Towards universal access to skilled birth attendance: the process of transforming the role of traditional birth attendants in Rural China

Abstract

BackgroundInstitution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. However, the question of how to engage traditional birth attendants (TBAs) in the advocacy campaign for SBA poses a number of challenges. This paper aims to demonstrate how TBAs in rural regions of China have been integrated into the health system under a policy of institutional delivery.MethodsResearch was conducted through literature and document reviews and individual in-depth interviews with stakeholders of the safe motherhood program in rural Guangxi Zhuang Autonomous Region, China. A total of 33 individual interviews were conducted with regional and local politicians, policy makers, health managers, health providers, civil society members, village cadres for women affairs, former TBAs, village maternal health workers, mothers and their mother-in-laws.ResultsSince 1998, TBA’s traditional role of providing in-home care during childbirth has been restructured and their social role has been strengthened in rural Guangxi. TBAs were redesigned to function as the linkage between women and the health system. A new policy in 1999 shifted the role of TBAs to village maternal health workers whose responsibilities were mainly to promote perinatal care and institution-based delivery of pregnant women. This successful transformation involved engaging with government and other actors, training TBAs for their new role, and providing incentives and sanctions for human resources management.ConclusionsThe China experience of transforming the role of TBAs in Guangxi rural area is an example of successfully engaging TBAs in promoting institution-based childbirth.

Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996–2016)

“…Government support; 3. Clinic support Jiang, et al [ 77 ] 2016 Guangxi province Traditional Birth Attendance (TBAs); Village Maternal Health Care Workers Not reported Mobilization of pregnant women for institutional delivery, assisting with home visit for basic care and escorting pregnant women to the hospital for childbirth. Different levels of training in Maternal Child Health hospitals: emphasized identifying high-risk pregnancies and assisting with referrals; for TBAs, focused on care during childbirth and referral skills; for trained birth attendance (TrBAs), additional midwifery training and were required to conduct at least 30 independent deliveries under the supervision of an obstetrician.…”

“…The level of training received by CHWs differed across studies. For example, in a study conducted in Guangxi, the training for TBAs is focused on care during childbirth and referral skills while the training for trained birth attendances (TBAs) included additional midwifery training and conducting of at least 30 independent deliveries under an obstetrician’s supervision [ 77 ]. CHWs also received other types of training including health education communication skills [ 23 ], computer skills [ 79 ], mobile phone app use [ 22 ], TB/HIV control and management [ 40 , 82 ], and verbal autopsy interview skills [ 74 ].…”

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study

“…9 However, it has been reported that the majority of women who delivered at home felt that this option was more comfortable and convenient. 26 – 28 Therefore, the factors of deliveries at home were not only financial status and transportation, but also comfort and convenience on them. The maternal and child health book was generally distributed to women at health facilities in the Philippines.…”

Bridging the Gap for Maternal Newborn and Child Health Human Resources in Rural Uganda: Experiences and Lessons Learnt from World Vision East African Maternal Newborn and Child Health Project Implementation, Kitgum District

“…Health center based childbirth, with the ultimate achievement of universal access to skilled birth attendance is a key strategy to avert the maternal and newborn rated deaths in many developing countries [19]. It is this same reason as to why projects like the EAMNeCH project focused on mobilization of households for institution delivery and inclusion of delivery at health facility related indicators in the monitoring and evaluation framework.…”