“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

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.