Academic journal article Journal of Anthropology

Traditional Birth Attendants and Policy Ambivalence in Zimbabwe

Academic journal article Journal of Anthropology

Traditional Birth Attendants and Policy Ambivalence in Zimbabwe

Article excerpt

Academic Editor:Kaushik Bose

Sociology Department, University of Zimbabwe, P.O. Box MP 167, Mount Pleasant, Harare, Zimbabwe

Received 20 September 2013; Revised 23 December 2013; Accepted 24 December 2013; 7 May 2014

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

African traditional healthcare is grounded in thousands of years of knowledge and has sustained life, on its own or in concert with Western medicine. A traditional birth attendant is defined as a person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs [1]. According to Kruske and Barclay [2] approximately half of all births in developing countries are attended by traditional birth attendants (TBAs) and as many as 95% of women are attended by TBAs. It is against this background that I argue that rather than continuing to develop interventions grounded in a Western medicine world view of healthcare there is need to develop programs that are inclusive of healers who reflect the sociocultural beliefs of the community. There is also need to understand the local context and value traditional knowledge systems. Such calls are themselves not a new phenomenon; for example, Jordan [3] called for the replacement of top-down, culturally inappropriate, biomedically oriented models with those of mutual accommodation. This is what Graham [4] calls the "partnership paradigm," that is, the mutual cooperation of biomedical and indigenous systems. However, it is at the interface between biomedical (Western) and indigenous systems that problems arise and also lie. The worldwide hegemony of Western biomedicine makes mutual accommodation an elusive goal.

Globally, TBAs assist in 60-80% of all deliveries and even more in the rural areas of developing countries. For many women living in the global south, antenatal care as well as institutional deliveries with skilled health workers remains a distant reality. Inclination towards home births supervised by TBAs is associated with cultural norms and religious beliefs as well as cost and accessibility of the services. Many countries, including Zimbabwe, often have a shortage of trained medical professionals and maternal health care is thus usually provided by TBAs [5-7]. TBAs speak the local language, have the trust of community members, provide psychosocial support at birth, and are thus an integral part of African medicine [8-11]. Though their number in developing countries is not known, conservative estimates suggest that there will be about 180 million nonskilled birth attendants in sub-Saharan Africa by 2015 [12].

2. The Zimbabwean Context

In sub-Saharan African countries many child bearing women are still being attended by TBAs and relatives at deliveries [12, 13]. The literature shows that births without skilled personnel and without access to life-saving drugs are the commonest practice for millions of mothers in the poorest countries where mortality rates and morbidity of the mothers are the highest [12, 14]. Recent statistics indicate that across the world 287,000 women die in pregnancy and childbirth every year [14]. This is translated as one mother dying every 2 minutes, 800 each day. In Zimbabwe, ten women die every day of pregnancy-related complications [15]. Moreover, 7-10 million women and girls suffer severe or long lasting illnesses caused by pregnancy and childbirth complications [14]. The use of unskilled personnel (including TBAs) is argued to be among the reasons for the high maternal and infant mortality rate in sub-Saharan Africa. This has been influenced by a global policy shift from TBA-focused intervention to skilled attendance and institutional birthing. For more than three decades, the WHO and other agencies of the United Nations promoted training of TBAs as a global public-health strategy to reduce maternal mortality [16]. …

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