Nigeria’s mothers are facing a crisis. The country currently has the fourth highest maternal mortality ratio with 814 maternal deaths/100,000 births and without drastic changes, Nigeria’s women will continue to die from preventable causes. Training and regulating the traditional birth attendants (TBA) in the country may be one step in radically changing the care these mothers receive.
Particularly in the most rural areas of the country, a large percentage of women are not seeking maternal care from health facilities or skilled providers but are rather choosing to seek care from traditional birth attendants (TBA) in their communities. In fact over 20% of all births in Nigeria are attended by a TBA, with some regions of the country reaching as high as 85%. Women are choosing this route of care for a number of reasons including cost, access, and cultural preference and as such ignoring their important role undermines efforts to improve care. This fact has been recognized by several international agencies, including the WHO, and programs supporting the training and integration of TBAs into the health system have been implemented by these agencies in other countries.
Utilizing TBAs in Nigeria on a national level would not be simple and would require the full support of international agencies already working in the country. However, with this support, Nigeria could accomplish the task. A limited model of how this could work is being developed in Lagos State under the regulation of their state-level traditional medicine in order to meet the needs of those in areas with limited access to facilities. Nigeria’s House of Representatives is working to pass a bill to form a traditional medicine council that will be tasked with establishing regulations for traditional practitioners and promote cohesion with the conventional health system for the improved health of the population. If fully supported by international agencies, this council could be the launching point for creating a national program that regulates and trains TBAs based on evidence-based recommendations and bring them in harmony with the conventional health system. When combined with other health reform in the country, the training and regulation of TBAs in Nigeria could change the tide towards better maternal health care and improved outcomes for mothers in even the most rural parts of the country.
Social, Cultural & Behavioral Issues in PHC & Global Health 
March 12, 2019 at 12:05 am |
It is indeed unfortunate that Nigeria is reeling under such high maternal mortality rates. I agree with your recommendations that traditional birth attendants/midwives would be one of the best ways to reduce MMR. Sri Lanka has been a model for success in maternal mortality health. The rates are the best in south east asia, considering that there is a significant population that is rural and with poor infrastructure. The country has invested heavily in training midwives and most deliveries are attended by a skilled birth attendant, who also visits the families, educates them and encourages them to visit the primary health clinics. The midwives also undergo a training and certification process.
Nigeria can adopt a similar approach by using community volunteers, training them and employing them as skilled TBAs. But it does require a strong political will. In this day and age, it is a matter of shame when a mother dies because two lives are lost….
Click to access MS_case_6.pdf
March 14, 2019 at 9:13 pm |
Great Post Ruthechadwick, I couldn’t agree more on the issue. (TBAs.) .Coming and working with several physicians in South East Asia especially Thailand where I used to worked as a physician near the border of Thai-Myanmar for 2-3 years. the picture was the same 50-60% give birth by TBAs this might raise up to 90% for the tribal population or migrants.
Under the circumstance that we lacking of professional healthcare worker at the rural areas, It was best the utilize the existing valuable human resource to such as TBAs.
The topic that I would like to make recommendation for training which usually lacking from some training was lack of referral skills. The problems I found are try are lacking of skill of detecting case that should be refer beforehand at the ANC Phase such as Large Gestational Age which might be Twin pregnancy or mother who have underlying condition such as HIV etc. and at Labor phase such as breech position or umbilical cord contraction or Post Delivery phase such as postpartum hemorrhage which were result in increase neonatal-maternal death.
Regulated TBAs is equally important. Although we need a lot of TBAs but unqualified TBAs can do more harm than good.I couldn’t agree more.
Lastly I would like to send the best wishes that Nigeria could scaled up the training and regulating TBAs ^_^
Penny