Leveraging Traditional Birth Attendants to Improve Maternal Outcomes in Underserved Areas

Introduction

Traditional birth attendants (TBAs) reside within a majority of the low-resource communities and the rural areas. Over the centuries, these women, usually older and more reputable members of society, have been able to advise pregnant women during their pregnancy, labor and postpartum care with the use of traditional wisdom and cultural beliefs.

Though TBAs in the past were not professionally trained in medicine, they have a profound understanding and trustworthiness of the local community, a factor that makes these entities irreplaceable when it comes to maternal health. In the current times, there is an extended revelation of the usefulness of incorporating TBAs in the formal healthcare systems. Through training and support of TBAs, nations are filling significant maternal care gaps in Africa and South Asia, thus dramatically lowering maternal deaths, and making their deliveries safe where otherwise these women would have not received any sources of modern medicine.

This article discusses the way, in which the framework of equipping and training traditional birth attendants with tools, skills, and referral mechanisms is changing maternal indicators in underserved areas.

The Persistent Challenge of Maternal Mortality

A Global Health Priority

Maternal mortality is a serious problem even in this era of advanced developments globally. As postulated by the World Health Organization (WHO), about 287,000 women in 2020 succumbed due to easily avertable factors linked to pregnancy and childbirth. Most of these deaths were in settings with low resources where access to skilled birth attendants and emergency obstetric care is low.

Alot of factors partake to these statistics:

• Insufficient skilled healthcare workers in rural communities
• Very far roads to health facilities
• Home births being favoured less than cultural beliefs
• Financial and poverty barriers
• Time wasting in identifying complications

To deal with them, there is a need to provide new approaches that can be connected with local cultures and realities.

Traditional Birth Attendants: Guardians of Maternal Health

Historical Role and Cultural Importance

There are TBAs who have been midwives, counsellors and spiritual guides to many communities. Along with this their work is not just to deliver babies but also to give support to the emotions, herbal medicine and advice in ways that are culturally acceptable. TBAs are friendly and preferred over official people in medicine by thousands of women.

Nevertheless, TBAs were traditionally uneducated in terms of medical practice in treating such complications as haemorrhage, prolonged Labor or infections. This is one of the gaps that have led to deaths of mothers and unborn children especially at times of emergencies when they are away distances of health facilities.

Transforming TBAs into Health Allies

Training as a Game Changer

Most health ministries and NGOs have ended up adopting an inclusive model where TBAs are not shut out. In Africa and South Asia training programs have indicated that TBA training that include evidence-based clinical medicine practice:

• Lower dangerous traditional practices
• Better hygiene during delivery
• Endorse early identification of signs of danger
• Strengthen community health education

Training usually rounds up:

• Good delivery practices (e.g. cutting of umbilical cords by sterile blades)
• The ability to note the indications of obstructed Labor or haemorrhage
• Simple nursing techniques with a baby, such as thermal protection
• Antenatal visit counselling and nutrition as well as postpartum care counselling

TBAs also learn the when’s and wherefores of referring a woman on to skilled personnel and this forms a very important linkage between the community and the health system.

Case Study: Sierra Leone

Integrating TBAs into Maternal Health Strategy

The level of maternal mortality is very high in Sierra Leone. TBAs had been marginalized up to several years in the endeavour to have facility-based births. Nevertheless, the current policy of the government changed into integration instead of isolation.

In partnership with NGOs, TBAs in Sierra Leone can be trained on safe delivery methods, identification of high-risk pregnancy as well as referrals to emergencies. They also receive clean delivery kits and communication devices to receive health centers.

There were impressive results in a pilot program in rural districts:

• Increasing in facility-based deliveries
• Lowered maternal deaths
• Better trust between communities and health care providers

TBAs have proved worthwhile in health promotion through motivating women to visit their antenatal care and breaking the myths of delivery in hospital.

