WUNRN
HEALTH-AFRICA:
Bringing Traditional Birth Attendants Into the
Mainstream
Joyce Mulama
MAPUTO, Sep 22 (IPS) - In an ideal world, all of Africa's
women would have access to clinics, nurses, obstetricians, medicines: the
panoply of staff and equipment needed to make the process of giving birth as
safe as possible.
Failing that, what can be done to lessen the risks
that come with delivering babies? For one, improve the skills of traditional
birth attendants (TBAs), say delegates who met this week in Mozambique at an
African Union (AU) gathering on sexual and reproductive health care.
"We
need to look at upgrading their skills so that they are not TBAs, but are at a
higher level such as midwives," Thoraya Ahmed Obaid, executive director of the
United Nations Population Fund, told journalists in the Mozambican capital --
Maputo.
"This is important, since in some communities TBAs are the only
reproductive health care providers present."
A plan of action adopted
Friday by AU health ministers underscores this need, pledging to "build capacity
of all categories of Sexual and Reproductive Health and Rights (SRHR) service
providers including nurses (and) TBAs..."
The initiative marks a
departure from previous attitudes to traditional birth attendants, who have
often taken second place to accredited health workers -- who have the benefit of
formal training.
In a feature published by IPS in February last year
(HEALTH-KENYA: Do Safer Births Require a Break With Tradition?), the director of
the reproductive health division at Kenya's Ministry of Health, Josephine
Kibaru, noted that use of TBAs was undermining efforts to reach the Millennium
Development Goals (MDGs).
Eight MDGs were agreed on by global leaders at
the Millennium Summit held in 2000 at the United Nations, in New York. They
include a goal to reduce maternal mortality by three quarters, by 2015.
But, Kibaru has re-evaluated her position.
"We cannot just sit
and continue to bury our heads in the sand. The TBAs are there in our
communities. We need to work together with them, encouraging them to refer
pregnant women to health facilities early enough," Kibaru told IPS.
Amidst fears that many TBAs were failing to direct women who experienced
birth-related complications to clinics and hospitals in time to prevent these
problems leading to death, efforts have been made to discourage attendants from
performing deliveries in Kenya. They are now urged to become involved in
activities such as contraceptive distribution, said Kibaru.
Retired
midwives have also been called back into service to offer women the chance of
having babies with skilled personnel in attendance.
But, the reality
remains that about a quarter of all births in the East African country are
overseen by TBAs, this according to government figures.
What also cannot
be denied is that many women feel more comfortable giving birth with traditional
attendants.
"These women find TBAs more supportive of them because TBAs
attend to only one woman at a time, while a skilled attendant in a hospital
setting tends to fall short of the individual support to the woman -- given that
she has to attend to other cases as well," Eddie Mhlanga, professor of
obstetrics and gynaecology at the University of KwaZulu-Natal in South Africa,
told IPS.
When those skilled attendants are present, that is.
"We need to see how to bring TBAs to the health systems so that they can
reduce the impact of the brain drain, especially at facilities for primary
care," Mhlanga said.
As is frequently noted, the migration of African
health professionals to wealthier countries -- prompted by low pay and poor
working conditions -- has put a severe strain on health services across the
continent, especially in rural areas.
It has contributed to a situation
where Africa shoulders more than 24 percent of the global disease burden, with
assistance from just three percent of health workers (these statistics from
'Working together for health', the 2006 World Health Report produced by the
World Health Organisation).
According to Warren Naamara, country
coordinator in Ghana for the Joint United Nations Programme on HIV/AIDS, drawing
traditional birth attendants into the health system will involve providing them
with the means to work in a clean, safe environment -- and also with education.
"It is all about training TBAs in how far they can and cannot go. There
are some things they cannot do, like surgery," he noted.
"Where they
anticipate complications, let them refer such cases to the nearest delivery
point, because their work has trained them to detect a woman who may not deliver
smoothly."
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