The Place of Traditional Birth Attendants in Global Maternal Health: Policy Retreat, Ambivalence and Return

In this chapter, I tell the story of the waxing and waning of the status of the traditional birth attendant (TBA) in global maternal health policy from the launch of the Safe Motherhood Initiative in 1987 to the present. Once promoted as part of the solution to reducing maternal mortality, the training and integration of TBAs into formal healthcare systems in the global south was deemed a failure and side-lined in the late 1990s in favour of ‘a skilled attendant at every birth’. This shift in policy has been one of the core debates in the history of the global maternal health movement and TBAs continue to be regarded with deep ambivalence by many health providers, researchers and policymakers at the national and global levels. In this chapter, I take a critical global heath perspective that scrutinises the knowledge, policy and practice of global health in order to make visible the broader social, cultural and political context of its making. In this chapter, I offer a series of critiques of global maternal health policy regarding TBAs: one, that the evidence cited to underpin the policy shift was weak and inconclusive; two, that the original TBA component itself was flawed; three, that the political and economic context of the first decade of the SMI was not taken into account to explain the failure of TBAs to reduce maternal mortality; and four, that the reorganisation of the Safe Motherhood movement at the global level demanded a new humanitarian logic that had no room for the figure of the traditional birth attendant. I close the chapter by looking at the return of TBAs in global level policy, which, I argue, is bolstered by a growing evidence base, and also by the trends towards ‘self-care’ and point-of-use technologies in global health.

It's a Long Walk: Lasting Effects of Maternity Ward Openings on Labour Market Performance

Being born in a hospital versus having a traditional birth attendant at home represents the most common early life policy change worldwide. By applying a difference-in-differences approach to register-based individual-level data on the total population, this paper explores the long-term economic effects of the opening of new maternity wards as an early life quasi-experiment. It first finds that the reform substantially increased the share of hospital births and reduced early neonatal mortality. It then shows sizable long-term effects on labour income, unemployment, health-related disability and schooling. Small-scale local maternity wards yield a larger social rate of return than large-scale hospitals.

Socio-cultural Importance of Newborn Healthcare Practices of Parengi Porja Tribe Living in Hilly Forested Areas of Andhra Pradesh, India: An Anthropological Analysis

The study aims to understand the traditional healthcare management of the newborns of the Parengi Porja tribe. The Parengi Porja tribe is a Particularly Vulnerable Tribal Group (PVTG) that inhabits the Eastern Ghats, which is a continuous high hilly region of Visakhapatnam district, Andhra Pradesh, India. The members of this tribe strongly believe that the earliest weeks of a newborn’s life is the time for the greatest probability of death and disability. To avoid these misfortunes, they strictly follow the traditional healthcare regimen for newborns, which has significant socio-cultural importance. For this study, 105 neonates were purposively selected, and their mothers were interviewed for data collection. The research data were analysed by qualitative methods that included participant observation, in-depth interviews and focus group discussion. The collected data were repeatedly cross-checked with other elderly female members like grandmothers, and sutranimaizi (traditional birth attendant [TBA]) through interviews to strengthen the efficiency and authenticity of the data. The findings of the study show that this tribal population has its understanding of the management of neonatal health, which is socio-culturally ingrained, sanctioned and transmitted through generations.

Literatur Review: Kebijakan dan Strategi Pemberdayaan Masyarakat Dalam Menurunkan Angka Kematian Ibu dan Bayi

