Traditional birth attendants and maternal mortality in Ghana (original) (raw)
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Developing Country Studies, 2013
Maternal and newborn morbidity and mortality continue to be a problem with a huge disparity between developed and developing countries. About 99% of maternal and newborn deaths occur in low and middle income countries, globally amounting to about 500 000 maternal deaths and 8 million peri-neonatal deaths per year. In this settings Traditional Birth Attendants (TBAs), who are mostly women embedded in the community and its socio-cultural frame with no formal medical training and no connection to the formal health system, play a major role around childbirth. TBAs exist since centuries and still continue to be the major providers of care for families, in poor and remote areas where they assist up to 50-80% of deliveries. This paper therefore examine the role Traditional Birth Attendants play in maternal and child health in remote communities in the Yendi District of the Northern Region of Ghana and to come out with some policy recommendations that will help in achieving the MDGs 4 and 5. Introduction: Rites, special places, special caretakers and tools for childbirth can be identified back to prehistory of mankind (Beausang 2000). Nowadays Traditional Birth Attendants (TBAs), who are community members with no formal medical training, still continue to provide numerous services around childbirth all over developing countries as traditional practitioners. They are mentioned in literature back to mid 19th century (Lang 2005) and have been involved in national and international health programs since that time, with a peak of interventions in the 1970s and 1980s. The enthusiasm declined in the 1990s with a debate on their cost-effectiveness and the missing impact of TBAs training to reduce maternal mortality. By 1997, senior policy makers decided to shift priorities on the provision of "Skilled Birth Attendants" (SBA). The definition of SBA excluded TBAs and resulted in subsequent withdrawal of funding for TBA training and exclusion of TBAs in policies and programs worldwide (Kruske & Barclay 2004). Data from the World Health Organization (Proportions of births attended by a skilled health worker. WHO 2008) show, that worldwide 34% of births, i.e. 45 million births, occur at home assisted by a TBA or family member or nobody at all. This scenario we find especially in developing, poor and remote areas. In some countries (Afghanistan,
The impact of traditional birth attendant training on delivery complications in Ghana
Health Policy and Planning, 2000
In their efforts to reduce maternal and neonatal morbidity and mortality, many national and international agencies make considerable investments in training traditional birth attendants (TBAs). The value of TBA training is controversial, and plausible arguments are made both for and against. Numerous process evaluations are reported in the literature and the results are mixed, though generally positive. Outcome evaluations, however, are scarce. This article describes an outcome evaluation of TBA training conducted in two districts of Brong-Ahafo Region, Ghana, during 1996. Design and methods: Data from a random sample survey of 1961 clients of TBAs were subjected to logistic regression modelling to determine the effect of training on maternal outcomes, controlling for other independent variables. Results: Of eight outcomes modelled, three were associated with training and five were not. Three additional outcomes were not modelled, primarily due to low prevalence. Conclusions: Despite some inherent design limitations, this study found that the evidence for a beneficial impact of TBA training was not compelling. Training sponsors should consider alternative health investments and, where TBA training remains the intervention of choice, be realistic about expectations of impact.
Tanzania Journal of Health Research, 2013
This paper presents discussion on impact of training traditional birth attendants (TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and newborn mortality in rural settings in sub-Saharan Africa. The importance of TBAs for years has been denied by professional western trained health practitioners and other scientists until during the late 1980s, when World Health Organization through Safe motherhood 1987 found TBAs have a significant role in reducing maternal and newborn mortality. Trained TBAs in sub-Sahara Africa can have positive impact on reducing maternal and newborn mortality if the programme is well implemented with systematic follow-up after training. This could be done through joint meeting between health workers and TBAs as feed and learning experience from problem encountered in process of providing child delivery services. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes. However projects targeting TBAs should not be of hit and run; but gradually familiarize with the target group, build trust, transparency, and tolerance, willing to learn and creating a better relationship with them. In this paper, some case studies are described on how trained TBAs can be fully utilized in reducing maternal and newborn mortality rate in rural areas. What is needed is to identify TBAs, map their distribution and train them on basic primary healthcare related to child deliveries and complications which need to be referred to conventional health facilities immediately.
International Journal of Reproductive Medicine
Background. Traditional birth attendants play significant roles in maternal health care in the rural communities in developing countries such as Ghana. Despite their important role in maternal health care, there is paucity of information from the perspective of traditional birth attendants regarding their role on maternal health care in rural areas in Ghana. Objective. The aim of this study was to explore and describe the role of traditional birth attendants in maternal health care in the rural areas in Ghana. Methods. A qualitative explorative approach was adopted to explore the role of traditional birth attendants in maternal health care in the rural areas of Ghana. Ten (10) out of a total of twenty-seven (27) practising traditional birth attendants in the study area were purposefully selected from five (5) rural communities in the Bongo District of Ghana for the study. Data were collected through in-depth, unstructured, individual interviews using a guide. Data collected from the...
