Banning traditional birth attendants from conducting deliveries: experiences and effects of the ban in a rural district of Kazungula in Zambia

Abstract

BackgroundIn 2010 the government of the republic of Zambia stopped training traditional birth attendants and forbade them from conducting home deliveries as they were viewed as contributing to maternal mortality. This study explored positive and negative maternal health related experiences and effects of the ban in a rural district of Kazungula.MethodsThis was a phenomenological study and data were collected through focus group discussions as well as in-depth interviews with trained traditional birth attendants (tTBAs) and key informant interviews with six female traditional leaders that were selected one from each of the six zones. All 22 trained tTBAs from three clinic catchment areas were included in the study. Content analysis was used to analyse the data after coding it using NVIVO 8 software.ResultsHome deliveries have continued despite the community and tTBAs being aware of the ban. The ban has had both negative and positive effects on the community. Positive effects include early detection and management of pregnancy complications, enhanced HIV/AIDS prevention and better management of post-natal conditions, reduced criticisms of tTBAs from the community in case of birth complications, and quick response at health facilities in case of an emergency. Negatives effects of the ban include increased work load on the part of health workers, high cost for lodging at health facilities and traveling to health facilities, as well as tTBAs feeling neglected, loss of respect and recognition by the community.ConclusionCountries should design their approach to banning tTBAs differently depending on contextual factors. Further, it is important to consider adopting a step wise approach when implementing the ban as the process of banning tTBAs may trigger several negative effects.

Opting for home birth in rural Bangladesh: An assessment of the current status and reasons

“…31,46,47 Although this is a contested topic within the international community, many stakeholders agree that traditional birth attendants can play an important role in maternal and newborn health. 6,7,9 Although the government of Bangladesh has not taken these extreme measures, they are not considering including them in the broader strategy by assigning them any supporting role. 49 However, many countries have demonstrated a resistance to collaborating with traditional birth attendants and, in some cases, have taken extreme measures to prevent them from assisting women during birth.…”

Repositioning traditional birth attendants to provide improved maternal healthcare services in rural Ghana

“…This retraining approach would focus on generating novel ways of practicing the TBA ‘craft’ without endangering clients. Indeed, an increasing body of literature has demonstrated the effectiveness of combining traditional and modern knowledge systems in healthcare service delivery . While this fosters cooperation and commitment from all stakeholders especially among local level actors who most often feel relegated, it also enhances the knowledge base for dealing with complex health situations.…”

“…As practiced in other countries including India, Kenya, and Rwanda, TBAs could be used as potential agents in promoting male involvement in maternity preparedness . Alongside gradually reducing their “direct involvement in attending births,” these new tasks will keep TBAs active, relevant, and involved in what most of them recognize as their livelihood and culturally mandated role …”

“…Indeed, an increasing body of literature has demonstrated the effectiveness of combining traditional and modern knowledge systems in healthcare service delivery. [21][22][23][24][25] While this fosters cooperation and commitment from all stakeholders especially among local level actors who most often feel relegated, it also enhances the knowledge base for dealing with complex health situations. In settings like Ghana where most rural communities still lack well-resourced modern health facilities, the need for a collaborative model even becomes more crucial towards enhancing the skills of TBAs to support in health-care delivery in remote areas.…”

“…[34][35][36] Alongside gradually reducing their "direct involvement in attending births," these new tasks will keep TBAs active, relevant, and involved in what most of them recognize as their livelihood and culturally mandated role. 24 There is ample empirical evidence from countries like Kenya, Somalia, Tanzania, and Uganda for task shifting and reorientation of TBAs to help improve maternal and child healthcare. For instance, studies that have assessed the impact of reorienting TBAs from conducting deliveries themselves to promoting SBA-assisted deliveries at health facilities suggest that such reorientation approaches can lead to increased uptake of supervised delivery.…”