205878 Lives and Work of Traditional Birth Attendants in Rural Haiti

Wednesday, November 11, 2009: 1:30 PM

Betty Joseph-Pierre , UCONN Health Center, Shelton, CT
Judy Lewis, MPhil , Department of Community Medicine, University of Connecticut, Farmington, CT
Kathryn C. Kaplan , Haitian Health Foundation, Jeremie, Haiti
Bette Gebrian, MPH PhD , Haitian Health Foundation, Jeremie, Haiti
Traditional Birth Attendants (TBAs) continue to play a significant role in childbirth and delivery in many parts of the world. Almost 95% of births in the Grand Anse (South-Western) region of Haiti take place at home and most of these are assisted by TBAs.

The Haitian Health Foundation (HHF), a Connecticut based NGO, provides maternal and child health (MCH) in Jérémie, Grand-Anse. Using computerized, census-based registration, health services and indicators are tracked. HHF has trained and supervised TBAs for 20 years; now covering 350 TBAs. But little is known about how TBAs are selected/identified and replaced, conditions of their work, and the role of the community in selection and performance monitoring. This research explored these issues through qualitative interviews with 20 TBAs, selected to provide a broad spectrum of care based on gender, age, frequency of deliveries and training.

Based on preliminary analysis, several patterns are clear. TBAs are “called” to their work by God or through dreams. They are usually daughters/sons of TBAs, and start their apprenticeship in middle age (late 30s-40s). Their major source of income is agriculture or petty trading. They do not provide prenatal care; families come when the woman is in labor. TBAs have a responsibility to go when called to a delivery, feel they are respected for their work and have community approval in part based on HHF training/supervision.

These interviews suggest that training the next generation of TBAs should involve practical hands-on training, better linkage with clinics and hospitals and ongoing support.

Learning Objectives:
1. Understand the way the work of TBAs is organized and supervised. 2. Describe the role of societal, organizational, and individual factors influencing TBA practices and outcomes. 3. Describe current controversies about the role of TBAs in rural areas of low resource countries.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a MBA degree at Quinnipiac University concentration in Health Management, and I am currently a MPH Student at UCONN Health Center.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.