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In an ideal world, all of Africa's women would have access to clinics, nurses, obstetricians, medicines: the panoply of staff and equipment needed to make the process of giving birth as safe as possible. Failing that, what can be done to lessen the risks that come with delivering babies? For one, improve the skills of traditional birth attendants (TBAs), say delegates who met in September 2006 in Mozambique at an African Union (AU) gathering on sexual and reproductive health care.

"We need to look at upgrading their skills so that they are not TBAs, but are at a higher level such as midwives," Thoraya Ahmed Obaid, executive director of the United Nations Population Fund, told journalists in the Mozambican capital -- Maputo.

"This is important, since in some communities TBAs are the only reproductive health care providers present."

A plan of action adopted Friday, September 22, 2006, by AU health ministers underscores this need, pledging to "build capacity of all categories of Sexual and Reproductive Health and Rights (SRHR) service providers including nurses and TBAs..."

The initiative marks a departure from previous attitudes to traditional birth attendants, who have often taken second place to accredited health workers -- who have the benefit of formal training.

In a feature published by IPS in February last year (“HEALTH-KENYA: Do Safer Births Require a Break With Tradition?”), the director of the reproductive health division at Kenya's Ministry of Health, Josephine Kibaru, noted that use of TBAs was undermining efforts to reach the Millennium Development Goals (MDGs).

Eight MDGs were agreed on by global leaders at the Millennium Summit held in 2000 at the United Nations, in New York. They include a goal to reduce maternal mortality by three quarters, by 2015.

But, Kibaru has re-evaluated her position. "We cannot just sit and continue to bury our heads in the sand. The TBAs are there in our communities. We need to work together with them, encouraging them to refer pregnant women to health facilities early enough," Kibaru told IPS.

Amidst fears that many traditional birth attendants were failing to direct women who experienced birth-related complications to clinics and hospitals in time to prevent these problems leading to death, efforts have been made to discourage attendants from performing deliveries in Kenya. They are now urged to become involved in activities such as contraceptive distribution, said Kibaru.

Retired midwives have also been called back into service to offer women the chance of having babies with skilled personnel in attendance.

But, the reality remains that about a quarter of all births in the East African country are overseen by traditional birth attendants, this according to government figures.

What also cannot be denied is that many women feel more comfortable giving birth with traditional attendants.

"These women find TBAs more supportive of them because TBAs attend to only one woman at a time, while a skilled attendant in a hospital setting tends to fall short of the individual support to the woman -- given that she has to attend to other cases as well," Eddie Mhlanga, professor of obstetrics and gynecology at the University of KwaZulu-Natal in South Africa, told IPS.

When those skilled attendants are present, that is.  "We need to see how to bring TBAs to the health systems so that they can reduce the impact of the brain drain, especially at facilities for primary care," Mhlanga said.

As is frequently noted, the migration of African health professionals to wealthier countries -- prompted by low pay and poor working conditions -- has put a severe strain on health services across the continent, especially in rural areas.

It has contributed to a situation where Africa shoulders more than 24 percent of the global disease burden, with assistance from just three percent of health workers (these statistics from 'Working together for health', the 2006 World Health Report produced by the World Health Organisation).

According to Warren Naamara, country coordinator in Ghana for the Joint United Nations Programme on HIV/AIDS, drawing traditional birth attendants into the health system will involve providing them with the means to work in a clean, safe environment -- and also with education.

"It is all about training TBAs in how far they can and cannot go. There are some things they cannot do, like surgery," he noted.

"Where they anticipate complications, let them refer such cases to the nearest delivery point, because their work has trained them to detect a woman who may not deliver smoothly." 

Article by:  Joyce Mulama

Maputo, Mozambique IPS –TerraViva Europe, The European Edition of the IPS (Inter Press Service - The Global News Agency) Daily Journal is responsible for the contents of this article.