ABSTRACT

The study is designed to examine the impact of traditional birth attendant practices (TBAs) in primary health care and on women. Randomly-selected women (n=100) were interviewed to gain a more thorough understanding of the impact of traditional birth attendant practices (TBAs) in primary health care.

Research question 1: what made women start receiving care from traditional birth attendant? Shows that 12% visits TBAs because of the cost of services in the hospital, 32% visits TBAs because of family member’s opinion while 36% visits TBAs because of accessibility.

Research question 2: Have they ever encountered any complications from birth complication from birth attendant’s shows that 68% of the respondents have encountered complications while 32% of while respondents have not.

Research question 3: What forms of complications do pregnant women encounter from traditional birth attendant? Shows that 31.3% of the respondent had excessive bleeding, 26.9% had retention of placenta, 11.9% had fresh stillbirth, 10.4% of the respondent lost their babies and 6.0% had in one way or the other lost a relative.

Research question 4: How were the complications resolved? Shows that 22% of the respondents were referred to the hospital, 23.7% was solved using herbal preparation, 10.2% was solved by encouraging maternal efforts, 1.7% was by manipulating the womb manually, 1.7% of the respondents were given bed rest and 22% was solved by encouraging maternal efforts and bed rest. .

 All this result makes it possible for the researcher to conclude that the effect of traditional birth attendant on women is negative. Continuing efforts to examine the effect of TBAs on pregnant women may benefit in the reduction of maternal and neonatal mortality and morbidity

CHAPTER ONE

INTRODUCTION

1.1     Background of Study

Since the adoption of the Primary Health Care (PHC) approach in Nigeria in 1979, government has recognized the need for integrating traditional birth attendants (TBAs) into the PHC system and had consequently initiated TBAs training programmes. In spite of the high patronage of traditional birth attendants, many of their practices during childbirth have been found to adversely affect the health of mothers.

One of the strategies Ministries of Health and their partners have adopted with the aim of promoting safe motherhood since the 1980’s is training unskilled traditional birth attendants (TBAs). However, the assumption that training of traditional birth attendants (TBAs) would contribute greatly to reduce maternal mortality has been disproved in recent years (World Bank, 2003). The training of traditional birth attendants (TBAs) is meant to reduce post-partum infection by encouraging cleanliness and discouraging dangerous practices. While such training may reduce these particular problems, labour and delivery will still be complicated in a certain number of cases. TBAs have neither the skills nor the equipment to treat life threatening complications. Without medical education, supplies and equipment, these TBAs can assist at normal deliveries but cannot handle life-threatening complications (Koblinsky, 1999, World Bank 2003 a, World Bank 2003 b).

Maternal and new-born morbidity and mortality continues to be a problem with a huge disparity between developed and developing countries. Around 99% of maternal and new-born deaths occur in low and middle income countries, globally amounting to about 500 000 maternal deaths and 8 million peri-neonatal deaths per year. In this settings traditional birth attendants, which are mostly women embedded in the community and its socio-cultural frame with no formal medical training and no connection to the formal health system, play a major role around childbirth. TBAs exist since centuries and still continue to be the major providers of care for families, in poor and remote areas where they assist up to 50 – 80% of deliveries nowadays. TBA training has been part of on-going interventions for decades to improve health on community level. At the end of the 1990s the Safe Motherhood Initiative (SMH) made a shift in policy to address the persisting high numbers of maternal deaths by focusing on “skilled birth attendants” (SBA). TBAs were not regarded as skilled and therefore not included in this definition. As a consequence they dropped out of international SMH policies. Despite on-going global efforts neither the intended coverage of 90% SBA for all child-bearing women nor a major achievement to lower maternal and new-born mortality in the countries with the highest burden can be reported.

Although much attention has been given to training TBAs in low- and mid-income countries, the evidence on focusing on training traditional birth attendants leads to mixed results in terms of increased referrals for appropriate conditions. In urban and peri-urban areas there appears to be no impact, while there is some improvement in rural areas with low prevalence rates of the use of maternal care services (Alisjahabana 1995; Bailey 1994;).

