Globally, half a million of women die every year from pregnancy related causes. Since 1987, two major safe motherhood initiatives have been developed to solve the problem. Firstly, large scale training of Traditional Birth Attendants (TBAs) was recommended. Secondly, the focus was shifted to skilled birth attendants with EmOC (Emergency Obstetric Care). However, over the last two decades, little progress has been made since the coverage of skilled attendants at birth is less than 50% in sub Saharan Africa. EmOC coverage is even lower. Thus, in reality less than half of women avail themselves to the recommended strategy instead relying on other complementary birth assistance and seeking help from previous TBAs. This book, therefore, is questioning the existing strategy as well as recent attempts to overcome the current” outreach gap” on childbirth assistance in sub Saharan Africa. The study has used systematic review method developed by the Cochrane collaboration. It included 23 studies from comprehensive search of seven electronic databases. The review would help highlighting the gaps of implementing the recommended childbirth assistance strategy in resource limited situations.