Midwives’ views of traditional birth attendants within formal healthcare in Nigeria

BackgroundDiscourses around the journey to motherhood in many poorly-resourced countries, particularly in the sub-Saharan African region, with no link to death and danger are limited. The custodians of traditional practices – the traditional birth attendants – are often blamed for the high maternal deaths in this region. Conventional institutional and international thinking about traditional birth attendants is that they are dangerous and therefore should no longer be allowed to practice.AimTo explore midwives’ views of traditional birth attendants’ place within formal healthcare settings in Nigeria.MethodsHermeneutic phenomenological and poststructural feminist approaches were used. Seven midwives volunteered for semi-structured individual face to face interviews.FindingsThe responses of the midwives were diverse and conflicting. Some midwives believe that the traditional birth attendants should be banned, arguing that they are responsible for low uptake of hospital-based maternity care by women which in turn leads to an increase in maternal deaths. Contrastingly, other midwives expressed a view that the traditional birth attendants ‘cannot be phased out’ due to their valid contributions, particularly in the rural areas where access to formal maternity care is limited by intractable structural problems.ConclusionPolicy makers need to reconsider the role of traditional birth attendants. This should involve not only their integration into formal healthcare to work alongside formally trained maternity care providers, but also fostering a healthcare atmosphere where respect and recognition of each practitioner’s skill is paramount.     

Review of educational interventions to increase traditional birth attendants’ neonatal resuscitation self-efficacy

Background

Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality.

Traditional birth attendants’ roles and homebirth choices in Ethiopia: A qualitative study

BackgroundIn Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all.ObjectiveThis study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site.MethodA qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form.FindingsThe study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed.ConclusionsThere is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.     

Unilateral collaboration: The practices and understandings of traditional birth attendants in southeastern Nigeria

Background

Despite the promotion of hospital-based maternity care as the safest option, for less developed countries, many women particularly those in the rural areas continue to patronise indigenous midwives or traditional birth attendants. Little is known about traditional birth attendants’ perspectives regarding their pregnancy and birth practices.

From birth expectations to birth forecasts: a partial-adjustment approach

"As women's expectations about their own future fertility tend to deviate systematically from realizations, these expectations cannot be used directly for forecasting purposes. This paper discusses a partial-adjustment approach for deriving forecasts from the expectations. The sensitivity of the results to various assumptions is examined. Empirical results obtained for the Netherlands seem promising."     

Development of birth registration and birth statistics in the United States

The registration of vital events in the United States has always been under the authority of State and local areas. The preparation of national birth statistics has been made possible through a co-operative working arrangement between the Federal Government and the States. This paper traces the development of registration systems in the United States from colonial days to the present period. The absence of adequate registration systems throughout the country, during the nineteenth century, led to the use of data collected in the decennial population censuses of 1850–1900 for estimating birth rates. This procedure was abandoned because of the unreliability of the results. Steps leading to the formation of the national birth-registration area in 1915, when it included ten States and the District of Columbia, and. activities resulting in its completion in 1933 are discussed.

A major portion of the paper outlines the nation-wide test of birth-registration completeness conducted in 1940 in conjunction with the decennial census of population. Important results of the test are presented, and the methodology is explained. A similar test is being carried out in 1950. Data derived will be used to focus attention on local areas requiring registration promotion. Correction factors for statistical series based on registered events will also be obtained. The final section of the paper indicates the steps States are taking to improve quality of reporting on the birth record. Changes in the content of the standard certificate of live birth since 1915 are summarized and the statistics tabulated from birth certificates detailed.     

Perinatal and social factors predicting caesarean birth in a 2004 Australian birth cohort

Background

The proportion of babies born by caesarean section in Australia has almost doubled over the last 25 years. Factors known to contribute to caesarean such as higher maternal age, mothers being overweight or obese, or having had a previous caesarean do not completely account for the increased rate and it is clear that other influences exist.

Ambient temperature,birth rate,and birth outcomes: evidence from South Korea

Population and Environment - The effects from rising temperatures, a symptom of climate change, have become a significant concern. This study finds that one additional day with a maximum...     

Age-parity-specific birth rates and birth probabilities from census or survey data on own children

The ‘own-children’ method is a census- or survey-based reverse-survival technique for estimating age-specific birth rates for years previous to enumeration. In this paper it is extended to estimate birth rates and birth probabilities by parity as well as by age. The refined method is tested for accuracy by comparing ‘own-children’ estimates of age-parity-specific birth probabilities for the United States in 1969 with parallel estimates obtained by the method used in Vital Statistics of the United States. The ‘own-children’ estimates give relatively lower values at ages 15-19 and higher values at ages above 40, but compare well in between. The discrepancies are probably due mainly to adoption of illegitimate children of young mothers by older women. The ‘own-children’ estimate of the total fertility rate is very close to the published vital statistics estimate.     

Teachers and the birth rate

A theoretical model is developed in which the market for teachers is linked to the time path of fertility in the general population. The model is simple in its components but when the components are combined they form a complex long-memory dynamic system. Simulation experiments are carried out to investigate the effects of changes in fertility rates on supply/requirements imbalances in the teachers' market, the median age of teachers, and other variables. The model (and by implication, the real-world system) is found to be highly volatile in response to fertility variations.This study was supported by a grant from the Social Sciences and Humanities Research Council of Canada. The authors are grateful for the able research assistance provided by Guy Brockington and Renqun Wang and for the helpful comments of the referees.     

