1.0 Introduction
1.1 Background of Study
Maternal and child health remains a fundamental indicator of national health development, reflecting the overall effectiveness of a country’s healthcare delivery system. In Nigeria, and particularly in rural and semi-urban areas like those found in Oyo State, traditional birth attendants (TBAs) have played a long-standing role in maternal care. Despite the advent of modern obstetric services, TBAs continue to serve as primary caregivers during pregnancy, childbirth, and postpartum periods for many women, especially where access to skilled birth attendants is limited (Ezeome & Ezeome, 2018). In many African societies, childbirth is deeply rooted in cultural and traditional beliefs. TBAs are often considered custodians of indigenous knowledge passed down through generations, providing not just clinical support but also emotional, spiritual, and cultural reassurance to pregnant women (Okafor & Rizzuto, 2020). Their involvement is largely due to several persistent challenges within the formal health system, including inadequate infrastructure, shortage of skilled personnel, high cost of services, and long distances to health facilities.
Nigeria continues to face high maternal and neonatal mortality rates despite interventions aimed at improving reproductive and child health. The World Health Organization (2023) emphasizes that the global maternal mortality ratio remains unacceptably high in low-income countries, with Nigeria contributing significantly to the global burden. According to the National Population Commission (NPC) and ICF (2019), Nigeria's maternal mortality ratio is estimated at 512 deaths per 100,000 live births, and neonatal mortality is 39 per 1,000 live births. In this context, TBAs are often both a necessity and a challenge: while they bridge the gap created by the formal healthcare system, their lack of formal medical training raises concerns about the quality and safety of care provided.
Maternal and child health remains a significant public health priority globally, particularly in developing countries like Nigeria. One of the vital actors in the maternal healthcare delivery system, especially in rural and underserved communities, is the Traditional Birth Attendant (TBA). According to the World Health Organization (WHO, 2022), a Traditional Birth Attendant is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs (WHO, 2022).
Traditional Birth Attendants have historically played a central role in maternal care, especially where formal health services are limited or culturally inaccessible. In Nigeria, a large percentage of rural births are still attended to by TBAs, primarily due to factors such as geographical inaccessibility, cost of medical care, cultural preferences, and trust developed over generations (Adewuyi & Adefemi, 2016). While Traditional Birth Attendants often lack formal training in modern medical procedures, they are trusted members of their communities and are often the first point of contact for pregnant women. Their influence in maternal and child health cannot be underestimated, particularly in areas where the health infrastructure is weak.
The persistence of high maternal and child mortality rates in Nigeria has necessitated a closer examination of all components of maternal healthcare delivery. The 2018 Nigeria Demographic and Health Survey (NDHS) reported that the maternal mortality ratio stood at 512 deaths per 100,000 live births, with neonatal mortality at 39 per 1,000 live births (National Population Commission [NPC] & ICF, 2019). In Oyo State, like many parts of Nigeria, TBAs continue to deliver a significant proportion of maternity services. Their roles range from providing antenatal care, assisting during delivery, offering postpartum support, and sometimes treating minor illnesses of newborns. However, there is an ongoing debate about their efficacy, safety, and integration into the formal healthcare system. This study, therefore, seeks to explore the role of Traditional Birth Attendants in maternal and child health.
1.2 Statement of Problems
Investigation revealed that the healthcare system in Oyo State, like many parts of Nigeria, is overstretched and under-resourced. As a result, many women still turn to TBAs due to their affordability, accessibility, and familiarity. However, Traditional Birth Attendants may lack the necessary skills to manage complications such as hemorrhage, obstructed labor, or neonatal distress. The absence of proper equipment and sterile procedures is exposing mothers and babies to life-threatening infections and birth injuries (Ntoimo et al., 2021).
Furthermore, government and non-governmental organizations have made several attempts to integrate TBAs into the formal healthcare system through training and partnership programs, but the outcomes remain inconsistent. A major challenge is the lack of regulation and supervision of traditional birth attendant activities. Without a standardized framework, TBAs are operating independently, which is contributing to delays in referrals, poor management of high-risk pregnancies, and increased maternal and infant morbidity (Ezeome & Ezeome, 2018). It is against the backdrop that this study seeks to investigate how TBAs contribute to maternal and child health in Oyo State, the challenges they face, and how their services can be integrated or regulated in collaboration with the formal healthcare sector.
