Paper short abstract:

This presentation describes and analyses the services of TBAs in Monkey Bay Area in Mangochi District in Malawi for the period 2004-2011, and evaluates the impact of the ban. It exemplifies the difficulties to apply ambitious global goals to diverse local settings.

Paper long abstract:

In an attempt to lower the prevailing high maternal and child mortality rates, and the reach MDG5 by 2015, the Government of Malawi decided in October 2008 to prohibit Traditional Birth Attendants (TBAs) to assist births in Malawi. The aim of the paper is to describe and analyse the services of TBAs in Monkey Bay Area in Mangochi District in Malawi for the period 2004-2011, and evaluate the impact of the ban. It builds on an analysis of data in the Health Monitoring Information System (HMIS), and qualitative interviews with TBAs conducted before and after the ban. In general, TBAs assisted women to deliver in about 1/3 of all births before the ban; after the ban, birth attendance by health professionals increased by about 50-75% in the two state-run health facilities, and three CHAM facilities. At the same time, community expressed their anger about the ban, and its implementation. The ban on TBA exemplifies the difficulties to apply ambitious global goals to diverse local settings. Within the current socio-economic situation of Malawi, shared with many low-income countries in sub-Saharan Africa, it is difficult to see how TBAs can be excluded to serve women to deliver in their own communities. Ways need to be sought to integrate their activities in the over-all health services, first for preventive activities, but also how to improve the quality of their work, and referral practices.