Social Roles and Birthing Practices of Traditional Birth Attendants in India with reference to other Developing Countries

AbstractPregnancy and childbirth complications are a leading cause of death and disability among women of reproductive age in developing countries. The high maternal and infant mortality rates and low uptake of antenatal and postnatal care have been topics of deliberation for researchers in the fields of medicine, public health, anthropology and sociology. Worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by Traditional Birth Attendants (TBAs) and/or family members. Since the 1970s the training of TBAs has been one of the primary single interventions undertaken by funding agencies, who assume that maternal and perinatal mortality in developing countries is high because many women deliver babies at home, assisted by TBAs or relatives. However, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or a failure, given the evidence that the maternal mortality rate (MMR) in developing countries did not reduce. Hence, many donor agencies providing funding for TBA training in developing countries have withdrawn funds, reallocating them to providing skilled attendants during delivery. Researchers have expressed concern that a shift in policy has taken place without adequate evidence about the relevance and effectiveness of the TBA training program.The objective of this paper is to review research evidence from India and other developing countries on the relevance of TBAs by assessing their contribution to providing maternal and infant health care service at different stages of pregnancy, during and after delivery; outcomes of training; and birthing practices adopted by them in home births. This review reveals that TBAs acquire knowledge of the birth process through experience, which they bring to their practice and which they use to explain events in their local context. Certain harmful TBA practices have changed and others have been introduced into the community through training. An appropriate understanding of useful and harmful local practices in communities is therefore important background information that trainers need to know before conducting training programs in a particular area. Certain redundant birthing practices such as discarding colostrum, bathing babies immediately after birth, using unhygienic material to cut and apply on the cord and delayed weighing of babies continue to be practiced not only in home births but also in health institutions in India. This review article highlights the importance of training to improve TBAs' knowledge, together with community awareness programs. Potentially detrimental cultural beliefs need to be addressed too, when TBA training programs are initiated in order to improve maternal and child health outcomes.