Introduction
Traditional birth attendants (TBAs) still form the foundation of maternal care in most regions of the world, particularly the rural and geographically-isolated regions. These traditional agents of the community have assisted women through pregnancy, birth and even during the postpartum stages across several generations. Nevertheless, although it cannot be denied that they are culturally relevant, the problem is that a lack of medical education among TBAs traditionally led to avoidable maternal, as well as neonatal deaths.
But a transformation of tremendous magnitude has taken place. In various regions, governments, non-governmental organizations (NGOs) and agencies that work in the field of global health, are initiating specialized training and empowerment programs to up-skill the TBAs. These programs deal with safe methods of child birth, hygiene, and proper referrals to qualified medical attention. The mission is straightforward: to transform TBAs not only into the traditional practitioners but also critical health partners in the community so as to achieve better maternal and child health outcomes in a sustainable manner.
The article discusses the redefinition of the TBAs role that structured education is providing, the quantifiable effects that the latter has on the maternal mortality rate, and why cultural awareness training is significant to ensure that change is viable.
The Enduring Role of Traditional Birth Attendants
Historical Importance
The TBAs are part and parcel of societies that date back to long periods of time ago. They do much more than help in physical delivery; they give emotional support, cultural procedures, and postnatal direction. To access maternal care in any community that has little or no modern, accessible health centers or is culturally opposed to them, TBAs are usually the sole choice.
The Challenge of Limited Medical Training
Traditional approaches used by TBAs at times involve practices that may be outdated or unsafe in spite of their social status. Examples include:
- Non-sterile instruments Use
- Late referral in cases of emergency
- Medically-unfounded use of herbal remedies
These practices have ensured that maternal mortality rates in most low resource area continue to be obstinately high.
Global Health Context: The Maternal Mortality Challenge
Understanding Maternal Mortality Rates
The world health organization (WHO) estimates that in 2020, 287,000 women were killed during the process of childbirth and pregnancy. More than 94 percent of this death happened in the low-income and lower-middle-income countries. Among the principles are:
- Shortage of skilled birth attendants
- Delay in emergency referrals
- Poor hygiene at the time of birth
- Inadequate limit in antenatal care
The high level of community trust of TBAs presents a great opportunity. Countries can solve these preventive causes of maternal mortality by providing them with modern skills.
WHO Recommendations on TBA Training
Retreats of WHO on its position on TBAs have developed. In the beginning, the global health policies concerned themselves with replacing the TBAs with skilled professionals. Nevertheless, being aware of the ongoing healthcare shortages, the WHO currently promotes:
- Education of safe delivery TBAs
- Utilization of TBAs in provision of health education
- Development of referral services between TBAs and complicated care
This paradigm makes a point of cultural-specific solutions instead of universal exclusion.
Training TBAs: A Global Movement
Core Components of TBA Training Programs
Although successful TBA training programmes differ very widely in their composition across countries, there are certain common features:
- Clean Delivery Techniques: Training in sterilization procedure, hand cleaning and cord cutting.
- Danger Sign Recognition: Educating TBAs to know when there is an occurrence of complication such as prolonged labour, haemorrhage or infection.
- Emergency Referrals: Putting in place programs to transfer cases to health facilities as soon as they occur and on high-risk cases.
- Newborn Care: Training the TBAs on thermal protection and infant breast-feeding initiation, and basic infant resuscitation.
- Record Keeping: Empowering TBAs to record births and result so that they could be monitored.
Culturally Sensitive Approaches
Successful programs do not disrespect the cultural positions of TBAs. Trainers do not trade how valuable they are by framing contemporary skills as its supplement rather than improvement. This approach:
- Establish trust
- Boosts the rate of training attendance
- Assures acceptance of new practices in the community
- Case Studies: Training Initiatives That Make a Difference
- Bangladesh: A National Model
Bangladesh has been at the forefront in the process of making TBAs in the formal health structure. Some of the main highlights consist of:
- Training Reach: More than 150, 000 TBAs trained within the country.
- Curriculum: Concentrated on clean delivery, and danger signs, and referral activities.
- Impact: Regions that had trained TBAs experienced a significant decline in the occurrence of complications around home deliveries and an increased progress of institutional delivery.
In Bangladesh, TBAs have become important co-workers in the improvement of antenatal care and safe childbirth, which has had great effect as far as maternal outcomes are concerned.
