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Cited by 51Global Maternal and Child HealthMaternal and Perinatal Health InterventionsHealth and Conflict Studies

The evolving role of traditional birth attendants in maternal health in post-conflict Africa: A qualitative study of Burundi and northern Uganda

Open access
Chi, Primus Che, Urdal, Henrik·2018·SAGE Open Medicine
DOI 10.1177/2050312117753631PMC PMC5777562
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Abstract

Objectives: Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era. Methods: A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach). Results: Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas. Conclusion: The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.

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  • The WHO has recommended utilizing trained traditional birth attendants where service gaps exist to health care workers in low-resource settings, and efforts have been successfully executed in Eastern Burma, Burundi, and along the Thai-Myanmar border.

    “The WHO has recommended utilizing trained TBAs where service gaps exist to health care workers in low-resource settings (WHO, Citation1970), efforts that have been successfully executed in Eastern Burma (Mullany et al., Citation2008), Burundi (Chi & Urdal, Citation2018), and along the Thai-Myanmar border (White et al., Citation2016).”

    From Recommendations to improve maternal mortality among Rohingya women in Bangladeshi refugee camps (2025) · cites this paper as Chi & Urdal, 2018

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References 28 · Cited by 51

Research works printed but not linked: 25

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Authors
Chi, P. C., & Urdal, H.
Affiliations
  • Karolinska Institutet (SE)
  • Peace Research Institute Oslo (NO)
Corresponding author
Chi, Primus Che
ORCID
Venue
SAGE Open Medicine
Publisher
SAGE Publications
Published
2018-01-01
Volume
6
Pages
2050312117753631-2050312117753631
ISSN
2050-3121 (ISSN-L)
DOI
10.1177/2050312117753631
PMC
PMC5777562
OpenAlex
W2787803724
Cited by
51
References
28
Citations by year
2026: 5 · 2025: 5 · 2024: 11 · 2023: 7 · 2022: 3 · 2021: 4 · 2020: 9 · 2019: 4 · 2018: 3
FWCI
5.52
Type
journal article
Language
en
Open access
Licence
Locations
  • SAGE Open Medicine (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Norges Forskningsråd (Project 230861 Armed Conflict and Maternal Heal)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
Keywords
traditional birth attendants, maternal health, post-conflict societies, childbirth, skilled birth attendants, Burundi, Northern Uganda, birth companions, health workforce shortage, conflict-affected countries, non-governmental organizations

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