Women in Laos have a one in 33 chance of dying as a result of childbirth.

That rate is among the worst in the region, considerably higher than neighbouring Cambodia, where it's one in 48 or Vietnam where it's one in 280. So why are so many women and their children dying? Many argue that a lack of midwives could be largely to blame. Now - after a 23 year break - Laos is re-introducing specialised mid-wifery training.

Presenter: Helene Hofman
Speakers: Dr Monir Islam, Director, Family Health and Research Program, World Health Organisation, South-East Asia Regional Office; Della Sherrat, Field Birth Attendant Co-ordinator, United Nations Population Fund (UNFPA), Laos; Boathip Phongsavath, Program Officer for Laos, United Nations Population Fund (UNFPA); Magdalen Drani, International Nurse-midwife Trainer, United Nations

• Listen:
• Windows Media

HOFFMAN: Two mothers and 20 newborns. Laos has a population of just over 6-point-2 million, but it loses that many mothers and babies to childbirth every day. Now the local government, with the backing of the United Nations Population Fund, is seeking to turn that trend around. They've conducted an assessment, and concluded that access to affordable and reliable ante-natal services and midwives is largely to blame.

Dr Monir Islam, Director of the Family Health and Research Program with the World Health Organisation's South-East Asia regional office, explains:

ISLAM: If you look at the access to skilled care for pregnant women it's very low. It would be say about 20 per cent. So women do not have access to the right care during pregnancy and childbirth and particularly access to emergency obstrical care services so there is a lack of skilled care and where they have services, we also have to look at the quality of services. The training of midwives and people with midwifery skills for making a difference in countries.

HOFMAN: About 80 per cent of births in Laos take place outside of a hospital environment and many are assisted only by untrained birthing assistants. Today - there are fewer than 100 midwives working in the country. Della Sherrat, a field birth attendant co-ordinator working with the United Nations Population Fund Laos office has been helping to identify issues with the system.

SHERRAT: They've really not had any midwives trained since 1986 and the reason why - and it happened in many countries - was the move to make this multipurpose all singing all dancing health worker, which unfortunately sounds good until you realise that most of them are trained exclusively in hospitals and in hospitals many women are not giving birth so the nurses were simply not getting hands on training.

HOFMAN: Since 2007, Della Sherrat has been working with the Laos Ministry for Health to reduce maternal mortality. They are currently training about 160 midwives across eight schools, with the first intake due to graduate in November.