Nigeria: The Lagos State Initiative
TBA training has played a crucial role in Nigeria and the Lagos State in particular. Highlights include:
- Collaboration: Alliances between NGOs and the government such as Pathfinder International.
- Results: More facility-based deliveries and earlier detection of problems.
- Community Engagement: Official community health workers Trained TBAs are considered as official community health workers, which gives these individuals a sense of pride and cooperation.
The Impact on Maternal Mortality Rates
Quantifiable Results
There have been significant results of training TBAs:
- Bangladesh: The ratio of maternal mortality per 100,000 live births decreased to 173 per 100,000 live births in 2017 as compared to 574 per 100,000 live births in 1990.
- Nigeria (Lagos): Reductions in deaths caused by TBA integration were more than 20 percent in communities exposed to TBAs integration programs.
- Nepal: Having TBA training in the regions led to more referrals and reduced complications during delivery at home.
Although training is not the solution to every problem, it serves as a key lever of preventing preventable deaths.
Building Strong Referral Networks
Importance of Timely Referrals
Not even the most dedicated TBA in training can handle severe obstetric emergencies on her own. Programs emphasize:
- Educating TBAs with the acknowledgment of the scope of their practices
- Furnishing them with cell phones or contacting devices
- The association of them with the ambulance services or community transport systems
TBAs who have completed training about referral guidelines in Uganda have helped to increase the number of women who sought care on time with obstetrical emergencies and therefore they had to survive.
TBAs as Community Health Educators
Extending Beyond Birth Assistance
A larger number of well trained TBAs are becoming health educators. Its added responsibilities are:
- Promoting ante-natal clinic attendances
- Informing mothers about diets and healthy conditions
- Creating awareness of negative myths about pregnancy and child birth
- Assistance to family planning activities
This transformation is in tandem with the overall agenda of enhancing the maternal and child health in a holistic manner.
Challenges in Scaling TBA Training
Funding and Resources
In order to sustain training programs, funding is required on:
- Materials needed for training
- Cleaning delivery tools
- Refresher and supervision courses
- Incentives for TBAs
There are numerous programs depending on donors. In this respect, the sustainability is questioned.
Resistance to Change
Every TBA does not readily embrace modern practices. These difficulties are, among others:
- Adherence to historic ways of doing things
- The fear to lose community respect
- Low literacy levels that make training to be complicated
To get over the resistance, it is necessary to use culturally sensitive communication.
Technology: A New Frontier in TBA Training
Mobile Health (mHealth) Innovations
TBA training is having a technology revolution. Innovations include:
- Mobile Apps: Train TBAs on the process of delivery and lists of danger signs.
- SMS Alerts: Remind the TBAs of training or emergencies protocols.
- Data Collection: Electronic resources are used to monitor maternal outcomes to enhance policy planning.
TBAs in Ethiopia using mobile technology had a faster response in reporting emergencies and made faster referrals, thus saving lives.
The Future of TBA Empowerment
Integrating TBAs INTO National Health Systems
In the future, the countries are implementing the hybrid models:
- TBAs are involved in normal child births of low-risk pregnancies.
- They also deal with high risk or emergency cases with skilled professionals.
- TBAs do not only act as community educators and health advocates.
The reality acknowledged by integration involves the position of TBAs that will continue to be of great importance in those places where health infrastructure shortages exist.
WHO Endorsement and Policy Shifts
The changing advice of WHO highlights that a long-term improvement of maternal and child health advocates the utilization of community assets such as TBAs. Instead of marginalizing them health systems should:
- Empower TBAs with skills that are up to date
- Create referral linkages
- Make sure there is support and supervision
Conclusion
The health of mothers and children is facing significant changes as a result of empowering the traditional birth attendants through organized training. Despite this there are difficulties still, such as the lack of funding, resistance due to culture, but evidence is always there that trained TBAs save lives. They help to align the societies between modern and traditional health care, and provide a culturally agreeable avenue towards safe pregnancies and childbirth.
The future of the maternal and child health does not lie in replacing TBAs, but in collaborations. Putting TBAs in possession of the essential information and providing them with an opportunity to work within the national health systems, we make a step toward a world where no woman will lose her life due to the preventable complications during pregnancy or childbirth.
Green development requires further investments, responsible partnership, and creative thinking. This is not the end of the journey, but every trained TBA is hope: a reminder that modern medicine and cultural tradition can come together, hand in hand to save mothers and kids all over the world.
