Pregnant women favor traditional birth attendants in Uganda despite ban

By Hamza Kyeyune

KAMPALA, Uganda (AA) - Uganda is projected to have 75% of all baby deliveries performed by skilled birth attendants by end 2020.

But Traditional Birth Attendants (TBAs) is an area where meeting that mark is hard to achieve.

TBA is one of the trickiest topics in global health. Despite having no formal training, TBAs have provided maternity care during and after pregnancy, and childbirth throughout the world, prior to the development of organized systems of medical care.

Today, TBAs are still active in developing countries although not recognized as medical practitioners. They command a high societal standing and many families seek TBAs as health care providers.

Many inherit the job from their own mothers or are simply respected older members in the community.

According to the Ministry of Health’s Reproductive, Maternal, Newborn, Child and Adolescent Health Sharpened Plan for Uganda 2016-2020, about 416,000 women annually are still not assisted by a skilled birth attendant. Like many developing countries, Uganda has a high maternal mortality rate of 343 per 100,000 live births.

The government outlawed TBAs in 2010 arguing they cannot handle hemorrhaging in women, which contributes to 42% of maternal deaths and is the leading cause of death in maternal mortality in the country.

The government said TBAs work in unhygienic conditions, which can cause infections and in situations where a baby is not lying properly in the mother’s womb -- a situation might call for a Caesarian-section, which they cannot perform.

The ban, however, has not eliminated TBAs. Many expectant mothers, especially in rural areas, say they prefer TBAs to skilled health workers because of their politeness, care and comfort during labor and child birth.

But some women say the proximity to medical facilities prevents them from using TBAs, while for others it is the traditions and local customs.

Zainab Aine, 30, a mother of four said she delivered all her children with a TBA and has never encountered any pre or postnatal challenges.

TBAs Anadolu Agency spoke to said there is no way they can deny care to women who come for help.

Nakimera Ruth, 70, a TBA in Wakiso district said although the government stopped the practice, pregnant women still go to them for help.

“I have never had a death or heard any of the mothers complaining about my services,” she said. She practiced as a TBA for 34 years before receiving formal training as a midwife from the Medical Research Council (MRC) in Masaka.

She said most of the women who go to her shun government facilities due to non-dignified care, non-consensual care (coerced Caesarean section), verbal abuse, discrimination toward the poor and young mothers, among other reasons.

“Demand for TBAs in Uganda won’t disappear until every woman feels that skilled midwives in government facilities are approachable and available, at that point, TBAs will fade away on their own,” she adds.

Ruth Mugisha, 64, a TBA in Sheema district said although the government encourages expectant mothers to deliver in hospitals because they are safer, it is simply not realistic.

“If every woman turned up at a hospital, the maternity wards would be overwhelmed with the numbers. Already, there is shortage of health workers in almost all government facilities and shortage of basic supplies like gloves, this means that if all expectant mothers went to hospitals, they would perhaps be at greater risk. The few available health workers wouldn’t cope,” said Mugisha.

Silence Zuriat, a senior medical laboratory scientist, said with many deliveries outside health centers, the role of TBAs cannot be overlooked.

“Major contributing factors to maternal death are delays in recognizing danger signs, deciding to seek care, reaching care, and receiving care at health facilities. These are health system components provided by the government,” she said. “TBAs can be a good link between the community and these health facilities, especially if they have been sensitized to know their limits. For instance, they can be instructed on when it is advisable to refer mothers to the health facilities. In so doing, they will be acting as health teammates to support skilled attendants, rather than a threatening environment of over-medicalization of this natural event."

Emmanuel Ainebyoona, a public relations officer at the Ministry of Health, sees it differently and said expectant mothers should not go to TBAs because they are not mandated to conduct deliveries.

“Some expectant mothers could have probably experienced unfriendly midwives maybe because of emotional burnout, but we are eliminating that through continuously educating our staff to be kind and courteous,” he said.