Introduction
The health of women and children is one of the most acute issues of global health. Although contemporary medicine recorded impressive progress in mortality rate among women and newborns, the wide gap between the world of big cities and the healthcare system in isolated locations with very weak or even non-existent infrastructure still exists. Traditional Birth Attendants (TBAs) have remained the first port of call in taking care of pregnant women as well as newborns in such regions.
However, TBAs are most of the time stuck amidst adoration as well as condemnation. They are renowned to be culturally relevant but disregarded because of a lack of formal medical training and represent a crucial crossroad between tradition and the modern health system. Since the nations begin to seek sustainable methods of maternal health enhancement, the role of Traditional Birth Attendants is no more an option to comprehend, but a necessity.
This paper discusses the historical background, the current facts, the myths, and possibilities of the role of TBAs based on the premise that they have the potential in bridging the maternal and neonatal health gap by becoming part of national health programs.
Historical and Cultural Foundations of TBAs
Ancient Origins
TBAs are present not only in human societies, but they have existed millenniums. Childbirth in ancient cultures was regarded not as only a physical process, but as a spiritual one- knowing, rituals, and emotional support were needed. Most societies had women use their elderly and experienced fellow women to help them during labour, cope with cases of complication using traditional knowledge, as well as during the postpartum recovery.
Even nowadays TBAs still tend to have wider functions sometimes including baby delivery. They:
- Perform rituals so that there are safe pregnancies
- Prescribe natural medications to general ills
- Advise women on fertility, nutrition and after birth care
- Act as community consultants on issues of women health
The products of their labour carry their centuries of ancient knowledge that has been handed down through generations.
Cultural Significance
TBAs possess social capital in the underserved and rural communities that the formal health workers do not. They:
- Communicate in local language fluently
- Know beliefs and cultural taboos
- Frequently easy to access day or night
- Charge cheap fees or receive in-kind payment
These are the factors that render TBAs essential particularly in areas where women are unwilling to travel long distances and seek care at hospitals due to poverty and cultural beliefs.
Debunking Common Myths About TBAs
Myth 1: TBAs Are Universally Dangerous
Among the most powerful accusations towards TBAs, there is that TBAs can not be deemed safe as they contribute to high maternal mortality rates. Even though it is true that TBAs are not usually formal medicine wise, one cannot paint the entire picture with black and white.
- Reality: Numerous TBAs have been trained and they practice safer behaviours. Learned TBAs in places such as Bangladesh and Nigeria have been demonstrated to help maternal outcomes, with several researchers expressing out that these TBAs increased maternal results of clean deliveries and referrals.
Myth 2: TBAs Resist Modern Healthcare
The other issue is the perception that TBAs do not embrace modern medicine because of being superstitious or prideful.
- Reality: Most TBAs are keen to work with the health systems as long as they are respected and trained. It has been shown by several programs that TBAs are willing to refer complex cases, encourage antenatal visits as well as welcome the practice of modern deliveries when they are properly supported to do so.
Myth 3: TBAs Are Obsolete
There is an assumption that in-time the modern healthcare systems will succeed in removing the necessity of TBAs.
- Reality: In regions where the nearest hospital is reserved by hours and where transport facilities are erratic, TBAs are the most convenient ones available to a majority of the women. De-listing them without an option may create a gaping dice that is filled with danger.
The Real Impact of TBAs on Maternal and Neonatal Health
Trusted Community Agents
TBAs are usually the friends that one can confide in. Women can confide fears or symptoms to TBAs that they would never reveal to a medical personnel, but to a person of assigned sex as female. This trust leads to an early initiation of the interception of complications, e.g.
- Bleeding excessively
- Prolonged labour
- Infection signs
- Symptoms of eclampsia
With the training of TBAs on the identification of such danger signs and their immediate intervention, rates of maternal and neonatal mortality are reduced.
Linking Traditional and Formal Systems
TBAs run as mediators between the customary beliefs and biomedical treatment when combined harmoniously. They help:
- Dispel misleading urban legend, e.g. that there are foods to avoid during pregnancy
- Promote institutional delivery among the high-risk pregnancies
- Advance family planning and post-partum care
- Play the role of referral agents to competent facilities
Experience in Nepal and Uganda has demonstrated that TBAs may be valuable partners when it comes to expanding the reach of the national health systems.
Documented Success Stories
- Bangladesh: TBAs were trained in community-based programs and led to an upsurge in institutional deliveries and a decrease in maternal deaths. TBAs became powerful educators in the field of health, transforming the norms of childbirth in the community.
- Nigeria: TBAs were given clean delivery kits and trained in some northern states. The mortality among pregnant mothers reduced with TBAs directing more of the number of pregnant women to hospitals due to complications.
- Kenya: TBAs have also partnered with community health volunteers in order to visit the homes and to encourage antenatal care and safe delivery practices.
