Rethinking the role of Traditional Birth Attendants (TBAs) in rural communities – outcomes from a study in Ethiopia

Literature shows the insignificant impact on maternal mortality and delivery outcomes when training TBAs. In Ethiopia they assist 30% of all deliveries while skilled health staffs assist 6%. Evaluating the community component of the safe motherhood project implemented from 2000-2003 in Ethiopia, CARE realized that the social functions of TBAs in their community were more important to the project outcomes than their possible attribution to reduced maternal mortality. Training of TBAs comprised of Home Based Life Saving Skills to detect early danger signs and to make referrals, promoting facility-based pregnancy care and skilled delivery and encouragement to accompany the clients to the facilities.

A community based comparative cross sectional survey was conducted including 1038 women, complemented by eighteen focus group discussions, individual in-depth and key informants' interviews.

The project observed quantitative increase in referrals from TBAs, in Emergency Obstetric Care utilization and in TBA assisted deliveries in the communities. TBAs collaborated increasingly with the facilities. Clients' satisfaction with facility care increased while harmful traditional birth related practices decreased in the communities.

The social role of TBAs is an undervalued aspect in the international discussion on usefulness of capacity building for TBAs. TBAs are committed volunteers, highly respected by the communities; adequately trained they can become catalysts to overcome cultural barriers to access skilled delivery services as major decision makers on referrals.They can increase trust between the health facility and the community, increasing the willingness of marginalized uneducated villagers to access skilled delivery services and make them change harmful cultural practices.