Abstract
AbstractIn this chapter, I tell the story of the waxing and waning of the status of the traditional birth attendant (TBA) in global maternal health policy from the launch of the Safe Motherhood Initiative in 1987 to the present. Once promoted as part of the solution to reducing maternal mortality, the training and integration of TBAs into formal healthcare systems in the global south was deemed a failure and side-lined in the late 1990s in favour of ‘a skilled attendant at every birth’. This shift in policy has been one of the core debates in the history of the global maternal health movement and TBAs continue to be regarded with deep ambivalence by many health providers, researchers and policymakers at the national and global levels. In this chapter, I take a critical global heath perspective that scrutinises the knowledge, policy and practice of global health in order to make visible the broader social, cultural and political context of its making. In this chapter, I offer a series of critiques of global maternal health policy regarding TBAs: one, that the evidence cited to underpin the policy shift was weak and inconclusive; two, that the original TBA component itself was flawed; three, that the political and economic context of the first decade of the SMI was not taken into account to explain the failure of TBAs to reduce maternal mortality; and four, that the reorganisation of the Safe Motherhood movement at the global level demanded a new humanitarian logic that had no room for the figure of the traditional birth attendant. I close the chapter by looking at the return of TBAs in global level policy, which, I argue, is bolstered by a growing evidence base, and also by the trends towards ‘self-care’ and point-of-use technologies in global health.
Highlights
In this chapter, I tell the story of the waxing and waning of the status of the traditional birth attendant in global maternal health policy from the launch of the Safe Motherhood Initiative in 1987 to the present
Critical global health scholarship shares much in common with the health policy and systems research (HPSR) agenda defined by Sheikh and colleagues (Sheikh et al, 2011) in terms of its attention to wider influences and micro processes that shape the multiple levels of policy decisions and practices and sees them as non-neutral
One, that the evidence cited to underpin the policy shift was weak and inconclusive; two, that the original TBA component itself was flawed in its failure to account for cultural specificity; three, that the political and economic context of the first decade of the Safe Motherhood Initiative (SMI) that constrained its implementation was not taken into account; and four, that the reorganisation of the Safe Motherhood movement at the global level demanded a new humanitarian logic that had no room for the figure of the traditional birth attendant
Summary
In 2002, the International Confederation of Midwives met for their triennial Congress in Vienna. American and New Zealand midwives stood out in their defence of TBAs and their criticism of the official withdrawal of support for them at the level of global policy. Their perspective made sense given the grassroots origins of midwifery as a social movement in these jurisdictions where midwives had often trained. To acknowledge TBAs as their near equivalents was fundamentally at odds with the concept and parameters of a health profession It was argued at meetings I attended that such a move would jeopardise the standing of midwifery in the eyes of other health professions and the relatively recent place of the ICM at the table in policy decisions regarding major global maternal health initiatives. The TBA experiment at the level of global maternal health policy appeared to be well and truly finished
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
