Traditional birth attendants and birth outcomes in low-middle income countries: A review

Traditional birth attendants (TBAs) provided delivery care throughout the world prior to the development of organized systems of medical care. In 2016, an estimated 22% of pregnant women delivered with a TBA, mostly in rural or remote areas that lacked formal health services. Still active in many regions of LMICs, they provide care, including support and advice, to women during pregnancy and childbirth. Even though they generally have no formal training and are not recognized as medical practitioners, TBAs enjoy a high societal standing and many families seek them as health care providers. They are generally older women who have acquired their skills acting as apprentices of other TBAs or are self-taught. WHO and other international organizations have focused maternal mortality reduction efforts on the availability of skilled birth attendance, which excludes TBAs as providers of care. However, as countries move towards SBA, policy makers need to make the best use of TBAs while simultaneously planning for their replacement with skilled attendants. They often serve as a bridge between the community and the formal health system; once women are inside an institution, TBAs could potentially act as doulas, providing company and making women feel more comfortable in an unknown environment. In this paper, we will review who TBAs are, how many births they attend worldwide worldwide, where they provide delivery care, and finally, their relationships with the formal health care system and the communities they serve.