Lives and Work of Traditional Birth Attendants in Rural 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.