Analysing open birth interval distributions

Summary This paper began with the recognition that open birth interval distributions are analogous to age distributions. It then became clear that closed birth interval distributions are, somewhat more loosely, analogous to mortality schedules, and that the relationship between open and closed birth interval distributions could be explored by imitating the formal demography of mortality and age distribution. Pursuing this programme, we develop the formal demography of open and closed birth interval distributions and show that under certain assumptions open interval distributions may be used to estimate closed interval distributions, just as age distributions may be used to estimate mortality. An illustrative application to Indonesian data is given.     

The third birth in Sweden

This paper considers the formulation, estimation and interpretation of microdynamic models of fertility. Our model explains parity choices, sterility, childlessness, interbirth intervals and initiation of pregnancy within a unified framework. We develop a general methodology for estimating the determinants of transition times to births of different orders. Our procedure incorporates time-varying explanatory variables and unobservables. We present conditions that justify conventional formulae relating hazards to survivor functions when time-varying variables enter hazards. We also consider the validity of widely-used piecemeal estimation strategies that focus on one birth at a time. We consider methods for selecting a best model among a class of non-nested models. Two criteria are set forth and used to evaluate the detminants of third births in Sweden.We find that two models fit Swedish microdata equally well. One model is consistent with neoclassical economic theory. It assigns a central role to the wages of men and women in explaining the timing and spacing of births. The other model is purely demographic and excludes wages. Purely statistical criteria cannot distinguish these models although in other work we show that the economic models are more parsimonious in terms of the number of parameters that must be estimated and are better able to forecast aggregate time series.We demonstrate how to interpret the output of multistate fertility models. Wage effects on third births are decomposed into two components: (a) an in direct effect that determines whether a woman is at risk to have a third birth, and (b) a direct effect on the transition rate to the third birth given that a woman has had two births. We find that female wages play an important role in postponing first births but play only a minor role in explaining childlessness. Female wages substantially affect third births. Male wage effects are weaker. We find that female wage effects weaken for more recent cohorts of women. This evidence is consistent with the introduction of progressively more pronatal Swedish policies.This research was supported by NIH Grant No. HD-19226 to NORC. We have benefited from the comments of Elja Arjas and Ricardo Barros. This paper was presented at an IUSSP Conference in Paris, France, in March 1988, and as an invited lecture at the Fourth ESPE Meetings in Istanbul, Turkey, June, 1990. This paper is one part of a trilogy. Heckman and Walker (1990a) presents a succinct summary of the main economic results. Heckman and Walker (1990b) presents a more complete discussion of the empirical results. This paper presents a more purely demographic discussion.     

How menstrual shame affects birth

In Western, industrialised culture, menstruation and birth are commonly seen as unstable, pathological processes requiring medical control. Girls learn to see menstruation as shameful and secretive. Menarche is a nodal event around which girls’ beliefs and attitudes to being female are organised. The perception of menstruation as a liability has foundational implications for future female experiences, particularly birth. Other cultures have recognised menstruation and birth as spiritual phenomena, with menarche and childbirth experienced as powerful initiatory processes. My PhD research explored the links between cultural attitudes to menstruation and spirituality, and women's experiences of birth. My feminist perspective recognised the power imbalances, patriarchal controls and structural inequities that oppress women in their intimate body experiences. Menstrual shame was identified as a core patriarchal organising principle that inculcates and perpetuates male dominance and female subordination. Engendering the perception of female physiology – and thus womanhood – as inherently flawed, menstrual shame was a key factor that predisposed women to approach birth feeling fearful, disempowered and vulnerable to intervention. However, my research also unearthed a counter-cultural group of women who had transformed their relationship with both menstruation and birth. Redesignating menstruation as a spiritual phenomenon enabled these women to dismantle their menstrual shame, connect with their female spirituality and give birth fearlessly and powerfully. For others, the profound spirituality of birth transformed their understanding of menstruation. Contrary to cultural norms, both menstruation and birth can be sacred female experiences which are sources of authority and empowerment.     

First birth timing in Australia

This paper examines the concept of delayed childbearing in Australia, in comparison with other Western countries. In addition to presenting statistics to examine changes in the age at which women enter parenthood, survey data from the Australian Family Project are used to investigate the factors influencing the timing of the first birth. Using a framework proposed by Bloom (1984), the paper presents a proportional hazards regression model of first birth timing. Some attempt is made to examine changes over time in the factors affecting the age at first birth.     

Infant mortality and birth intervals

Summary In the course of a demographic inquiry which also offered medical advice to the respondent women, information was obtained on the reproductive life and child mortality of women in three regions of Upper Volta. Foetal mortality rates are inversely correlated with fertility rates, whereas the opposite holds true of the mortality of children aged up to four years. An explanation of this phenomenon is attempted, showing how large variations in mortality rates continue to exist in developing countries. The second section of the paper deals with spontaneous abortions which happen much more frequently than is believed in Black Africa and with the effect of pathological sterility on birth intervals. Account is taken of the taboo on sexual relations after children have been born, a taboo which continues to be kept in the region studied and which as an important effect on inter-birth intervals.