Following training courses for traditional birth attendants among refugee Afghan women in Pakistan, a survey was conducted to test the knowledge and practices of the participants and of mothers whose babies had been delivered by them, using untrained birth attendants as the basis for comparison. Marked improvements in knowledge and skills were demonstrated, and recommendations made by the trained birth attendants about breast-feeding, maternal nutrition, immunization and hygiene were generally followed by mothers before and after delivery. Furthermore, far fewer complications and deaths were associated with deliveries performed by trained birth attendants than with those conducted by their untrained colleagues. The training of traditional birth attendants was clearly an effective way to educate women about hygiene and health.