Integration of traditional birth attendants into primary health care

Abstract

An evaluation of domiciliary midwifery services in a suburban area of Benin City, Nigeria, revealed that mothers liked them mainly because of the provision for home delivery. The integration of traditional birth attendants into organized health care was considered desirable by both mothers and the midwifery staff. Domiciliary midwifery services are recommended as a means of integrating traditional birth attendants into primary health care.

PIP: If appropriately trained and supervised, traditional birth attendants can play a crucial role in the primary health care system of developing countries and their roles can be expanded to include immunization, family planning education, contraceptive distribution, the administration of injection, and diagnosis of conditions such as anemia and toxemia. A pilot project established in 1976 in a suburban area of Benin City, Nigeria, provides valuable insights about strategies for integrating traditional birth attendants into the organized health care sector. The state health management board, concerned about congestion in hospital maternity wards, set up a domiciliary midwifery unit, comprised of trained midwives and community health nurses. Women with no identifiable risk factors are prepared for home birth, which costs about a third of birth in a government hospital. To evaluate the effectiveness of this approach, 600 of the 12,052 pregnant women who received services through the program in 1982-85 were randomly selected for follow-up. 478 of the 600 women had opted for home delivery, although 9 were referred to the hospital due to labor complications. 196 delivered with the aid of a program midwife; in the remaining home deliveries, the midwife could not be summoned and a traditional birth attendant was present. There were 11 neonatal deaths in the sample. Program midwives expressed support for government recognition of traditional birth attendants, but identified a need for training in infection control. Likewise, the traditional workers favored a cooperative arrangement with the orthodox health system and wanted both training and certification. Thus, transportation problems in the midwifery program had the unintended affect of creating a close relationship between untrained and trained midwives, and the feasibility of having domiciliary midwifery units provide training for birth attendants in their catchment area was documented.