Traditional birth attendants (TBAs) cover around forty three percent of Ugandan births, yet the country’s health policy alienates them from learning about HIV prevention, particularly the prevention of mother to child transmission (PMTCT).
Saidat Namale, a TBA in Uganda, has criticised the way in which TBAs are “left out of the whole process” of PMTCT yet handle many deliveries. She says she has even delivered babies for pregnant health workers.
“Most women do not have help when delivering and come [to a TBA instead]. They don’t have material like razors, polythene and cotton needed in hospitals. Some do not even have clothes to wrap their babies in. Some will tell you ‘my husband went to Juba [an area in Uganda] and I don’t have any support’. You cannot chase them away but in hospitals they are often chased,” she said.
When asked about the risk of HIV and AIDS and preventing the transmission of HIV, Saidat says: “When women come you ask them about their health situation and draw conclusions because most do not reveal the truth about their status. When you discover they are positive you tell them about the provision of medicine that can prevent mother to child transmission in hospital and they relax.”
She adds: “When delivering them we were trained that prevention can be got if the cord is tied and released early without blood exchange between mother and child. When I was delivering [a girl called] Nampija Sofia I tied the cord and placed the baby on the side. Her mother was HIV positive and asked me if her baby would live and she has lived, and is sixteen years old without HIV, though both her parents died.”
In 2009, the Ugandan government banned TBAs. As discussed by Malinga Joseph in 2010 in The Guardian, a government circular discussing the termination of support for TBAs recognised there was “a big unmet need” for skilled medical professionals in Uganda, especially in hard to reach areas, which was driving women to seek the services of TBAs. However, by training TBAs the government felt it was sending mixed messages that would be mistaken for endorsement of TBAs as a strategy to reduce maternal mortality.
Nevertheless, the ban offers no solution. As renowned health writer Esther Nakkazi in her UgandascieGirl blog argues: “they are still the providers of choice of many women in Uganda’s rural areas”.
This is echoed in Saidat’s reflection that many women deliver by the roadside before reaching health centres and turn to a TBAs to help. There are also many women who are economically challenged and cannot meet the cost levied by health centres for cotton, gloves and soap – as well as the insults given to them by health workers for not having these materials.
The incessant weakness in Uganda’s health sector caused by a lack of medical personnel, coupled with challenges of poor infrastructure and poverty, call for the government to enhance PMTCT mechanisms by further training TBAs and extending prevention opportunities to them.