1.3 Purpose of the Study
The purpose of this study is to examine the role played by Traditional Birth Attendants (TBAs) in the delivery of maternal and child health services in Oyo State. It seeks to understand their practices, assess their contributions and challenges, and explore ways in which their services could be improved or integrated with the formal healthcare system. The study aims to provide a comprehensive evaluation that will inform policies to enhance maternal and child health outcomes in the state.
1.4 Aim and Objectives of the Study
The aim of this study is to assess the role of Traditional Birth Attendants in the improvement of maternal and child health in Oyo State. In achieving the above stated aim, the following specific objectives were laid out as follows:
- To examine the services provided by Traditional Birth Attendants to pregnant women and newborns.
- To assess the level of knowledge and training of TBAs in maternal and child health practices.
- To identify the challenges faced by TBAs in delivering maternal and child health services.
- To evaluate the collaboration between TBAs and formal healthcare providers.
- To suggest strategies for improving the role of TBAs in maternal and child health care delivery.
1.5 Research Questions
Based on the objectives of the study, the following research questions have been formulated:
- What types of maternal and child health services are provided by Traditional Birth Attendants in Oyo State?
- What is the level of knowledge and training of TBAs in safe delivery practices?
- What are the major challenges faced by TBAs in maternal and child health delivery?
- How effectively do TBAs collaborate with formal healthcare providers?
- What strategies can be used to improve the contribution of TBAs to maternal and child health?
1.6 Significance of Study
The outcome of this research will benefit the Ministry of Health by providing data that will support evidence-based policymaking and program design for maternal and child health. It will also help traditional birth attendants by identifying gaps in their knowledge and practice, offering recommendations for training and capacity building.
Furthermore, the study will assist healthcare professionals in understanding the cultural context of childbirth and in developing collaborative models with TBAs. Additionally, the study will inform local communities and pregnant women about the risks and benefits of using TBAs, promoting safer healthcare choices.
Lastly, the study will contribute to academic literature by filling the gap in empirical data on the role of TBAs in the Nigerian healthcare system, especially within the context of Oyo State. It will raise awareness among health professionals and the general public about the importance of cultural sensitivity in maternal healthcare delivery.
1.7 Scope of Study
This study focuses on the role of Traditional Birth Attendants in maternal and child health within Oyo State, Nigeria, using the Oyo State Ministry of Health as the case organization. The research covers selected local government areas where TBAs operate and considers only those providing maternity-related services. The study is limited to the activities, experiences, challenges, and interactions of TBAs with pregnant women and health officials in this geographical area.
1.8 Limitations of the Study
Several limitations were encountered during the course of this study, which may have influenced the results and conclusions.
- Time Constraints: A study of this nature needs relatively long time during which information for accurate or at least near accurate inference could be drawn. The period of the study was short, time posed as constraints to the research.
- Financial Constraints: The research would have extended the survey to other area at the empirical level, but limitation as included cost of transportation to the source of material and the cost of time setting of the already completed work.
- Lack of Cooperation: Many of the respondents are usually aggressive on issue that border cooperation among the respondents border.
- Response Bias: The study will involve surveys and interviews with cooperative managers and members. Response bias may occur if respondents provide socially desirable answers or if there is reluctance to disclose negative financial information due to privacy concerns or fear of repercussions.
1.9 Definition of Terms
Traditional Birth Attendant (TBA): A person, usually a woman, who assists mothers during childbirth and has learned the art through apprenticeship or personal experience rather than formal medical training (WHO, 2022). TBAs often serve rural communities where access to hospitals is limited.
Maternal Health: The health of women during pregnancy, childbirth, and the postpartum period. It includes healthcare services aimed at reducing maternal mortality and ensuring safe delivery (UNFPA, 2020).
Child Health: The physical, mental, and social well-being of children from birth to adolescence, including interventions that reduce infant and child mortality (UNICEF, 2023).
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