Most deliveries in the Dominican Republic happen in hospitals, but maternal mortality rates are still a significant issue, particularly in nonteaching hospitals where maternity auxiliary nurses primarily assist with births.
A series of educational conferences, led by midwifery teams from the U.S. and Puerto Rico, were implemented to address this issue and led to the establishment of Proyecto ADAMES, a nongovernmental organization focused on enhancing the skills of these nurses.
A qualitative evaluation showed that, while documentation of their improved skills was weak, the educational initiative positively impacted the knowledge, skills, and attitudes of the nurses, indicating that enhanced training may help reduce maternal mortality.