The role of traditional birth attendants (TBAs) in maternal health has been a topic of discussion and research for decades. While modern obstetric care has dramatically reduced neonatal mortality rates in developed countries, many developing regions still rely heavily on TBAs for childbirth. A recent study titled "From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya" sheds light on how TBAs can be pivotal in increasing the number of deliveries overseen by skilled birth attendants (SBAs) in rural Kenyan health facilities.
The Study's Approach and Findings
This research was conducted in a rural region of Kenya, where TBAs were enlisted to educate pregnant women about the benefits of delivering in healthcare facilities. The TBAs received a stipend for each woman they referred to such facilities. The study compared the percentage of prenatal care patients who delivered at the intervention site with those who delivered at control sites before and after implementing this referral program.
The results were promising. The intervention led to a significant increase in SBA deliveries at the intervention health facility compared to control sites. Specifically, the absolute increase in SBA delivery rates from the pre-intervention period to the intervention period was 24% at the intervention site, compared to just 5.7% at control sites. This demonstrates that TBAs, when empowered and incentivized, can play a crucial role in encouraging women to utilize healthcare facilities for childbirth.
Implications for Practitioners
The success of this program offers several insights for practitioners looking to improve maternal health outcomes:
- Community Engagement: Engaging TBAs within their communities can bridge gaps between traditional practices and modern healthcare, fostering trust and collaboration.
- Incentivization: Providing stipends or other forms of recognition can motivate TBAs to refer more women to healthcare facilities, thus increasing SBA-assisted deliveries.
- Education and Training: Continuous education for TBAs about potential childbirth complications and the benefits of facility-based deliveries can enhance their effectiveness as community health advocates.
- Sustainability: While stipends are effective short-term motivators, long-term strategies should focus on changing community norms towards favoring facility-based births.
The Role of Policy
The study also examined the impact of Kenya's policy change that abolished fees for maternity services in public facilities. Interestingly, while this policy was intended to increase SBA deliveries, it did not significantly impact the control sites' delivery rates. This suggests that policy changes alone may not be sufficient; grassroots programs involving local stakeholders like TBAs are essential for meaningful change.
A Call for Further Research
This study highlights the potential for TBA referral programs to improve maternal health outcomes significantly. However, further research is needed to explore how these findings can be adapted and implemented in other regions with similar challenges. Understanding cultural nuances and logistical barriers will be crucial for replicating success elsewhere.
