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      Perspective of Traditional Birth Attendants on Their Experiences and Roles in Maternal Health Care in Rural Areas of Northern Ghana

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          Abstract

          Background

          Traditional birth attendants play significant roles in maternal health care in the rural communities in developing countries such as Ghana. Despite their important role in maternal health care, there is paucity of information from the perspective of traditional birth attendants regarding their role on maternal health care in rural areas in Ghana.

          Objective

          The aim of this study was to explore and describe the role of traditional birth attendants in maternal health care in the rural areas in Ghana.

          Methods

          A qualitative explorative approach was adopted to explore the role of traditional birth attendants in maternal health care in the rural areas of Ghana. Ten (10) out of a total of twenty-seven (27) practising traditional birth attendants in the study area were purposefully selected from five (5) rural communities in the Bongo District of Ghana for the study. Data were collected through in-depth, unstructured, individual interviews using a guide. Data collected from the interviews were transcribed verbatim and analysed to identify themes.

          Results

          Six main roles of traditional birth attendants on maternal health care in rural areas were identified in this study: traditional birth attendants conduct deliveries at home, they provide health education to women on nutrition during pregnancy and lactation, they arrange means of transport and accompany women in labour to health facilities, they provide psychological support and counselling to women during pregnancy and childbirth, and traditional birth attendants are not paid in cash for the services they render to women in the rural areas.

          Conclusion

          Our study brought to light the critical role traditional birth attendants play in maternity in rural and remote areas in Ghana. There is a need for skilled birth attendants to collaborate with traditional birth attendants in rural and deprived communities to provide quality and culturally accepted care in the rural communities.

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          'They treat you like you are not a human being': maltreatment during labour and delivery in rural northern Ghana.

          Cheryl A Moyer, Philip Adongo, Raymond A Aborigo … (2014)
          to explore community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana, and compare findings against The White Ribbon Alliance's seven fundamental rights of childbearing women. a cross-sectional qualitative study using in-depth interviews and focus groups. the Kassena-Nankana District of rural northern Ghana between July and October 2010. 128 community members, including mothers with newborn infants, grandmothers, household heads, compound heads, traditional healers, traditional birth attendants, and community leaders, as well as 13 formally trained health-care providers. 7 focus groups and 43 individual interviews were conducted with community members, and 13 individual interviews were conducted with health-care providers. All interviews were transcribed verbatim and entered into NVivo 9.0 for analysis. Despite the majority of respondents reporting positive experiences, unprompted, maltreatment was brought up in 6 of 7 community focus groups, 14 of 43 community interviews, and 8 of 13 interviews with health-care providers. Respondents reported physical abuse, verbal abuse, neglect, and discrimination. One additional category of maltreatment identified was denial of traditional practices. maltreatment was spontaneously described by all types of interview respondents in this community, suggesting that the problem is not uncommon and may dissuade some women from seeking facility delivery. provider outreach in rural northern Ghana is necessary to address and correct the problem, ensuring that all women who arrive at a facility receive timely, professional, non-judgmental, high-quality delivery care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study

            Cephas Sialubanje, Karlijn Massar, Davidson H. Hamer … (2015)
            Background Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women’s preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. Methods We conducted ten focus group discussions (n = 100) with women of reproductive age (15–45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Results Our findings show that women’s lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Conclusion Our findings suggest a need to empower women with decision-making skills regarding childbirth and to lower barriers that prevent them from going to the health facility in time. There is also need to improve the quality of existing facility-based delivery services and to strengthen linkages between TBAs and the formal health system.
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              Skilled birth attendance: what does it mean and how can it be measured? A clinical skills assessment of maternal and child health workers in Nepal.

              M Carlough, Nora McCall (2005)
              The presence of a skilled birth attendant at delivery is important in averting maternal and neonatal mortality and morbidity. It has now shown that even trained traditional birth attendants (TBAs) cannot, in most cases, save women's lives effectively because they are unable to treat complications, and are often unable to refer. Qualified midwives and doctors are often not available in the rural areas and community settings where most women in developing countries deliver. Defining the minimum competency level necessary to meet the definition of skilled birth attendant is important, particularly in countries such as Nepal with limited availability of facility-based emergency obstetric care. Maternal and child health workers are local women aged 18-35 who completed a 15-week course in maternal and child health. As the role of MCHWs has expanded to meet the country's needs for skilled attendance, a 6-week "refresher" course in midwifery skills is offered. The results of this clinical skills assessment of 104 randomly selected MCHWs from 15 districts across Nepal supports the premise that MCHWs with appropriate training have an acceptable level of knowledge and skill, demonstrated in a practice situation, to meet the definition of community level skilled birth attendants. Yet, competency alone will not necessarily improve the situation. To affect maternal mortality in Nepal, MCHWs must be widely available, they must be allowed to do what they are trained to do, and they must have logistical and policy support.
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                Author and article information

                Contributors
                Peter Adatara:
                ORCID: http://orcid.org/0000-0002-4344-6753
                Journal
                Journal ID (nlm-ta): Int J Reprod Med
                Journal ID (iso-abbrev): Int J Reprod Med
                Journal ID (publisher-id): IJRMED
                Title: International Journal of Reproductive Medicine
                Publisher: Hindawi
                ISSN (Print): 2356-7104
                ISSN (Electronic): 2314-5757
                Publication date Collection: 2018
                Publication date (Electronic): 1 October 2018
                Volume: 2018
                Electronic Location Identifier: 2165627
                Affiliations
                1Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
                2Public Affairs Unit, University of Health and Allied Sciences, Ho, Ghana
                Author notes

                Academic Editor: Yves Jacquemyn

                Author information
                http://orcid.org/0000-0002-4344-6753
                http://orcid.org/0000-0002-7918-2999
                http://orcid.org/0000-0002-1267-2061
                http://orcid.org/0000-0001-5271-3975
                Article
                DOI: 10.1155/2018/2165627
                PMC ID: 6188853
                PubMed ID: 30364067
                SO-VID: 41f549f2-d2ab-45fe-a29d-6036e90e944a
                Copyright © Copyright © 2018 Peter Adatara et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 May 2018
                Date revision received : 20 July 2018
                Date accepted : 5 September 2018
                Categories
                Subject: Research Article

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