journal of Gynecology & Obstetrics 63 Suppl. 1 1998 S53S60 Traditional birth attendants and their practices in the State of Pernambuco rural area, Brazil, 1996 I. Carvalho a,  , A.S. Chacham b , P. Viana a a Grupo Curumim, Recife, Brazil b Department of Demography, Uni  ersidade Federal de Minas Gerais, Belo Horizonte, Brazil Abstract Objecti  e: To obtain socioeconomic information about TBAs in the State of Pernambuco and information concerning their practices. Method: Statistical analysis of the answers to structured questionnaires applied to 127 TBAs. Results: The results of a survey with 127 TBAs conducted in the rural area of the State of Pernambuco Ž . Brazil is presented in this paper. TBAs in rural Pernambuco are a group of basically old and very poor and uneducated women. Most of them learned to attend births by themselves or by helping another TBA. Thirty percent learned midwifery in hospital delivery rooms, helping doctors and nurses. How the TBAs learned to help births seemed to be the most influential factor on the kind of practices they use. TBAs who learned from other TBAs from the community seem to have the least interventionist approach, followed by the TBAs who learned by themselves. They are more likely to perform more home births and avoid practices such as shaving the pubic hair, vaginal exams, artificial rupture of the membranes, episiotomy and early cord clamping. Conclusion: The way women learned midwifery is the most important determinant of their practice.  1998 International Federation of Gynecology and Obstetrics Keywords: Obstetrics; Midwifery; Traditional midwives; Natural childbirth; Traditional birth attendants; Practices; Brazil 1. Introduction In Brazil, as well as in other Latin American countries, since the 1970s, the ante-natal and obstetric care of the poorest segment of the popu- lation has become the object of several official  Corresponding author, Rua Major Codeceira 37, Santo Amaro, 50100070 Recife, Brazil. Fax: 55 81 4279100. health programs. One of the main objectives of these programs is to encourage doctors to partici- pate in deliveries, rather than traditional birth Ž . attendants TBAs , as a way to increase safety. The results of these initiatives have been satisfac- tory in the sense that they did expand pre-natal care and increased the number of hospital deliv- eries. But these programs did not fully reach the goals proposed, given the still very high rates of perinatal and maternal mortality and morbidity, 0020-729298$ - see front matter  1998 International Federation of Gynecology and Obstetrics Ž . PII:S0020-7292 98 00184-2