Birthing Practices of Traditional Birth Attendants in South Asia in the Context of Training Programmes

Abstract

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes.This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless signifi cant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between Acknowledgements: Dr Carla Patterson was involved in conceptualizing the PhD thesis. Sadly she passed away in August 2005 and was unable to share the results of her study.

Community perceptions towards the new role of traditional birth attendants as birth companions and nutrition advocates in Kakamega County, Kenya

“…Women reported a positive view of the new roles of re‐oriented TBAs, who were said to respond holistically to the women's needs through practical, material, and emotional support during pregnancy, delivery, and postpartum. This is consistent with other studies in Africa, Asia, and Latin America that also observed the potential role of TBAs in providing maternal and child health care service, emotional support, and advice during the antenatal, delivery, and post‐partum period (Bergström & Goodburn, ; Kayombo, ; Saravanan, Turrell, Johnson, & Fraser, ; Taleb et al, ). The CBMNH‐N project found that it is possible to change the behaviour and care practices of TBAs with an appropriate strategy.…”

Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya

“…Consequently, TBAs were sidelined, and in some countries banned from attending deliveries. However, for complex reasons, many women in low-income settings are still cared for at the time of childbirth by TBAs rather than SBAs (Bergstrom & Goodburn 2001; Kruske & Barclay 2004;Saravanan et al 2010). These reasons include the fact that TBAs are respected and familiar members of their communities who offer comfort and kindness to labouring women.…”

How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance

“…However, 45 million women deliver without skilled care each year [20], twothirds of whom will be assisted by a TBA [11,[21][22][23]. The continued popularity of TBAs in many settings can be attributed to persistent barriers to SBA access and the affordability, accessibility, and cultural acceptability of TBAs [24,25]. It has been argued that failure to link TBAs, SBAs, and health systems has limited progress in the past [26].…”