THE IMPACT OF TRADITIONAL BIRTH ATTENDANT PRACTICE IN THE PRIMARY HEALTH CARE SYSTEM

ABSTRACT

The study is designed to examine the impact of traditional birth attendant practices (TBAs) in primary health care and on women. Randomly-selected women (n=100) were interviewed to gain a more thorough understanding of the impact of traditional birth attendant practices (TBAs) in primary health care.

Research question 1: what made women start receiving care from traditional birth attendant? Shows that 12% visits TBAs because of the cost of services in the hospital, 32% visits TBAs because of family member's opinion while 36% visits TBAs because of accessibility.

Research question 2: Have they ever encountered any complications from birth complication from birth attendant's shows that 68% of the respondents have encountered complications while 32% of while respondents have not.

Research question 3: What forms of complications do pregnant women encounter from traditional birth attendant? Shows that 31.3% of the respondent had excessive bleeding, 26.9% had retention of placenta, 11.9% had fresh stillbirth, 10.4% of the respondent lost their babies and 6.0% had in one way or the other lost a relative.

Research question 4: How were the complications resolved? Shows that 22% of the respondents were referred to the hospital, 23.7% was solved using herbal preparation, 10.2% was solved by encouraging maternal efforts, 1.7% was by manipulating the womb manually, 1.7% of the respondents were given bed rest and 22% was solved by encouraging maternal efforts and bed rest.

All this result makes it possible for the researcher to conclude that the effect of traditional birth attendant on women is negative. Continuing efforts to examine the effect of TBAs on pregnant women may benefit in the reduction of maternal and neonatal mortality and morbidity.

CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Since the adoption of the Primary Health Care (PHC) approach in Nigeria in 1979, government has recognized the need for integrating traditional birth attendants (TBAs) into the PHC system and had consequently initiated TBAs training programmes. In spite of the high patronage of traditional birth attendants, many of their practices during childbirth have been found to adversely affect the health of mothers.

One of the strategies Ministries of Health and their partners have adopted with the aim of promoting safe motherhood since the 1980s is training unskilled traditional birth attendants (TBAs). However, the assumption that training of traditional birth attendants (TBAs) would greatly reduce maternal mortality has been repeatedly questioned. As Musie et al. (2022) note, TBAs continue to be regarded with ambivalence by health providers and policymakers, partly because evidence of their effectiveness in reducing maternal mortality remains mixed. The training of traditional birth attendants (TBAs) is meant to reduce post-partum infection by encouraging cleanliness and discouraging dangerous practices. While such training may reduce these particular problems, labour and delivery will still be complicated in a certain number of cases. TBAs have neither the skills nor the equipment to treat life-threatening complications. Without medical education, supplies and equipment, these TBAs can assist at normal deliveries but cannot handle life-threatening complications (Kassie et al., 2022; Rutledge et al., 2024).

Maternal and new-born morbidity and mortality continues to be a problem with a huge disparity between developed and developing countries. According to the World Health Organization (2025), approximately 260,000 women died during and following pregnancy and childbirth in 2023, with over 90% of all maternal deaths occurring in low- and lower-middle-income countries. Sub-Saharan Africa and Southern Asia accounted for around 87% of global maternal deaths in 2023. In these settings, traditional birth attendants mostly women embedded in the community with no formal medical training and no connection to the formal health system play a major role around childbirth. TBAs exist since centuries and still continue to be the major providers of care for families in poor and remote areas. TBA training has been part of on-going interventions for decades to improve health at the community level. At the end of the 1990s, the Safe Motherhood Initiative (SMI) made a shift in policy to address the persisting high numbers of maternal deaths by focusing on "skilled birth attendants" (SBAs). TBAs were not regarded as skilled and therefore not included in this definition, and as a consequence they dropped out of international SMI policies. Despite on-going global efforts, as of 2022 global skilled birth attendant coverage stood at 86%, still short of the target of 90% SBA for all child-bearing women (Alhassan et al., 2024; UNICEF, 2024).

