Role of Traditional Birth Attendants (TBAs) in Provision of Antenatal and Perinatal Care at Home Amongst the Urban Poor in Delhi, India

Abstract

More than 80% of deliveries amongst the urban poor are conducted at home, mostly by traditional birth attendants (TBAs). In all, 29 eligible TBAs in the study area were identified and interviewed to assess their knowledge and practices regarding antenatal and perinatal care. Their knowledge about complications in antenatal and perinatal period was inadequate. The majority provided inadequate advice to the mothers. Over seventy-nine percent (79.3%) gave injections of oxytocin. Sixteen (55.2%) did not wait or waited for less than 10 minutes for the mother to expel the placenta. Fourteen (48.3%) encountered excessive vaginal bleeding, but none knew how to manage it. Overall knowledge and care provided by the TBAs was poor.

Childbearing traditions of Indian women at home and abroad: An integrative literature review

“…The 12 articles from India were all original research articles and eight were carried out predominantly among rural populations, 10-17 two related to urban settings 18,19 and two analysed national data. 20,21 This high proportion of studies on the rural population might be related to the facts that in India 74% of the population resides in rural areas and 70% of rural births are at home, assisted by family members or traditional birth helpers.…”

“…22 Alongside this diversity, significant disparities in maternal and infant health exist depending on the person's class, place of residence, wealth and education. 10,18,[20][21][22]37 To evaluate the outcomes of caseload midwifery practice in a socially deprived and ethnically diverse inner-city area India is one of 189 countries committed to the Millennium Development Goal of reducing maternal and neonatal mortality rates by 75% during the period 1990-2015. 10,29 Since 2005, the Indian government has sponsored a cash-incentive scheme to poor and marginalised women to encourage them to give birth in an institution and receive antenatal and postnatal care.…”

Assessing regional variations in the effect of the removal of user fees on facility-based deliveries in rural Zambia

“… 16 Furthermore, trained TBAs can reduce perinatal deaths, neonatal deaths and stillbirths, 47 – 48 although others argue that TBAs offer poor obstetric services. 45 – 46 Between 1970 and 1990, the World Health Organisation promoted TBA training, as one strategy to reduce maternal and neonatal mortality; however, there is insufficient evidence to establish the potential for TBA training to improve peri-neonatal mortality. 65 Given that a larger share of women in Zambia were assisted by TBAs in 2007 (23.5%) compared to 2001/2 (11.7%), 66 the role of TBAs cannot be ignored.…”

“…In the African context, the primary alternative is a traditional birth attendant (TBA), an alternative that may or may not be an appropriate substitute, due to low levels of literacy, nonexistant to poor training and limited obstetric skills. 45 – 46 On the other hand, TBAs can be beneficial, especially if they are properly trained. 47 – 48 However, they need an appropriate support network to work effectively.…”

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study

“…Poor practice environments are characterized by inadequate compensation and supervision, lack of basic equipment and supplies, and ill-maintained facilities [ 1 – 7 ]. Negative provider attitudes and disrespectful treatment of patients in poor practice environments compromise quality of care and deter women from seeking safer facility births in areas where maternal mortality is high [ 8 , 9 ]. As a result, researchers and policymakers alike are turning their attention to the role played by practice environments in shaping the performance of personnel who deliver maternal health services in sub-Saharan Africa.…”