Maternity services and TBAs in Addis Ababa: biosocial factors related to birth place and outcome of pregnancy

Abstract

The maternal care used by 8843 women in Addis Ababa was correlated with pregnancy outcome in a household survey conducted in 1983. A 2-stage stratified probability sample was designed based on the 25 districts with sub-districts as the primary sampling unit. In this population hospital care costs U.S. $50 for delivery maternal-child health centers are free although only 3 of 25 have obstetric units. The City has a program to train midwives within the community health system yet not all practicing midwives (TBAs) are trained. 40% of births took place in hospitals 16% of births in MCH units; 443% at home; 19% were attended by midwives. Home births tended to be high risk: young primiparous grand multiparous poor uneducated. The 45 maternal deaths included 13 after illicit abortion 11 women who died undelivered 10 deaths in hospitals and 3 with TBAs in attendance. The maternal mortality was 3 times higher (410.7/100000) with home birth without TBA in attendance compared to TBA attended births (131.8/100000). There was an unexpected high number of neonatal deaths compared to stillbirths among those attended by TBAs. TBAs were given the responsibility in this population to attend a high proportion of high risk births such as grand multiparas premature births women with no antenatal care and unwanted pregnancies.