The International Journal of Health Planning and Management, 2019
SummaryFollowing the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community‐level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the he...
Demographic characteristics of women that use traditional birth attendants in Bongo District, Ghana
European Journal of Midwifery, 2020
INTRODUCTION Over the last decade, the government of Ghana has implemented several interventions aimed at increasing access to skilled birth-care services from trained professionals. Despite these efforts, there is a wide gap between antenatal care attendance and skilled delivery attendance, particularly in rural areas. Evidence shows that many women in rural and deprived communities in Ghana rely on traditional birth attendant (TBA) delivery services. This has created a gap where antenatal attendance is high while skilled delivery is relatively low. The purpose of this study is to identify and analyse the sociodemographic characteristics of women who use the services of TBAs in Bongo District, Ghana. METHODS Using a descriptive study design, a survey was conducted involving 330 mothers randomly selected from 1685 mothers who delivered at home by 2014 in Bongo District. The questionnaire for mothers who delivered at home by a TBA comprised 28 questions. RESULTS The results show that women who used TBA were older, without formal education, married, predominantly farmers, married to spouses who were farmers without formal education. Most of the sampled women were co-currently covered by the national health insurance. CONCLUSIONS This study describes the demographic characteristics of women who use a TBA. Therefore, ongoing efforts aimed at increasing access to and use of professional antenatal services should incorporate sociodemographic factors in the rural context.
2014
According to the World Health Organization (WHO), current estimate of maternal mortality ratios is at more than 1000 per 100,000 live births in most African countries. Despite the existence of modern health facilities in Nigeria, over 58% of deliveries take place at home whereas only 37% take place in hospitals. As outcomes of pregnancy and their sequelae are purely left to the providence of women in many rural communities, the place of delivery is a great determinant of maternal and child morbidity and mortality. With the shortage of skilled birth attendants and uneven geographical distribution of the few available ones; traditional birth attendants tend to fill in the gap. This study employed a cross sectional design and using a simple random sampling technique, 420 women within the reproductive age (18 -45 years) meeting the inclusion criteria for the study were selected. Results from the study indicated a high (88.8%) knowledge of Traditional Birth Attendants (TBAs) but a poor (51.1%) perception about their practices. A significant relationship was shown between age (P<0.05), education status (P<0.05) and the frequency of patronage of TBAs Services. Although, perception about TBAs practices was poor, the role of TBAs in the improvement of women's health (maternal and child health) in rural Nigeria cannot be ignored. TBAs remain major health resources in rural communities in developing countries as well as some parts of urban areas. Efforts need to be harnessed for training of TBAs through the Ministry of Health and Primary Health Care facilities close to their area of practices.
International Journal of Body, Mind and Culture: Cross-Cultural Interdisciplinary Health Studies, 2018
This article examines the impact of traditional birth attendants (TBAs) in rural areas of Ghana and Wurubegu-Anansu community in particular. It examines the challenges that TBAs face as well as the reasons why pregnant women in the community find it difficult to attend antenatal checkups at modern health centres or hospitals. The narratives bring to the fore the kind of advice that TBAs give to women who go to them for antenatal care as well as delivery care. The absence of a clinic within the Wurubegu-Anansu community was identified as one of the many reasons for pregnant women resorting to TBAs for assistance when their time is due for delivery. The findings suggest that TBAs in the study area do not practise on a full time basis because of the meagre income they receive after assisting women in delivery. TBAs therefore engage in different economic activities to support their families. Most of them engage in farming activities or in petty trading and only attend to women when the need arises. If the government of Ghana is unable to provide health facilities in all rural communities in the country, it should adopt the reformist approach through the auspices of the ministry of health. Thus, it should continuously equip and empower TBAs with medical training and delivery tools to enable them to carry out safe and efficient deliveries rather than encourage any policy or action that will hinder their activities.
2021
Background: Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities. Method: Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses. Results: The study found that quality of care was the main driver for traditional birth attendant delivery ...
Health Care for Women International, 2018
Traditional Birth Attendants (TBAs) have been a critical human resource in maternal health care delivery in Ghana. However, following the World Health Organization's directive for countries to discontinue using TBAs, the government of Ghana has since emphasized the use of skilled birth attendants. This policy shift created tensions between TBAs and Community Health Nurses. We examine this conundrum in this paper. We find that despite the ban, TBAs still attend a significant number of birthsa situation which has produced intense contestations and continuous jostling for "functioning space" and clients between TBAs and nurses. We recommend a consensus-based partnership approach that promotes cultural competence and is sensitive to contextual cultural practices that underpin pregnancy and childbirth.