The role of traditional birth attendants in the reduction of maternal mortality

Throughout history traditional birth attendants (TBAs) have been the main human resource for women during childbirth. Their role varies across cultures and at different times, but even today, they attend the majority of deliveries in rural areas of developing countries. There is little doubt that they have a significant role when it comes to cultural competence, consolation, empathy and psychosocial support at birth with important benefits for the mother and also for the new-born child. In many countries, training TBAs has been an important component of strategies to improve maternal and neo-natal outcomes. However, recent analyses have come to the conclusion that the impact of training TBAs on maternal mortality is low. An emphasis on large scale TBA training efforts could also be counterproductive, by holding back the training of the necessary numbers of medium level providers, particularly midwives. The main benefits from training TBAs appear to be improved referral and links with the formal health care system, but only where essential obstetric services are available. Some studies have observed that formal training is not a requirement for this function. Meeting the needs for medium level obstetric care providers is a tremendous challenge that will be difficult over a limited period of time. Training TBAs should be given a lower priority than developing essential obstetric care services and referral systems. Where TBAs are an important source of delivery care, policy makers need to make the best use of TBAs while simultaneously planning for replacement with skilled attendants.