Introduction
Traditional Birth Attendants (TBAs) remain to be the core focus of maternal care in most parts of the world, and specifically within the rural and underserved regions. They exist before modern medical networks appeared and were caused by age-old cultural practices and collective confidence. Even though medical facility development and woman support has come a long way, TBAs still play a significant role in areas where hospitals and skilled providers are inferior.
In this article, the merits of TBAs concerning their historical and cultural background and their changing role and their invaluable role in enhancing maternal and child health outcomes in low resource areas are discussed. It also points at the importance of empowering TBAs by training, policy support, and the merger into formal health care systems to facilitate health disparity bridging within rural communities.
Historical Context of Traditional Birth Attendants
Origins and Traditional Practices
Child birth has been a very personal and community affair in most societies going back over centuries. Such women were called TBAs, that is, older women in the community who could support a pregnant woman not only during labor, but also in pregnancy and postpartum recovery. They practiced through the influence of cultural beliefs, ancestral knowledge, and experiences which have been transmitted to one generation.
The practitioners of TBAs were known to employ man-made birthing mechanism, spiritual practices and medicines prepared by herbs to help women. Together with being midwives they were emotional and spiritual counselors. They offered their services freely, reliably and they were usually offered in the comfort of the home of the patient.
Status in the Community
TBAs were regarded in the past as holy figures in societies. They were regarded as supporters of women health and as the source of precious knowledge. They were part of the day to day lives of the women they served unlike formal healthcare providers. They were also able to give patient care with reference to cultural beliefs because they knew the local languages and culture better, as well as birthing practices.
The Present Role of TBAs in Rural Healthcare
Persistent Barriers to Formal Healthcare Access
In most rural areas, the healthcare infrastructure is not affordable or unavailable. The high costs of care, absence of transport infrastructure, bad roads, long distances, gender issues and norms have a large effect on women being unable to reach hospitals or clinics to obtain prenatal care and to deliver a child. Consequently, TBAs are the only or primary choices left available.
Some studies indicate that between 40 and 60 percent of the births in rural settings take place in African and South Asian countries still attended by TBAs. This figure explains why their services continue to remain relevant and shows the serious gaps amid formal healthcare delivery systems.
Expanded Responsibilities and Influence
In modern context, TBAs can become health educators, champions, and health links between the people and official health services. Now lots of them take up antenatal care, back immunization programs and even take up hygiene measures. They become more and more important in:
- Spotting issues during pregnancy
- Promoting the initial referrals to facilities
- Nutrition and breastfeeding Promotion
- Psychosocial support of mothers
They also help to manage childbirth and other related issues relating to the family and the surrounding community.
The Case for Empowering TBAs
Bridging the Gap Between Tradition and Medicine
TBAs can easily fill both cultural and logistical gaps within health care. They are able to give hygienic clean births that are safe using the most suitable training, and ensure that people are referred to complications on time. The training and support systems provide recognition to TBAs cultural values whiles ensuring their work in the field of safety is prioritized.
Many health professionals suggest, instead of seeing TBAs as the relic of the past or as something that is inexorably fighting the modern medicine, they should be viewed as a partner who is working with clinicians in the best possible way.
Training and Capacity Building
The experience of successful initiatives in other countries such as Bangladesh, Nigeria, and Nepal has demonstrated that when TBAs are educated about clean delivery practices, identification of danger signs, and care of newborn babies, maternal and neonatal deaths reduced substantially.
Modules for training usually include:
- Washing of hands properly and using of sterilised tools
- Watching vital signs
- Safe cutting of cord practices
- Postnatal care and counselling in antenatal
- How and when to place referrals to health care facilities
Through such initiatives TBAs are being altered to become the community health partners who support the work of trained medical workers.
Integrating TBAs into Formal Health Systems
Community Based Health Models
Some countries have embarked on ensuring that TBAs are incorporated into community health. The TBAs are used together with the Health Extension Workers in Ethiopia. They are prepared in Sierra Leone to escort pregnant women to facilities and get paid when they refer patients successfully.
Such models:
- Maximize partnership with conventional and formal providers
- Enhance confidence in healthcare initiatives by government
- Increase coverage in the hard-to-reach places
TBAs can be the initial contact places and engage in giving the bare minimum care together with connecting the women with upper levels of medical help when required.
Policy and Regulatory Frameworks
Improved results can be achieved by government policy in the recognition of TBAs. There are some nations:
- Put in place certification programs of TBAs
- TBAs included in national health care strategies for work force.
- Given TBAs with transport stipends and medical kits
This institutionalization provides an appropriate legitimacy to TBAs and holds them accountable and monitored with consistency in the quality of care.
Challenges and Limitations
Medical Risk Management
These TBAs are useful but cannot substitute skilled birth attendants in attending high-risk births, carrying out caesarean surgical interventions, or dealing with such complications as eclampsia or haemorrhage. There is a risk of unnecessary mortality when TBAs lack access to emergency obstetric care due to too much reliance on them.
It has to include the balanced approach of training, monitoring, and referral networks.
Cultural Resistance to Change
Some TBAs might refuse to embrace new practices because of set beliefs within them or the suspicion that they might lose their status in the community. In a similar fashion, medical practitioners might not be keen to cooperate fearing it would threaten their status.
Effective method of addressing this resistance is an ongoing dialogue, respect and strong participation by the community.
Global Health Goals and Role of TBAs
Aligning with Sustainable Development Goals (SDGs)
Sustainable Development Goal 3 of the United Nations sets an objective relating to the reduction of maternal mortality ratio to less than 70 per 100,000 live births by 2030. To attain this target, all human resource available should be maximized, including TBAs.
Dutifully trained and incorporated, TBAs can play a large role towards:
- Higher facility deliveries
- Early spotting of issues
- Better newborn caring
- Progressive health literacy at the ground level
- Strategic Partnerships
TBA programs are attracting the investment of international organizations, non-governmental organizations as well as governments. Programs such as UNICEF maternal and new born health programs have in most cases elements that empower the TBAs by training, equipping and monitoring them.
Such alliances play a vital role in the scaling of a proven model as well as in long-term sustainability.
Looking Ahead: The Future of TBAs
Digital Tools and Mobile Health
There is a tremendous potential of fusing technology into the practices of TBA. Mobile health applications known also as “mHealth” authorise TBAs to:
- Have recordings of patient’s information
- Get proper guidance on real-time basis by professionals
- Get emergency transportation systems
- Take part in continuing training programs
Countries such as India and Kenya have seen results and coordination with the TBAs due to the use of mHealth tools in order to liaise with the health centers.
Redefining Their Role in the 21st Century
The role of TBAs is required to change as health systems transition. They may be imagined beyond being birth attendants but rather:
- Maternal health activists Community
- Health data disseminators
- Family planning support agents mental health support agents
- Mediators in diversified medical establishments
This flexibility predetermines their status as an essential element of the future community-driven health models.
Conclusion
Traditional Birth Attendants have been the pillars of maternal care and have been serving for centuries especially in the rural, underserved and remote areas. That they are relics of the past is farfetched since they remain important healthcare providers in areas that lack accessibility to formal medical systems.
The training, integration, and supportive policy framework of TBAs can also be seen as an empowerment and a tactic of enhancing better maternal and child health outcomes besides being an acknowledgment of their cultural significance. TBAs as they go hand in hand with the entire world towards universal health coverage should be accepted as important allies in the overall quest of rescuing the lives of the people as well as achieving health equity within communities.
