Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania

Abstract

BackgroundTraditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women’s health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system.MethodsQualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania.ResultsThe results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative.ConclusionsInstead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health.

Gender Determined Roles and Under-Five Mortality among Agro-Pastoralist Communities in Handeni District, Tanzania

“…Traditional births attendants were most of the time eager to help their fellow women during delivery, though it is a risky activity as sometimes there were cases beyond their ability to handle. Poverty makes expecting mothers who would wish to go to formal health facilities to postpone and opt for informal ones (Pfeiffer & Mwaipopo, 2013). The observed number of under-five mortality was likely to be caused by use of informal health facilities including child delivery at traditional birth attendants.…”

Effectiveness of Health Sector Reforms in Reducing Disparities in Utilization of Skilled Birth Attendants in Tanzania

“…It was assumed that resources would be channeled to the poor and the vulnerable groups, as more funding was allocated to the services included in the essential health package (Brown 2000;Ensor et al 2002). It was important to strengthen the healthcare system and bridge the gaps between the community and formal health sector to enhance utilization of skilled birth attendants (Pfeiffer and Mwaipopo 2013). It was also assumed that the health package successfully helped with such strengthening and bridging.…”

Association between birth attendant type and delivery site and perinatal outcomes

“…Zambia has 1956 health facilities and only 23 376 healthcare providers, which is far below the WHO recommendation . While user fees for delivery have been abolished in Zambia since April 2006, factors that influence the use of a skilled birth attendant during delivery include demographic, socioeconomic, and other family‐specific characteristics, such as the distance between the nearest health facility and its provided quality care coupled with bad roads and expensive or unavailable transport, presence of a male birth attendant, and the absence of a free delivery kit . Many Zambian women living in rural settings reside far from a facility where emergency obstetric care services are offered, and the impact of distance to place of delivery is as high as that of education or socioeconomic status …”

“…16 While user fees for delivery have been abolished in Zambia since April 2006, 17 factors that influence the use of a skilled birth attendant during delivery include demographic, socioeconomic, and other family-specific characteristics, such as the distance between the nearest health facility and its provided quality care coupled with bad roads and expensive or unavailable transport, presence of a male birth attendant, and the absence of a free delivery kit. 8,18 Many Zambian women living in rural settings reside far from a facility where emergency obstetric care services are offered, and the impact of distance to place of delivery is as high as that of education or socioeconomic status. 8 While there has been policy change in many developing countries, including Zambia, to stop the funding and training of TBAs 19 and women are recommended to deliver at health facilities, 20 many women still deliver at home and TBAs are considered essential providers of obstetric care.…”