The British Medical Journal published two articles this week in their Head to Head feature focusing on the use of traditional birth attendants (TBAs). The use of TBAs has led to contentious debates in recent years.
Joseph Ana, a former health commissioner in Nigeria, argues that TBAs can have a positive impact on maternal and perinatal health:
Where traditional birth attendants have been trained and integrated into existing health systems, they have not posed any threat to skilled midwives; rather, they have been seen as stakeholders in the effort to improve maternal health. They are very helpful as “counsellors,” comforting frightened rural women with complicated labour, often in the middle of night, in difficult to reach remote villages without electricity, water, or transport and no skilled health worker. In fact, it should be considered unethical to stop a lay person from assisting in such circumstances, especially one with many years’ experience.
However, Kelsey A. Harrison, a retired gynecologist and obstetrician who worked in Nigeria, believes that TBAs are detrimental to maternal outcomes:
Their use is a distraction in that it seeks to manage extreme poverty instead of working to eliminate it…From an equally practical standpoint, we should be worried by the fact that once something substandard gets entrenched it becomes difficult to replace it with something better in future…Initiatives that exclude traditional birth attendants have been shown to improve maternal health.