Abstract
BackgroundInstitution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. However, the question of how to engage traditional birth attendants (TBAs) in the advocacy campaign for SBA poses a number of challenges. This paper aims to demonstrate how TBAs in rural regions of China have been integrated into the health system under a policy of institutional delivery.MethodsResearch was conducted through literature and document reviews and individual in-depth interviews with stakeholders of the safe motherhood program in rural Guangxi Zhuang Autonomous Region, China. A total of 33 individual interviews were conducted with regional and local politicians, policy makers, health managers, health providers, civil society members, village cadres for women affairs, former TBAs, village maternal health workers, mothers and their mother-in-laws.ResultsSince 1998, TBA’s traditional role of providing in-home care during childbirth has been restructured and their social role has been strengthened in rural Guangxi. TBAs were redesigned to function as the linkage between women and the health system. A new policy in 1999 shifted the role of TBAs to village maternal health workers whose responsibilities were mainly to promote perinatal care and institution-based delivery of pregnant women. This successful transformation involved engaging with government and other actors, training TBAs for their new role, and providing incentives and sanctions for human resources management.ConclusionsThe China experience of transforming the role of TBAs in Guangxi rural area is an example of successfully engaging TBAs in promoting institution-based childbirth.
Highlights
Institution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries
It was clear that the target of reducing maternal mortality ratio (MMR) in China could not be reached without effective policy interventions to address the disparity gaps between urban and rural areas
This paper aims to describe and discuss the process of transforming the role of traditional birth attendants (TBAs) in China’s Guangxi Zhuang Autonomous Region as a case study, to illustrate how government successfully integrated TBAs into the health system in rural regions with the ultimate goal of universal access to SBA
Summary
Institution-based childbirth, with the ultimate goal of universal access to skilled birth attendance (SBA), has been selected as a key strategy to reduce the maternal mortality rate in many developing countries. In 1998, after almost years of implementation in China, it was clear that training TBAs without having a strong functioning health system to ensure quality maternal services would not be effective for rapidly and significantly reducing the MMR [8]. This was in consistent with the global evidence years later [9,10,11]. TBAs were encouraged to discontinue home delivery, advocate for institution-based childbirth and assist with maternal healthcare as village maternal health workers
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