Case Study: Bangladesh

Community Based Approach

The maternal mortality in Bangladesh has decreased significantly during the last decades, partly because TBAs have been included in the formal healthcare activities. To fill in the gap, the government, in collaboration with the NGOs such as BRAC, initiated training programs of TBAs on:

• Safe and clean delivery practices
• Counselling under family planning
• Earlier updates of pregnancy complications

TBAs who are trained are used in most of villages in conjunction with community health workers. TBAs will not deal with complications beyond their capability and thus refer women to clinics; even accompanying them to clinics. This model privileges cultural desire to have home births but still, there is a safety net in case of an emergency.

A single study in a rural area in Bangladesh established that the rate of death of a mother reduced substantially in societies where TBAs were taught and incorporated into referral systems.

Case Study: Nigeria

Bridging Gaps in Northen Regions

The northern part of Nigeria also has extreme maternal mortality rates due to cultural influences on traditional birthing trends and because health organizations are inaccessible. The attempt to shut out TBAs was counter worst since many women kept delivering at home.

The government, together with other partners such as the Nigeria Health Watch deployed training programs to convert TBAs into maternal health advocates. The current amount of TBAs trained in Nigeria:

• Promoting antenatal care attendance
• Refer and identify high risk pregnancy
• Participation on sterilization delivery techniques
• Educating about birth preparedness towards families

Findings indicate better qualified birth attendance and decline in the practice of harmful traditional customs such as unhygienic cutting of the umbilical cords.

Cultural Alignment: The Secret Ingredient

Why Trust Matters

The success or failure of maternal health interventions is dependent on an acceptable state among the community. Cultural authority and trust, which outsiders usually do not possess, are in the hands of TBAs. Their approval may transform community norms to practices that are less risky.

In some sections of south Asia TBAs have played a pivotal role in dispelling some of the dangerous myths like maintaining a distance between particular foods and pregnancy or the benefits of delaying breastfeeding. Likewise, traditional beliefs that surround childbirth in African communities may deter women in seeking medical attention, but due to their help, TBAs successfully navigate through them.

Cultural compatibility is critical since messages on maternal health will be conveyed in a manner that acknowledges the values and beliefs of the locals.

Building Referral Networks: Connecting TBAs to Formal Systems

The Role of Communication

The part of the solution is training TBAs. Maternal care needs to be handled by efficient referral systems. A large number of programs prepare TBAs with:

• Mobile handsets for urgent calls
• Supports for transportation (e.g., motor bike ambulances)
• Partnering with close hospitals and clinics

 In Ethiopia, TBAs are incorporated into the Health Extension Program and receive assistance to refer women to skilled facilities this will result in the access to the skilled facilities in a short time. In regions where there exists effective referral system, maternal mortality rates have been reduced drastically.

Overcoming Challenges in TBA Integration

Resistance and Policy Shifts

Although there have been positive results, there has been reluctance among certain governments to incorporate TBAs as they would worry that it would increase the number of births at home and reduce facility births. But there is evidence that more trained TBAs will be likely to recommend professional care.

Key complications include:

• Making sure there is a frequent training quality
• Supervision and supplies funding
• Filling in the gap between the traditional and modern practices
• Keeping TBAs motivated on an insufficient pay basis

Incentive, recognition programs and those that offer sustained support find more success in terms of addressing these issues.

Innovations Supporting TBAs

Technology and Tools

Technology is advancing TBA roles:

• Mobile applications guided TBAs through safer delivery steps.
• Reminders on SMS encourages antenatal care.
• Digitalized information collection strengthens health tracking

In India, a few TBAs are using mobile applications to record evidence of birth outcomes and this can be used in real time by health officials to track the health trends of all the maternal health.

Conclusion

The utilization of traditional birth attendants in the delivery of favorable maternal outcomes is not only a strategy but a lifesaver to millions of women in under served regions. TBAs help overcome cultural barriers, provide reliable care, and are one of the important connections between communities and the contemporary healthcare system.

In Sierra Leone, Bangladesh and Nigeria, TBAs have been trained and integrated, and measurable improvements in mortality of mothers have been made. Such programs demonstrate that it is possible to overcome one of the most significant problems affecting human health due to respecting the local culture and providing TBAs with the required medical knowledge to develop lasting solutions.

TBAs must still remain policy and practice-central as governments and non-governmental organizations invest in maternal health. Their special role means that no woman no matter where she lives or what her financial makes will be left behind in the quest of safe motherhood.