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IMPACT OF TRADITIONAL BIRTH ATTENDANT PRACTICE IN PRIMARY HEALTH CARE CENTRE AMONG WOMEN IN ELU OHAFIA LOCAL GOVERNMENT AREA

CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

In many rural and developing communities, traditional birth attendants (TBAs) have long been the primary providers of maternal and newborn care. Their role is deeply ingrained in cultural and societal norms, often serving as the first point of contact for pregnant women seeking childbirth services (Karesh et al., 2022). This practice persists despite efforts to promote skilled birth attendance and improve maternal and child health outcomes through formal health care systems. Elu Ohafia Local Government Area in Nigeria reflects such a context, where TBAs play a crucial role in primary health care delivery, especially among women.

One of the key reasons for the persistent reliance on traditional birth attendants is the lack of accessible and affordable formal health care services in rural areas (Ahmed et al., 2021). Many women in these communities face challenges in accessing hospitals or skilled birth attendants due to distance, cost, or lack of transportation. As a result, they turn to TBAs who are more accessible and culturally familiar to them, despite the potential risks associated with untrained birth attendants (Mackenzie & Smith, 2020).

However, the continued practice of relying solely on traditional birth attendants raises significant concerns regarding the quality and safety of maternal and newborn care (Taylor et al., 2021). TBAs typically lack formal medical training and may use outdated or harmful practices during childbirth, leading to preventable complications and adverse outcomes for mothers and babies. This highlights the urgent need to address the gaps in maternal health services and promote evidence-based practices in rural areas (Rahman et al., 2020).

Efforts to improve maternal and child health outcomes in rural communities should focus on enhancing access to skilled birth attendance and strengthening primary health care systems (Wang & Crameri, 2014). This includes training and empowering community health workers, promoting antenatal care visits, and ensuring timely referrals for complications. Collaborative efforts between traditional birth attendants and formal health care providers can also help bridge the gap and improve overall maternal and neonatal health outcomes (Sharma et al., 2023).

In Elu Ohafia Local Government Area and similar settings, interventions should be tailored to address the specific socio-cultural factors influencing women’s choices regarding childbirth services (Jones et al., 2018). Understanding local beliefs, traditions, and perceptions related to childbirth is crucial in designing effective and culturally sensitive maternal health programs. Community engagement and education play a vital role in promoting awareness about safe childbirth practices and the importance of skilled birth attendance (Velavan & Meyer, 2022).

Moreover, integrating traditional birth attendants into the formal health care system through training and regulation can improve the overall quality of maternal and newborn care (Schwarzer et al., 2021). By providing TBAs with essential knowledge, skills, and tools, they can deliver care in a safer and more standardized manner, reducing the risks associated with unskilled practices. This approach acknowledges the existing role of TBAs while ensuring adherence to evidence-based guidelines and protocols (Aceng et al., 2021).

In essence, while traditional birth attendants have historically played a significant role in maternal and newborn care in rural communities, there is a pressing need to enhance the quality, safety, and accessibility of childbirth services. Collaborative efforts between traditional and formal health care systems, along with community engagement and education, can contribute to improving maternal and child health outcomes in areas where TBAs remain a primary source of care. Addressing socio-cultural factors and promoting evidence-based practices are essential steps towards achieving better health outcomes for women and newborns in these underserved regions.

1.2       Statement of Problem

The persistent reliance on traditional birth attendants (TBAs) in rural and developing communities poses significant challenges and gaps in maternal and newborn care (Taylor et al., 2021). Despite efforts to promote skilled birth attendance and improve maternal health outcomes through formal health care systems, many women continue to prefer TBAs due to accessibility and cultural reasons (Karesh et al., 2022). This situation raises several critical issues that need to be addressed.

Firstly, there is a lack of standardized training and regulation for traditional birth attendants, leading to variability in the quality and safety of care they provide (Ahmed et al., 2021). TBAs often rely on traditional practices and may lack updated knowledge and skills in managing obstetric emergencies or complications during childbirth (Mackenzie & Smith, 2020). This gap in training contributes to preventable maternal and neonatal morbidity and mortality.

Secondly, the limited integration of traditional birth attendants into the formal health care system hinders coordinated care and timely referrals for higher-level medical interventions (Wang & Crameri, 2014). Without clear protocols and collaboration between TBAs and skilled health professionals, there is a risk of delays in accessing essential services or appropriate medical interventions during childbirth (Rahman et al., 2020).

Moreover, socio-cultural factors play a significant role in perpetuating the reliance on traditional birth attendants, highlighting the need for culturally sensitive approaches to maternal health care (Jones et al., 2018). Deep-rooted beliefs, preferences, and perceptions about childbirth influence women’s decisions regarding where and how to seek maternity care, often favoring traditional practices over formal health care settings (Velavan & Meyer, 2022).

Addressing these gaps requires comprehensive strategies that involve capacity building for TBAs, strengthening health systems in rural areas, promoting community awareness and education, and fostering collaboration between traditional and modern health care providers (Schwarzer et al., 2021). By bridging these gaps, it is possible to improve the quality, safety, and accessibility of maternal and newborn care, ultimately leading to better health outcomes for women and infants in underserved communities like Elu Ohafia Local Government Area.

1.3       Objectives of the Study

The following research objectives were examined

1. To assess the utilization of traditional birth attendant services among women in Elu Ohafia Local Government Area.
2. To examine the maternal and neonatal health outcomes associated with traditional birth attendant practices.
3. To identify the factors influencing women’s choice of childbirth services in the study area.

 

1.4       Research Questions

The following research questions were asked:

1. What is the extent of traditional birth attendant utilization among women in Elu Ohafia Local Government Area?
2. What are the maternal and neonatal health outcomes observed in women who receive care from traditional birth attendants?
3. What factors influence women’s decision to seek childbirth services from traditional birth attendants?

1.5       Research Hypotheses

1. There is no significant association between the utilization of traditional birth attendant services and maternal health outcomes.
2. Socio-cultural factors do not significantly influence women’s choice of childbirth services in Elu Ohafia Local Government Area.

1.6       Significance of the Study

The significance of studying the impact of traditional birth attendant (TBA) practices in primary health care centers among women in Elu Ohafia Local Government Area (LGA) and similar rural communities cannot be overstated. This research holds substantial importance for several reasons, each contributing to a better understanding and improvement of maternal and newborn health outcomes in these areas.

Firstly, Elu Ohafia LGA represents a microcosm of many rural and developing communities globally where TBAs are the primary providers of maternal and newborn care. By studying the utilization and outcomes associated with TBA practices in this specific context, the findings can be extrapolated to inform policies and interventions in similar settings. This research can serve as a model for designing targeted strategies to address maternal and child health challenges in resource-constrained environments.

Secondly, understanding the factors influencing women’s choice of childbirth services, including the utilization of TBAs, is crucial for designing culturally sensitive and effective health programs. Socio-cultural factors such as beliefs, traditions, access barriers, and perceived quality of care significantly impact healthcare-seeking behaviors. By uncovering these factors through empirical research, healthcare providers and policymakers can tailor interventions to better meet the needs and preferences of local communities.