Implikasi hasil sensus penduduk 2020 terhadap kebijakan pembangunan kependudukan menunjukkan bahwa angka kematian ibu dan bayi di Inonesia masih cukup tinggi saat ini. Tahun 2015 tercatat 305 kematian per 100 ribu kelahiran dan tahun 2017 dengan 177 kematian per 100 ribu kelahiran. Untuk Tahun 2030 yakni kurang dari 70 per 100 ribu kelahiran. Indonesia menempati posisi ke tiga diantara 10 negara ASEAN. Literature review ini bertujuan untuk mendeskripsikan kebijakan dan strategi kemitraan bidan dan dukun serta mengajukan konsep pemberdayaan masyarakat dalam mendukung penurunan angka kematian ibu dan bayi di Indonesia. Metode yang digunakan dengan pencarian database melalui ProQuest, Scilit, Pubmed, Worldcat dan DOI. Sementara kata kunci yang digunakan dalam pencarian artikel antara lain midwife, traditional birth attendant, birth, social health, social and maternal health. Terdapat 12 artikel yang diperoleh dan 5 artikel yang dianalisis melalui analisis kesesuaian topik, tujuan, metode yang digunakan, ukuran sampel, dan hasil dari setiap artikel serta keterbatasan yang terjadi.Terdapat dua (2) artikel yang menyoroti tentang pemberdayaan masyarakat tanpa konsep yang konkrit. Disarankan konsep Sistem AGIL dapat dijadikan strategi pemberdayaan masyarakat untuk menurunkan angka kematian ibu dan bayi di Indonesia.

Perceptions and practices on newborn care and managing complications at rural communities in Bangladesh: a qualitative study

Background Community misperception on newborn care and poor treatment of sick newborn attributes to neonatal death and illness severity. Misperceptions and malpractices regarding neonatal care and neonatal complications are the leading causes of neonatal deaths in Bangladesh. The study was conducted to explore neonatal care’s perceptions and practices and manage complications among Bangladesh’s rural communities. Methods A qualitative study was conducted in Netrakona district of Bangladesh from April to June 2015. Three sub-districts (Upazilas) including Purbadhala, Durgapur and Atpara of Netrakona district were selected purposively. Five focus group discussions (FGDs) and twenty in-depth interviews (IDIs) were conducted in the rural community. Themes were identified through reading and re-reading the qualitative data and thematic analysis was performed. Results Community people were far behind, regarding the knowledge of neonatal complications. Most of them felt that the complications occurred due to lack of care by the parents. Some believed that mothers did not follow the religious customs after delivery, which affected the newborns. Many of them followed the practice of bathing the newborns and cutting their hair immediately after birth. The community still preferred to receive traditional treatment from their community, usually from Kabiraj (traditional healer), village doctor, or traditional birth attendant. Families also refrained from seeking treatment from the health facilities during neonatal complications. Instead, they preferred to wait until the traditional healers or village doctors recommended transferring the newborn. Conclusions Poor knowledge, beliefs and practices are the key barriers to ensure the quality of care for the newborns during complications. The communities still depend on traditional practices and the level of demand for facility care is low. Appropriate interventions focusing on these issues might improve the overall neonatal mortality in Bangladesh.

The Influencing Factors for A Pregnant Mother give Birth with Traditional Birth Attendant (A Case Study in. Bangko District, Rokan Hilir Regency, Riau)

This study discusses the existence of traditional birth attendant services in the district. Bangko till now. The purpose of this study was to describe the factors that influence pregnant women to give birth by using traditional birth attendants and also services provided by traditional birth attendants to pregnant women. This research is a descriptive type with a qualitative approach. The methods used in data collection were participatory observation and interviews, with informants, namely mothers who had given birth to traditional birth attendant and traditional birth attendant themselves. The results of the study are the factors that influence pregnant women who give birth with traditional birth attendants, namely the existence of hereditary habits, beliefs, social relations between patients and traditional birth attendants, social and economic conditions and background of mothers who give birth at a traditional birth attendant, more services for the traditional birth attendant. plenary, far health service distance with difficult transportation, and fear of using medical equipment. While the care provided by the traditional birth attendant includes examination of the patient's womb, the delivery process, and post-delivery services.

Uropathogens and antimicrobial susceptibility profiles of asymptomatic bacteriuria among pregnant women receiving antenatal care in traditional birth attendants homes in Ikono, Akwa- Ibom State, Nigeria