Challenges in Relying Solely on TBAs
It is clear that TBAs, although attractive in the above ways, cannot replace skilled birth attendants (SBAs) that are trained to deal with complications. Challenges include:
- Inability to manage an emergency like caesarean section
- Poor capacity to use medicines such as oxytocin
- Differences in quality of training in various regions
- Continued using of certain risky traditional methods
The integration should thus be planned and should be aimed at collaboration rather than substitution.
Opportunities for Integration into National Health Systems
Training and Capacity Building
Those countries who have managed to integrate TBAs will pay attention to comprehensive training. These cover:
- Neat delivery practices
- Referrals on time
- Detection of high risk pregnant pregnancies
- Simple measures on newborn care, such as thermal care and breast feeding promotion
Training not only makes TBAs into workers at the forefront of health work in line with the national standards but also changes them to some extent: some Traditional Birth Attendants become more professional than ever.
Registration and Regulation
This kind helps governments:
- Monitor the amount and the distribution of TBAs
- Activities must be watched
- Give lethal protection for mothers and TBSs
In Nigeria, some states such as Lagos have made registries of the TBAs together with the linkages to be supervised and supported by the health facilities.
Partnerships with Health Facilities
TBAs who work with clinics or hospitals also have a major impact on the outcome of mothers. The effective models are:
- TBAs referral incentives in bringing women to health institutions
- Sharing the supervision visits with nurses/ midwives
- Community meetings between TBAs and medical workers
These collaborations honour the community reputation of TBAs whilst caring to ensure the safety of mothers.
Leveraging Technology
TBAs can be even empowered by web of new technologies:
- Mobile phones enable TBAs to request ambulances or to consult with expert professionals in case they face some emergency events.
- Applications take TBAs through labour protocol and checklists of danger signals.
- In a real-time basis, digitalization of data collection enables the monitoring of maternal and newborn health indicators.
Ethiopia and India have been successful in using programs to implement mobile health (mHealth) tools as a way of increasing the capacity of TBAs to improve their capabilities.
Why Integration is a Public Health Priority
Reaching Underserved Populations
TBAs usually reside in the same communities wherein they serve women, which eradicates special impediments to healthcare. They all are crucial to be able on reaching:
- Women who are residing in remote village communities
- Nomadic populations
- Societies that have social mores that discourage facility births
Cost Effectiveness
The cost of training and integrating TBAs is affordable as opposed to sending massive numbers of competent individuals to every village that is remote. Traditional Birth Attendants do not bear the potential to substitute SBAs; however, they can alleviate the pressure on health systems, conducting normal deliveries without risks to the mother and the baby and referring to more qualified practitioners in case of complications.
Cultural Competence
The concept of cultural competence plays a very important role in healthcare delivery. Sensitive cultural issues which are assisted by TBAs include:
- Modesty during the birth of a child
- Gender aspects of care delivery
- Native rituals around pregnancy and birth
Their participation enhances the level of trust in the community and their different levels of willingness to use formal health services.
Global Health Policy and TBAs
WHO’s Stance
World Health Organization recognizes the potential roles that TBAs can contribute toward maternal health improvement when trained and integrated into appropriate care. Although WHO insists that all deliveries are to be managed by skilled personnel, it understands that, in most environments, TBAs are the only viable solution.
Sustainable Development Goals (SDGs)
SDG 3 will focus on evaluating maternal mortality rates worldwide and will ensure that by 2030 they must be less than 70:100,000 live births. To reach this target in low resource areas, it is important to utilise all possible community resources, including the TBAs, to bridge the gaps in access to maternal health care.
Recommendations for Policy and Practice
The strategies towards the future can be based on the evidence that was gathered worldwide but the immediate suggestions are as follows:
- Recognize TBAs Role: Formal discussions on TBAs should recognize the existence of TBAs as health personnel on a large scale.
- Invest in Training: The governments ought to invest in training programs that would instil the TBAs with the necessary skills and referral knowledge.
- Ensure Regulation and Supervision: There should be some monitoring systems to ensure quality and safety in operations.
- Create Collaborative Partnerships: The presence of TBAs should be utilized by health facilities in maternal health programs.
- Leverage Technology: The digital tools will streamline the effectiveness of TBAs and will help to be in touch with skilled providers.
- Sustain Funding: Training, supervision and incentive systems require long-term financial involvement.
Conclusion
Traditional Birth Attendants are not the relics to be forgotten or barring the way to progress. They are credible members of the community, and when used correctly, they give useful aid towards maternal and child health. They are important in reaching global health targets as stipulated by their cultural relevance, accessibility, and knowledge in the community.
Instead of excluding TBAs as some health systems do, there should be attempts to utilize their potentials. With careful training, monitoring and respectful cooperation, Traditional Birth Attendants have the power to encompass the gap widely perceived to exist amidst traditional and modern medicine to reduce the number of women sufferings due to unsafe pregnancies and cut future generations to have healthier lives.
