The return of the Traditional Birth Attendant

Lane, Karen; Garrod, Jayne

doi:10.7189/jogh.06.020302

Cited by 30 publications

(32 citation statements)

References 14 publications

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“…Delivery attended by a skilled provider improves delivery outcomes [ 20 ], but delivery by a fully and formally trained midwife or other highly skilled provider is often beyond the short–term capacity of many countries for all birhts. Strategies that integrate both skilled and traditional birth attendants into the health system are important to increase skilled birth attendance [ 21 , 22 ]. Delivery at a health facility improves access to emergency and critical care for prompt attention to life–threatening maternal complications [ 3 ], although the literature points out deficiencies in quality that are commonly observed at facilities [ 2 ] and some argue that facility delivery is not a necessary requisite for the reduction of maternal mortality [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Jennings¹,

Pradhan²,

Schleiff³

et al. 2017

Journal of Global Health

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BackgroundWe summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series.MethodsWe searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation.Results152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1–10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessments reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community–based interventions on antenatal care attendance, attended delivery and facility–based deliveries all showed a positive impact. The community–based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women’s groups, and provision of services by outreach teams from peripheral health facilities.ConclusionsThis comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community– and facility–based approaches, emphasizing potential added benefits from such holistic approaches. Community–based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.

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Section: Discussionmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Jennings¹,

Pradhan²,

Schleiff³

et al. 2017

Journal of Global Health

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“…While some countries have integrated the TBAs into the local health system and assigned them different roles within their communities, others have had little or no interaction with existing TBAs, with some TBAs engaged in clandestine childbirth-related activities. 7 , 8 This may be the case, especially in conflict-affected and impoverished settings where access to routine quality health care is a challenge.…”

Section: Introductionmentioning

confidence: 99%

The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda

Che

Urdal

2018

SAGE Open Medicine

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Objectives:Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era.Methods:A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach).Results:Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas.Conclusion:The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.

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“…If this fortitude in the face of labor was honorable and admirable, it had the effect of diminishing the practical knowledge and experience of the traditional birth attendants. Romanticized by some, vilified by others, the traditional birth attendant is at the heart of arguments over pre-colonial birthing practices, their relationship to bio-medical institutions introduced under French colonial rule, and the prospects for building both robust and culturally legitimate health systems with the capacity to meet the vast reproductive health needs of contemporary West African women (Lane & Garrod 2016).…”

Section: Rethinking the Significance Of The Traditional Birth Attendantmentioning

confidence: 99%

Traveling Companions: The Burial of the Placenta in Niger

Cooper¹

2019

Afr. stud. rev.

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Abstract:This article, part of a historical study of childbirth in the Sahel, draws upon oral interviews, ethnographic materials, and studies of midwifery to explore placenta burial in Niger. In the region the placenta is often referred to as the “traveling companion” that ushers the new human from one world to the next. Only through proper respect toward the placenta by means of careful burial can a woman’s future fertility be protected. The importance of protecting a woman’s future reproductive capacity accounts for both the centrality of this ritual to childbirth and for the appeal of the ritual expertise of elderly “traditional birth attendants” despite access to bio-medically trained midwives. Protecting a vulnerable parturient mother from the envy of those (such as co-wives) who might “tie up” her womb is an integral part of the process of childbirth. Appropriate placenta burial orchestrated by a woman’s therapy management group makes good on the cyclical intergenerational entrustment through which ancestors and descendants endure in a cycle linking birth and death, planting, and burial. “Traditional” rituals bear marks of major shifts in the agricultural economy, rapid urbanization, and ongoing adoption and reinterpretation of Islam. Multi-generational interviews reveal that across a broad range of ethnicities, status groups, and educational profiles, women in Niger share a concern for proper placenta burial. This approach to preserving women’s reproductive health and fertility is shared by adjacent neighbors, generations, and ethnicities.

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The return of the Traditional Birth Attendant

Cited by 30 publications

References 14 publications

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda

Traveling Companions: The Burial of the Placenta in Niger

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