It was also believed that TBAs could be trained to recognize obstetric complications and refer women with complications to a nearby health facility for treatment. There are two weaknesses in this plan. First of all, the signs and symptoms of serious complications including: any bleeding during pregnancy, excessive bleeding during or after delivery; convulsions; fever, chills and foul vaginal discharge; headaches in combination with swollen hands, face and feet; labour for more than 12 hours are not difficult to recognize (Wardlaw, Maine 1999). Every one (family decision maker including husbands, mothers, mothers in-law etc.) should be informed/educated to recognize these few danger signs, not just TBAs or pregnant women The more difficult problem with training TBAs to refer women with complications is that there is often no feasible referral option. In fact, it is precisely in circumstances where medical treatment is least available that training TBAs is usually proposed as a solution.

Every year, approximately 600,000 women die of pregnancy-related causes.1 Ninety-eight percent of these deaths occur in developing countries, and for every woman who dies, at least 30 others suffer injuries and, often, permanent disability. (Donnay, 2000)

A TBA has been defined by United Nations as a person who assists mothers during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs. TBAs presently deliver the majority of women in Nigeria as in other developing countries.( Fatusi and Abioye-kuteyi, 1997) It is estimated that between 60 and 80% of all deliveries in the developing countries occur outside modern health care facilities, with a significant proportion of this attended to by TBAs. In an eastern Nigerian study, it was found that although 93% of rural women who had a childbirth or a spontaneous abortion registered for prenatal care, 49% delivered at home under the care of TBAs.

Similarly, in a study of 377 women who delivered before arrival at the hospital in Ogbomosho, south western Nigeria, 65% of the mothers had been delivered by a TBA, while 73.7% had sought help from them for retained placenta with bleeding. In Mexico, TBAs attend to approximately 45% of all deliveries. In Chanchaga LGA of Niger State in north central Nigeria, 84% of households interviewed utilize the services of TBA or village health worker (VHW). A study carried out in Benin City showed that mothers prefer TBAs because they provide home delivery.

1.2     Statement of Problem

The topic became an area of interest to study as a result of the realization that some pregnant women encounter a lot of problem during delivery from traditional birth attendants because of the lack of training of some of the traditional birth attendants.

Similarly, it is also assumed that a sizeable number of the pregnant women tend not to know the implications or problems that could occur or happen to them from complications that could occur when delivering and the necessary attentions and care that will be needed to prevent these complications from being a life-long problem or leading to their death.

Furthermore, the increasing report of the cases of pregnant women that died during pregnancy or encounter life-long problems makes it necessary to look at the ways of solving these problems. Hence, this research project on the impact of traditional birth attendant practices in the primary health care system.

1.3     Purpose of Study

The main objective of this study is to examine the impact of traditional birth attendants in primary health care. The specific objectives of the study

1.     To identify the roles of traditional births attendants in the community

2.     To know if the effect of traditional birth attendants on pregnant women is positive or negative.

3.     To investigate the complications encountered by pregnant women that visits traditional birth attendants.

1.4     Research Questions

1.       What made women start receiving care from traditional birth attendants in Primary Health Centres?

2.       Have they ever encountered any complications from birth attendants?

3.       What forms complications do pregnant women encounter from traditional birth attendants

4.       How were the complications resolved?

1.5     Significance of Study

This study explore the meaning of traditional birth attendants, their role in the community primary health care system and the complications encountered, therefore it will be useful to people who are interested in knowing more about traditional birth attendants. It also found out that the effect of traditional birth attendant is negative and that they needed more training.

This study also helps one to know how to reduce maternal mortality and infant mortality and morbidity.

1.6     Scope of Study

The scope of this study is delimited to Odeda local government area of Abeokuta. The researcher attempts looking at the impact of traditional birth attendant practice in the primary health care system and on women within childbearing age. The focus was limited to women in five different communities in Odeda local government in order to have a sizeable and adequate size of sample.

1.7     Limitation of Study

The researcher faced a number of restraints in the course of carrying out this research project. They include; time constraints, financial constraints, uncooperative attitude of some of the respondents. These constituted limitations of this research project as some of the respondents did not return their questionnaire. The researcher only made do with responses of the respondents whose questionnaire were correctly completed and returned.

1.8     Operational Definition of Study

Traditional Birth Attendant (TBA): A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider.

Primary Health Care System:  Primary healthcare (PHC) refers to "essential health care" that is based on "scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community.

Child mortality: The probability of child dying between the first and fifth birthday.

Practices: They are those acts or actions that are done in relation to a particular issue. (WHO 2008) WHO states the Traditional Birth Attendants trained or untrained are excluded from the category skilled health workers. In this context, the term refers to traditional independent (of the health system) none formally trained and community-based providers of care during pregnancy, child birth and the postnatal period.

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