Background: Asymptomatic bacteriuria (ASB) in pregnancy is associated with adverse maternal and obstetric outcomes if untreated. The aim of this study was to determine the prevalence and susceptibility profile of ASB among pregnant women attending antenatal clinics in traditional birth attendant homes in Ikono, Akwa-Ibom State.Methods: The study was a cross sectional survey using 350 pregnant women with ASB. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured, bacterial colonies were identified and antibiotic sensitivity was done. Data was analyzed using SPSS version 20.0 and significant was set at ≤0.05.Results: The overall prevalence was 33.4% using 350 asymptomatic pregnant women. The mean age was 26.21±3.6 years and aged 27-32 have the highest prevalence (13.4) of ASB. 55.1% attained primary school, while 33.4% had informal education, monoparous (54%), 3rd trimester was 44.6% with 15.8% positive cases. Multigravidae was 71.1% with 19.4% positive cases. There was significant association of age, education, parity, occupation, monthly income, etc with ASB. The most common isolates were Escherichia coli (29.9%), then Klebsiella pneumonia (19.7%). Pseudomonas aeruginosa was susceptible to gentamicin (92%), Ciprofloxacin (83%) imipenam (83%) and azetronam (75%), while Staphylococcus saprophyticus was susceptible to imipenam (90%), then gentamicin at 80%. Multi-drug resistant were widespread in most of the isolates.Conclusions: Multi-drug resistant were observed in most of the isolates. Continuous and collaborative surveillance of ASB and antimicrobial resistance pattern are essential to reduce the consequence of asymptomatic bacteriuria in pregnant women.

Enhancing Traditional Birth Attendant Training in Guatemala

BACKGROUNDThis article describes the follow-up study to Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants, published in the International Journal of Childbirth in 2017. This current study had two purposes: (a) to implement and evaluate the use of enhanced training modalities (active-learning strategies and use of technology in a remote area), and (b) to pilot training-of-trainer (ToT) methods. The current study builds upon the previous study in which we conducted and evaluated a simulation-based training among low-literacy Guatemala traditional birth attendants (TBAs).MATERIALS AND METHODSIn the current study, we conducted a focus group with experienced TBAs (n = 8) to elicit concepts and issues important to address in the training. The 60-hour training designed for low-resource settings, was enhanced with active-learning strategies, technology, and ToT modules. We assessed pre–posttest knowledge and attitudes by paper-pencil format, and pre–post skills by demonstration using simulation.RESULTSTraining participants (N = 31) included the eight experienced TBAs from the focus group. Knowledge, skills, and attitudes all improved, with statistical significance achieved in many parameters. Evaluation of the training was positive and enhancement strategies were noted as particularly helpful. Two participants participated in the additional ToT modules and are now collaborating to provide short educational programs to other TBAs in their regions.CONCLUSIONTraining enhancement strategies have the potential to increase safe practice among TBAs where skilled birth attendants are lacking. Adding ToT modules enhances sustainability and exemplifies the importance of locally prepared trainers in a time when global interaction is severely limited.

Viewpoints of pregnant mothers and community health workers on antenatal care in Lweza village, Uganda

Background Uganda is a low-income country with high fertility, adolescent birth, and maternal mortality rates. How Ugandan Ministry of Health antenatal education guidelines have been implemented into standardized health education and how pregnant women utilize health facilities remains unclear. Objective We aimed to determine how women obtain education during pregnancy, what guidelines health educators follow, and what barriers exist to receiving antenatal care in Lweza Village, Uganda. Methods Household surveys were conducted with women in Lweza who were or had previously been pregnant. Focus group discussions were conducted with community members and Lweza Primary School teachers. Interviews were conducted with key informants, including midwives, a traditional birth attendant, a community leader, and a Village Health Team member. Data collection was done in English along with a Luganda translator. Results Of the 100 household surveys conducted, 86% of women did not meet the WHO recommendation of 8 antenatal appointments during their pregnancies. Reasons cited for inadequate visits included facing long wait times (>7 h) at health facilities, getting education from family or traditional healers, or being told to delay antenatal care until 6 months pregnant. Informant interviews revealed that no standardized antenatal education program exists. Respondents felt least educated on family planning and postpartum depression, despite 37% of them reporting symptoms consistent with postpartum depression. Education was also lacking on the use of traditional herbs, although most women (60%) reported using them during pregnancy. Conclusions Most women in Lweza do not receive 8 antenatal appointments during their pregnancies or any standardized antenatal education. Educational opportunities on family planning, postpartum depression, and the safety of traditional herbs during pregnancy exist. Future studies should focus on ways to overcome barriers to antenatal care, which could include implementing community-based education programs to improve health outcomes for women in Lweza Village.