Rutgers School of Public Health MPH student Ms. Kimberly Pierre and colleagues from across the northeastern United States have examined the role that Traditional Birth Attendants (TBAs) play in maternal health care in Nigeria. Their findings suggest that, while TBA tend to have informal training or no training at all, eliminating their use could cause maternal mortality rates to rise.
[Photo: Ms. Kimberly Pierre]
Nigeria’s population exceeds 100 million people; 80 percent live in rural areas. This, combined with the 374 ethnic groups and 774 local governments found in the country, sets the stage for wide variation in customs and practices that relate to childbirth. Worse still, Nigeria is one of many countries that bear the burden of a worldwide shortage of midwives, doctors, and nurses: just 41.2 percent of live births in the country were assisted by skilled health workers. Cost, convenience, and relationships make TBAs more accessible than other healthcare providers for many people.
Ms. Pierre and her colleagues analyzed 21 full-text articles surrounding TBA and maternal mortality rates in Nigeria. While they found an increasing number of women sought the services of skilled birth assistants (SBAs) and increases in prenatal care, eliminating the use of TBAs could leave some expectant mothers — especially those in rural areas — without access to any form of assistance. Even with their lack of formal training, TBAs fulfill important social and cultural roles within the communities they serve.
Training TBAs has been shown to increase the utilization of healthcare of women, both leading up to and following childbirth and also helps TBAs recognize their scope and limitations, paving the way for hospital referrals in the presence of complications,” says Ms. Pierre. “However, this desire for partnership between TBAs and the traditional healthcare system does not suggest that one should supplant the other; rather, it implies that improvement improvements in mortality and morbidity could be realized if TBAs and traditional healthcare work together.”
An increase in quality health education for women and their families is essential to improve the rates of maternal mortality and morbidity in Nigeria. While western medical knowledge is often used as the standard of acceptable medical practice, the lack of access to healthcare facilities lends itself to high utilization of TBAs in rural areas and developing countries. They are an essential link between healthcare and new mothers who, with formal training, have the potential to improve maternal health in Nigeria.
Aside from being a busy MPH student, Ms. Pierre is also the president of the Rutgers School of Public Health Student Government Association in Newark.
“Progresses and Challenges of Utilizing Traditional Birth Attendants in Maternal and Child Health in Nigeria” was published in the International Journal of MCH and AIDS.