“Don't use herbs in labor!”: Plants, pharmaceuticals, and the unmaking of traditional birth attendants in Ghana, 1970–2000

Abstract

This article considers efforts in the West African country of Ghana to improve maternal care through a network of trained “Traditional Birth Attendants,” or TBAs in the late twentieth century. It reconsiders the rise and fall of TBAs through the lens of increasing global access to essential medicines like oxytocin and misoprostol which reduced confidence in herbal medications for pregnancy complications. Interviews with policy makers and birth attendants reflecting on their involvement in TBA programs from the 1970s as well as analysis of archival documents and training manuals shows how pharmaceuticals rose in prominence at the same time birth attendants maintained medicinal plant knowledge. Over time, Ghanaian policymakers encouraged TBAs to avoid using herbs while caring for women during pregnancy. By the early 2000s, government went so far as to ban TBAs, and urged everyone to deliver with a skilled birth attendant (SBA) such as a nurse midwife or obstetrician more conversant in biomedical interventions including pharmaceuticals. This retrospective account of TBAs across several decades suggests that once Ghanaian officials had strengthened access to standardized pharmaceuticals, they lost confidence in traditional birth attendants and the herbal remedies they cultivated. Access to pharmaceuticals shaped the difference between skilled and— “unskilled” or “traditional”—birth attendants.