WHO IS A TBA?

  "A traditional birth attendant (TBA) is a person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other traditional birth attendants.

  A family TBA is a TBA who has been designated by an extended family to attend births in the family.

  A trained TBA is a TBA or a family TBA who has received a short course of training through the modern health care sector to upgrade her skills. The period of training is normally not more than one month, although this may be spread over a longer time".

  Joint WHO/UNFPA/UNICEF Statement of 1992

  TBAs are often older women, respected in the community for their knowledge and experience. They are often illiterate and learn their skills through working with other, more experienced TBAs. These women largely work in rural areas distant from health facilities and in poor, periurban areas with limited access to health services.

  The number of births attended by a TBA each year varies widely. In large extended families, a family TBA may deliver up to 24 babies in a year although five or six births is more usual. Some TBAs are assisting regularly, for example, conducting over three deliveries a month, while others may have long intervals such as a year in between deliveries.The frequency of practice has important implications for TBA training programmes, such as selection of trainees and retention of new knowledge by trainees (if techniques learned are not practiced within a reasonable time-frame).

  TBAs are private practitioners at the community level and may perform a mix of services. Some which may include providing assistance at birth and immediate post-partum care, as well as performing female circumcision, unsafe abortions and ritual practices such as "certifying" virginity at marriage (Egypt). Usually TBAs receive some remuneration for their services. It may be cash or in-kind, depending on the customs of the community and financial resources of the family.

  This financial income aspect of their work has to be kept in mind as TBAs are integrated in the formal health system or displaced by it. In some cases, once TBAs received training, communities perceived them as employees of the health system and refused to pay them as before. In order to promote timely referral by TBAs and to develop their link with the formal health system, TBAs may be paid a fee for the service of referring a patient.

Harry Gordon FRCS FRCOG

March 1999