Traditional Birth Attendants and The Effect on The Maternal Mortality Rate in Sub Saharan Africa: A Modified Aystematic Review
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Abstract
Background: Maternal mortality is a topic of global importance and has been recognised at both a national and international level through the publication of the Crisp (2007) report and the Millennium Development Goals (WHO, 1990). It is widely recognised that there is a global shortage skilled health professionals and because of this the role of the Traditional Birth Attendant (TBA) is prominent and many mothers choose to give birth with their assistance.
Aim: To investigate the effectiveness of the TBA’s role throughout pregnancy, labour and the post natal period in lowering the maternal death rate in Sub Saharan Africa.
Methods: A modified systematic review of the literature was undertaken exploring the use of TBAs and the care they provide with relevance to the maternal mortality rate. Five electronic databases were searched and primary research articles that fulfilled the inclusion criteria were included in the review. The identified literature was critically appraised using an adapted tool and the literature was analysed thematically.
Findings: This review produced seventeen papers which included both qualitative and quantitative methodologies. Four main themes were indentified in the literature; the role of the TBA, the woman’s choice of where to give birth, effectiveness of TBA training programmes and suggestions for future practice. Findings were discussed in light of the current available literature and policy and further suggestions are offered towards future practice and resource use.
Conclusions: The relationship between TBA use and the maternal death is complex and dependent on a range of factors. It was not possible to ascertain if TBAs had either a positive or negative impact on the maternal death rate within the limitations of this review. However, the opportunity to use TBAs as a resource to target the high maternal death rates of many countries seems extensive and the need for more empirical research into this area is acknowledged