Traditional Birth Attendants (TBAs)

The TBAs are generally older women who are respected by their communities. Most TBAs consider themselves as private practitioners who respond to requests for service and receive some compensation, mostly in kind. They assist women during delivery and immediately post-partum. Frequently their assistance also includes helping with everyday household tasks. Most TBAs go to the woman’s house to deliver although some also arrange a delivery area in their own house or compound. The majority of the TBAs reside in poor rural areas, very distant from health facilities. They often serve as a bridge with the formal health system, sometimes accompanying women to health facilities.

There are nearly 1,000,000 HIV-positive people in Malawi. Approximately 58% of adults (aged 15 and up) living with HIV in Malawi are women. Approximately 91,000 children aged 0-14 are also living with HIV and an additional 30,000 children are born HIV+ every year. Mother-to-child transmission is the second most common form of HIV transmission. The majority of infants acquire HIV during labour and delivery (65%). Other forms of transmission from mother to child are in uterus during pregnancy and during breastfeeding.  

There are 600,000 pregnancies every year and more than 50% of the births are attended by TBAs. Maternal and neo-natal death is one of the biggest problems affecting developing countries and Malawi has one of the highest death rates during childbirth. Recent figures from the Malawi Demographic and Health Survey show that 1,120 mothers and 4,200 babies die for every 100,000 live births.

TBAs can make the most impact in preventing maternal and neonatal infections including HIV transmission, prevent post partum sepsis, decrease deaths due to tetanus and other post-neonatal illnesses by being educated on identifying risks, conducting required preventive measures, if feasible making timely referrals to nearest clinic or applying clean and hygienic delivery.

TBAs in Malawi are inadequately trained; they learn most of their skills through working with other TBAs. Only recently policy makers favoured adding primary health care tasks to TBAs, such as giving advice on health matters, promotion and distribution of family planning methods, distribution of oral rehydration solution and iron tablets, referral for pre and post-natal care and for vaccinations. The need for an educational material on maternity and infant care is great.

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