Traditional birth attendants (TBAs) in Uganda are lay persons with minimal or no formal health training who assist during pregnancy, childbirth, and the immediate post-partum period.

The History of TBAs

As recently as the early 1900s, hospitals were non-existent for most people living in Uganda. With few options, people used traditional methods to deliver babies and care for illness. Today there are health centers and hospitals across the country – but many people still rely on the trusted services of a traditional birth attendant. TBAs provide prenatal care, help with labor and delivery, help with postpartum care and address maternal complications that arise during pregnancy or childbirth.

3 How TBAs Work

Traditional birth attendants are also known as TBAs, and they provide health care and advice to women during pregnancy, delivery, and for their new babies. Women will typically visit a TBA before or after giving birth, but TBAs may also come to the hospital when a woman is about to give birth. Traditionally, TBAs were selected by the woman’s mother or grandmother because she would know best who was skilled with childbirth.

4 Reasons why women still prefer TBAs

There are many reasons why Ugandan women prefer traditional birth attendants to professional health service providers. Some of these reasons include accessibility, affordability, culturally-significant experience, and sense of independence. Below is a brief overview on the four primary reasons why traditional birth attendants are preferred over professional health service providers.

• Attendance by TBAs can be arranged at a convenient time for the expectant mother. One of the biggest advantages that traditional birth attendants have over professionals is their ability to show up when they are needed most – right when labor begins. In contrast, medical practitioners require an appointment and will only arrive during office hours. The need for this convenience becomes greater as delivery day approaches.

• Even though being treated by a doctor or nurse may seem like a more expensive option, women with low incomes may not be able to afford it anyway. Furthermore, since TBAs do not charge anything upfront, women who are struggling financially know that any out-of-pocket expenses will be minimal.
Many women also choose traditional birth attendants because of the opportunity to participate in what some see as a deeply cultural experience. The birthing process is seen as one of life’s natural cycles that all women go through, without fear or shame. Additionally, there is a sense of independence present when choosing to give birth with the help of someone from your community instead of a stranger coming into your home and taking care of you. Mothers feel empowered and more in control of the situation when assisted by someone who shares similar customs and beliefs. Finally, other benefits of using a TBA include less medication use, closer connection between mothers and babies after birth, and lower risk of postpartum complications. These factors make them preferable to a healthcare provider even if they did cost something upfront.

Others believe that TBAs will be able to detect problems with the pregnancy before it’s too late for skilled health professional intervention. These old wives know how to cure illnesses with indigenous remedies that don’t require costly treatment like drugs, which most Ugandan families cannot afford. TBAs also provide emotional support and act as moral guides for expectant mothers in their communities.

Additionally, TBAs often deliver babies without any equipment other than cloths and boiling water. They also provide care for the mother’s postpartum period without charging anything. TBAs are often trusted by mothers because they know that they will not leave them with a bill if the baby dies.

4 The Challenges Faced by TBAs

With the development of medical care and advancements such as antibiotics, an increasing number of families are choosing to have their pregnant mothers delivered by skilled health professionals at a hospital or clinic. Due to this change, many traditional birth attendants have lost their trade and now have difficulty finding pregnant women who are interested in hiring them. For some rural women, traditional birth attendants offer help when they can’t afford private maternity services.

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