Trained traditional birth attendants's perspectives on Governments' decision to stop community-based deliveries in Kazungula District: a qualitative case study of Mukuni Chiefdom

Abstract

In 2010, the government of Zambia stopped training traditional birth attendants (TBAs) and forbade them from conducting home deliveries because they were viewed to contribute to maternal mortality. Since then, there has been no study done to get the perspectives of the TBAs after the policy ban in Zambia. This study explored the perspectives of trained TBAs on governments’ decision to stop community-based deliveries in Kazungula district. This was a qualitative case study conducted in Mukuni chiefdom of Kazungula district. It included only trained traditional birth attendants purposively selected in Mukuni area. A census was considered that included all twenty-two trained TBAs from three clinic catchment areas. Six female traditional leaders were selected one from each zone. Expert sampling was used. Data was collected through focus group discussions, in-depth interviews of TBAs and key informant interviews for leaders. Thematic content analysis was used to analyse the data after coding findings manually. The results showed that community-based deliveries continued despite the full knowledge of the ban by government. The reasons for the continuity include the lack of health facilities in some communities, poor transition methods from community-based deliveries to institutional deliveries, long distances and poor transport system, lack of delivery services at some local clinics and too many demands put up at clinics or hospitals. Trained traditional birth attendants continued conducting home deliveries because to them it was a moral duty they had to perform hence have no option because institutional-based delivery services were far from the communities. Effects of the ban included both negative and positive effects. Positive effects included TBAs having more time to do their own work, reduced criticisms from the community in case of a complication and quick response at health facilities in case of an emergency. Negative effects included extra work, high cost for lodging at health facilities, loss of respect and recognition by the community, introduction of penalty fees and getting back to untrained traditional birth attendants a situation which was worse than before the ban. Despite the global redirection from traditional birth attendance to skilled birth attendance, there was need to domesticate policy decisions as a nation-based on local evidence and practicality.