Abstract
BackgroundSince the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.MethodsThis study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.ResultsContrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.ConclusionIn this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.
Highlights
Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live
Though the number of deliveries taking place in health facilities has increased globally, about 40 million women still deliver without skilled care every year, about a third of whom are assisted by a Traditional Birth Attendants (TBA) [3]
We have shown how the traditional role of a TBA is respected and is used to navigate maternity care issues..We observed that from previous collaboration between TBAs and the formal healthcare system, TBAs were able to appreciate modern medical practices and the superiority of modern medicine in managing challenges like HIV and other complications that may arise during pregnancy and childbirth
Summary
Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In many developing countries, and especially in rural areas, TBAs continue to play a significant role. Maternal mortality remains a significant public health problem in developing countries, especially in subSaharan Africa, where 87 % of global maternal mortality occurs [1]. These high rates are attributed to insufficient and poor-quality care during pregnancy and childbirth [2]. Though the number of deliveries taking place in health facilities has increased globally, about 40 million women still deliver without skilled care every year, about a third of whom are assisted by a TBA [3]. Studies find that TBAs are valued because they are accessible at all hours, are affordable and are culturally acceptable since they usually share similar cultures and may or may not be relatives, or neighbours with their client communities [6,7,8]
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