The role of traditional birth attendants in Atakumosa, Nigeria

Abstract

All 26 traditional birth attendants (TBAs) and their 109 in 15 settlements in Atakumosa West Local Government (LGA) in Nigeria were interviewed to assess TBA training, practices and utilisation. The study showed that more than 80% of TBAs were older women with more than four children, practised single-handedly and held other occupations. About 54% of those studied had no designated room for deliveries; twenty-one (80.8%) did not consider any pregnant woman to be at high risk; three (11.5%) perform intravaginal examinations during labour and only a few recognise complications; twelve (46.2%) never refer patients. Despite these deficiencies, TBAs continue to practise in appreciable numbers and their services continue to be on demand in the communities under study. Nearly all of the clients interviewed had started to use TBAs by the age of 25 and 50% had used TBAs for all of their deliver ies. Most TBAs provide antenatal care and 77% had a case load of less than five clients per month. Ninety-six per cent of the clients had not been referred by the TBA before. Although 61 % of clients felt TBAs were both inadequately equipped and trained, the majority (91%) were satisfied with TBA care; 62% would use a TBA in a future pregnancy and 49% would rec ommend TBA care to other women. Low socio-economic status, illiteracy, poor awareness of modern maternal health (MCH) facilities, personalised care, strong family influence and easy access to TBA services were strong factors promoting traditional midwifery in the LGA. If adequately trained, equipped, supported and supervised, TBAs can contribute towards safe motherhood in Nigeria and in other developing countries.