In the public health debate on how to reduce maternal deaths, Traditional Birth Attendants (TBAs) are criticised for being unable to deal with haemorrhages and obstructed labour which account for most maternal deaths. Nonetheless, in rural Cameroon, TBAs continue to practice with significantly high approval ratings of their activities by their clientele. This research used ethnographic methods to explore the following questions: what factors explain the continuous demand and supply of TBAs? Do pregnant women employing their services consider the ‘risks’ involved? How do TBAs themselves perceive their services to society? The findings suggested that; the prevalence of TBAs, use of their services, and clients’ attitudes can be explained by a complex intertwined nexus of fear of HIV/AIDs stigma, gender, cultural beliefs and lack of access to formal health care systems. The TBAs interviewed considered their services as being humanitarian, but rural women interviewees had a more instrumental functional perception. These clients understood the risks involved, but considered TBAs to be relatively reliable safety nets when the formal health care system was seen as spatially or socially inaccessible.
Table of Contents
Introduction
Problem of study
Methodology
Findings
1. System of health care provision
2. Confrontations: women forgoing their farming days to access modern health facilities versus exhausting schedules on the part of skilled attendants.
3. Financial and social cost of using the formal health care system.
4. Language and communication between women and health care providers
5. Pregnancy and child birth belief systems
6. Social pressures from within the family social structure.
7. Gender in procreation
8. The fear of knowing their HIV/AIDS status and being stigmatized.
Conclusion
Contribution of Authors
References
Research Objectives & Key Themes
The research explores the persistent demand for Traditional Birth Attendants (TBAs) in rural Cameroon despite the availability of formal health systems, aiming to understand the factors behind this choice and whether there is a disconnect in how TBA services are perceived by providers versus the rural population.
- The influence of socio-economic factors and physical accessibility on maternal health choices.
- Cultural beliefs, taboos, and the role of TBAs in providing psychological support.
- The impact of HIV/AIDS-related stigma on healthcare-seeking behavior.
- Gender dynamics, family planning, and social pressures within rural family structures.
- The confrontation between the formal medical system and local rural realities.
Excerpt from the Book
3. Financial and social cost of using the formal health care system.
As already mentioned above, public health care providers are cheaper than mission and private providers who in some cases were the only providers in rural areas. In both cases, the natures of provider-client relationships as well as the cost of services were determining factors for women seeking skilled birth attendants. When women chose to receive medical attention from the private/confessional providers where they could pay later, they had to sacrifice their ‘last dime’ as well as mingle with women from higher social classes which were not always easy:
“I gave birth to my first child in the hospital and my box was a very old one. Even my bed sheets and everything I used to dress the bed. I felt too ashamed when I saw how other women’s beds were. It was as though I am the last person in this world. So, I decided that if my husband cannot buy new things. I will not go there again. I will call a TBA to deliver me here in the house where only I and my family will know how we live our lives” (Rose, in-depth interview in Bafanji, 2011)
Considering that, TBA assisted birth did not require a display of riches or status, women who used them felt more comfortable. In the same light, TBA’s believed that, they were serving humanity with gifts which only they inherited. Like Mama Franscica, a TBA aptly illustrated:
“God cannot take his time to build a child and put in a woman’s womb and give you the talent to remove it and you leave her to die because she does not have money! I count it joy and will never hesitate to offer my service whenever I see a case in need. You cannot understand how many children that I have delivered and today the village is full of kids. When you yourself look at their bright faces in school uniforms, tell me, aren’t your happy? Then, what more of me who takes part in their birthing process? Even on plantain leaves, the baby’s first cry sparks immeasurable joy and gives colour to my life!” (In-depth interview in Bafanji, 2011)
Summary of Chapters
System of health care provision: This chapter analyzes the landscape of healthcare in rural Cameroon, highlighting the disparity between the limited presence of government facilities and the reliance on expensive private or mission-based care.
Confrontations: women forgoing their farming days to access modern health facilities versus exhausting schedules on the part of skilled attendants.: The author examines the structural conflicts caused by long travel times for patients and stressful, rigid working conditions for medical staff, leading to mutual blame.
Financial and social cost of using the formal health care system.: This section discusses how the economic burden and the social intimidation felt by poorer women in modern hospital settings drive them toward the more accessible and egalitarian services of TBAs.
Language and communication between women and health care providers: It explores how communication barriers and perceived discrimination by medical staff lead marginalized women to avoid formal facilities.
Pregnancy and child birth belief systems: This chapter details the crucial role of cultural traditions and specific beliefs—some involving witchcraft or infidelity—that shape the birthing process and necessitate the support of a trusted TBA.
Social pressures from within the family social structure.: The author illustrates how the influence of in-laws and the need for familial approval often dictate the choice of birth attendant in rural settings.
Gender in procreation: This section investigates how rigid gender roles, family size expectations, and fear of marital instability influence women's choices regarding both family planning and birth attendants.
The fear of knowing their HIV/AIDS status and being stigmatized.: The final chapter analyzes how the fear of testing positive and subsequent social stigma pushes vulnerable women away from clinical prenatal programs.
Keywords
Traditional Birth Attendants, TBAs, humanitarianism, maternal health, formal health care system, accessibility, rural Cameroon, HIV/AIDS stigma, gender, cultural beliefs, ethnography, reproductive health, birth complications, social support, maternal mortality.
Frequently Asked Questions
What is the primary focus of this research?
This research investigates the dynamics of maternal health provision in rural Cameroon and why women continue to rely on Traditional Birth Attendants despite the existence of a formal medical system.
What are the key thematic fields covered?
The study covers socio-economic barriers, cultural and religious belief systems surrounding childbirth, the impact of HIV/AIDS stigma, gender roles in procreation, and the nature of the relationship between patients and healthcare providers.
What is the central research question?
The research asks what factors explain the persistent demand for and supply of TBA services, how clients perceive the risks involved, and how TBAs themselves interpret their service to society.
Which methodology does the author employ?
The study utilizes ethnographic methods, including in-depth interviews, focus group discussions, participant observations, and life history interviews conducted in three regions of rural Cameroon.
What does the main body of the text discuss?
It discusses eight primary factors: healthcare availability, time and access constraints, financial/social costs, language barriers, belief systems, family social pressures, gender dynamics in procreation, and HIV/AIDS stigma.
Which keywords define this work?
The core keywords include Traditional Birth Attendants (TBAs), humanitarianism, maternal health, rural Cameroon, health accessibility, HIV/AIDS stigma, and socio-cultural beliefs.
How does the author explain the 'humanitarian' perception of TBAs?
TBAs are perceived as humanitarian because they provide accessible, friendly, and often free support that aligns with local social solidarity, unlike the rigid and sometimes judgmental formal health system.
What role does HIV/AIDS stigma play in birth attendant selection?
HIV/AIDS stigma acts as a significant deterrent, as women fear that clinic visits will expose their status; since TBAs typically do not test for HIV, they offer a 'safer' alternative for these women.
How do familial social structures influence childbirth decisions?
In-laws and husbands often exert pressure on women to conform to traditional practices or discourage them from using medical facilities, citing past experiences or cultural expectations.
- Quote paper
- Glory Manambowoh Lueong (Author), 2013, Humanitarianism among Traditional Birth Attendants (TBAs). A case study of selected villages in rural Cameroon, Munich, GRIN Verlag, https://www.grin.com/document/265657