Although much attention has been given to training TBAs in low- and middle-income countries, the evidence on focusing on training traditional birth attendants leads to mixed results in terms of increased referrals for appropriate conditions. Studies show that while TBAs may improve obstetric knowledge and referral behaviour modestly, these effects cannot always be causally attributed to training alone, as training is often embedded in larger integrated packages (Rutledge et al., 2024). A demand and supply analysis of delayed referrals from TBAs to primary health care facilities in Nigeria further reveals that both provider-side and community-side barriers including financial constraints, cultural preferences, and inadequate referral systems significantly impede the pathway from TBA care to skilled facility-based care (Juqu et al., 2025).

It was also believed that TBAs could be trained to recognize obstetric complications and refer women with complications to a nearby health facility for treatment. There are two weaknesses in this plan. First of all, the signs and symptoms of serious complications including any bleeding during pregnancy, excessive bleeding during or after delivery, convulsions, fever and foul vaginal discharge, headaches combined with swollen hands, face and feet, and labour lasting more than 12 hours are not difficult to recognize (Esan et al., 2023; Oluwole et al., 2024). Every family decision maker, including husbands, mothers, and mothers-in-law, should be informed and educated to recognize these danger signs, not just TBAs or pregnant women. The more difficult problem is that there is often no feasible referral option. It is precisely in circumstances where medical treatment is least available that training TBAs is usually proposed as a solution.

Every day in 2023, over 700 women died from preventable causes related to pregnancy and childbirth (WHO, 2025). Approximately 92% of all maternal deaths occurred in low- and lower-middle-income countries, and most could have been prevented. Nigeria recorded the world's highest number of maternal deaths in 2023, accounting for over 28% of the global total, with barely 51% of all births attended by skilled personnel (AlignMNH, 2025; WHO, 2025).

A TBA has been defined by the World Health Organization as a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs (Esan et al., 2023). In Nigeria, as in other developing countries, a substantial proportion of women continue to be delivered by TBAs, particularly in rural areas. Unskilled delivery, including the use of traditional birth attendants, remains a major threat to reducing maternal mortality in Africa, as deliveries conducted by TBAs are associated with four times higher morbidity and mortality compared with deliveries supervised by midwives and other health professionals (Oluwole et al., 2024). It is estimated that between 60 and 80% of all deliveries in developing countries occur outside modern health care facilities, with a significant proportion attended by TBAs (Rutledge et al., 2024). In an eastern Nigerian study, it was found that although the majority of rural women registered for prenatal care, a large proportion delivered at home under the care of TBAs. On average, a traditional birth attendant provides delivery assistance in one in every three non-facility deliveries in Nigeria (Okeke et al., 2017, cited in Oluwole et al., 2024).

Similarly, studies in southwestern Nigeria have shown that a significant proportion of women who delivered before arrival at hospital had been attended by TBAs, with many seeking TBA help for complications such as retained placenta with bleeding (Esan et al., 2023). The preference for TBAs is driven by a combination of cost, cultural acceptance, accessibility, and the comfort of home delivery factors which are especially pronounced in rural and underserved communities (Oluwole et al., 2024; Kassie et al., 2022). In Ogun State specifically, studies have shown that integration of TBA services into the PHC system may contribute to reducing maternal mortality and achieving Universal Health Coverage, though this requires deliberate policy frameworks and accountability mechanisms (Enhancing Integration of TBAs into Modern Primary Health Care System in Oyo State, 2025).

1.2 Statement of Problem

The topic became an area of interest to study as a result of the realization that some pregnant women encounter a lot of problems during delivery from traditional birth attendants because of the lack of training of some of the traditional birth attendants.

Similarly, it is also assumed that a sizeable number of the pregnant women tend not to know the implications or problems that could occur or happen to them from complications that could arise during delivery, and the necessary attention and care that will be needed to prevent these complications from becoming life-long problems or leading to their death.

Furthermore, the increasing reports of cases of pregnant women who died during pregnancy or encountered life-long problems makes it necessary to look at ways of solving these problems. Hence, this research project on the impact of traditional birth attendant practices in the primary health care system.

