Online Program

“How can I stop working if I was chosen by my community?”: How Mozambican traditional birth attendants are promoting maternal and child health outside of home deliveries

Monday, November 2, 2015

Roseanne Schuster, MSc, Division of Nutritional Sciences, Cornell University, Ithaca, NY
Mosestia Machava, Maputo, Mozambique
Octávio de Sousa, BA, CARE Mozambique, Maputo, Mozambique
Delphine Pinault, BA, CARE Mozambique, Maputo, Mozambique
Sera Young, MA, PhD, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY
Health campaigns and national guidelines encourage pregnant women in low-income countries to deliver at health centers (HCs). In Mozambique this mandate has led traditional birth attendants (TBAs) to transition from attending home births to sensitizing women to deliver at HCs. Since it is unclear how this directive has impacted TBAs’ activities, we characterized the current responsibilities of “active” TBAs. Semi-structured interviews were conducted with 15 TBAs affiliated with HCs. Interviews were transcribed in Portuguese and manually coded by the first two authors. TBAs continue to play an important role liaising with their communities through home visits, accompanying women and children to HCs, and making health presentations. One-third of TBAs counseled women on family planning, most reported assisting with HC births, and nearly all reported openness to being trained for new activities. When asked how they felt about no longer attending home births, 80% of TBAs identified specific ways in which delivering at a HC reduced biomedical risk to women, infants, and/or themselves. Participants reported continuing in their work, even though former TBA colleagues had quit, due to their sense of responsibility to their communities. Motivated by responsibility to their communities, active TBAs felt that their mandate to promote maternal and child health was unchanged even though they no longer attended home births. TBAs’ new responsibilities were influenced by HC affiliation and supervision received. Thus, it is worth exploring whether standardizing training and support for TBAs to conduct other activities, e.g. family planning counseling, would be an appropriate extension of their role.

Learning Areas:

Diversity and culture
Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe changing responsibilities of traditional birth attendants (TBAs) in Mozambique Explain why TBAs continue to conduct their work even though primary responsibility has changed Discuss why incorporating other activities may be appropriate in context of TBA role

Keyword(s): Maternal and Child Health, Community Health Workers and Promoters

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My research focuses on community-based strategies to engage vulnerable populations in health care. Pregnant women in rural Mozambique are one such population. This is a part of my doctoral dissertation. I have also served as Project Manager and Study Director for other research efforts including designing and implementing interventions to connect and retain vulnerable populations in the continuum of quality care.
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.

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