1.3 Purpose of Study

The main objective of this study is to examine the impact of traditional birth attendants in primary health care. The specific objectives of the study are:

1. To identify the roles of traditional births attendants in the community.

2. To know if the effect of traditional birth attendants on pregnant women is positive or negative.

3. To investigate the complications encountered by pregnant women that visit traditional birth attendants.

1.4 Research Questions

1. What made women start receiving care from traditional birth attendants in Primary Health Centres?

2. Have they ever encountered any complications from birth attendants?

3. What forms of complications do pregnant women encounter from traditional birth attendants?

4. How were the complications resolved?

1.5 Significance of Study

This study explores the meaning of traditional birth attendants, their role in the community primary health care system and the complications encountered; therefore it will be useful to people who are interested in knowing more about traditional birth attendants. It also found out that the effect of traditional birth attendants is negative and that they need more training.

This study also helps one to know how to reduce maternal mortality and infant mortality and morbidity.

1.6 Scope of Study

The scope of this study is delimited to Odeda local government area of Abeokuta. The researcher attempts to look at the impact of traditional birth attendant practice in the primary health care system and on women within childbearing age. The focus was limited to women in five different communities in Odeda local government in order to have a sizeable and adequate sample size.

1.7 Limitation of Study

The researcher faced a number of restraints in the course of carrying out this research project. They include time constraints, financial constraints, and the uncooperative attitude of some of the respondents. These constituted limitations of this research project as some of the respondents did not return their questionnaire. The researcher only made do with responses of the respondents whose questionnaires were correctly completed and returned.

1.8 Operational Definition of Terms

Traditional Birth Attendant (TBA):

A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider. According to the World Health Organization, a TBA is "a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other traditional birth attendants" (Esan et al., 2023; Oluwole et al., 2024). TBAs are traditional independent non-formally trained and community-based providers of care during pregnancy, childbirth and the postnatal period, excluded from the category of skilled health workers (WHO, 2025).

Primary Health Care System:

Primary healthcare (PHC) refers to essential health care that is based on scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community.

Child Mortality:

The probability of a child dying between the first and fifth birthday.

Practices:

Those acts or actions that are done in relation to a particular issue. In this context, the term refers to the traditional, independent, non-formally trained, and community-based methods used by TBAs in the provision of care during pregnancy, childbirth and the postnatal period.

REFERENCES

AlignMNH. (2025). Evolving the role of traditional birth attendants in reducing maternal mortality. Retrieved from https://www.alignmnh.org/2025/07/28/evolving-the-role-of-traditional-birth-attendants-in-reducing-maternal-mortality/

Alhassan, R. K., Assan, M. A., Hammond, R., & Agoriba, J. (2024). Factors associated with skilled birth attendance in 37 low-income and middle-income countries: A secondary analysis of nationally representative, individual-level data. The Lancet Global Health, 12(7), e1134–e1145. https://doi.org/10.1016/S2214-109X(24)00145-1

Esan, D. T., Ayenioye, O. H., Ajayi, P. O., & Sokan-Adeaga, A. A. (2023). Traditional birth attendants' knowledge, preventive and management practices for postpartum haemorrhage in Osun State, Southwestern Nigeria. Scientific Reports, 13(1), 12196. https://doi.org/10.1038/s41598-023-39296-y

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Musie, M. R., Mulaudzi, F. M., Anokwuru, R., & Bhana-Pema, V. (2022). Recognise and acknowledge us: Views of traditional birth attendants on collaboration with midwives for maternal health care services. International Journal of Reproductive Medicine, 2022, 9216500. https://doi.org/10.1155/2022/9216500

Oluwole, E. O., Oluwadumila, T. E., Okafor, I. P., & Temitayo-Oboh, A. O. (2024). Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos State, Nigeria. PLOS ONE, 19(6), e0304856. https://doi.org/10.1371/journal.pone.0304856

Rutledge, J. D., Kiyanda, A., Jean-Louis, C., Raskin, E., Gaillard, J., Maxwell, M., Smith, T., Kershaw, T., Abrams, J. (2024). Recommendations for integrating traditional birth attendants to improve maternal health outcomes in low- and middle-income countries. International Journal of Maternal and Child Health and AIDS, 13, e019. https://doi.org/10.21106/ijma.019

UNICEF. (2024). Delivery care: Births attended by skilled health personnel. Retrieved from https://data.unicef.org/topic/maternal-health/delivery-care/

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