Paper short abstract:

The policy towards TBAs in Uganda is highly un-social and fails to address the underlying reasons for the existence of TBAs. By drawing from a global menu that is insensitive to local peculiarities the policy tends to work in tandem with the goal of access to maternal health for the vulnerable women

Paper long abstract:

In the 1960s, WHO championed policies for integration of traditional birth attendants (TBAs) in the delivery of maternal health services. By the1990s there was a realization that TBAs were not reducing maternal mortality and a new policy promoting skilled attendants saw national governments discouraging and banning activities of TBAs. Using ethnographic methods in a rural community of Luwero, Uganda, I investigated how this policy shift affected the configuration of maternity services. Because practicing TBAs are threatened with arrest they demand cash payment upfront from clients. Due to fear, TBAs refrain from helping delivering women even in circumstances where skilled attendants cannot be accessed. Many women navigate this situation through syncretic utilization of both TBA and formal healthcare which they keep secret from the formal healthcare authorities. Some mothers avoid formal maternity care due to fear of being reprimanded for utilizing TBA services. The policy towards TBAs produced an ambiguous environment in which access maternal health services are re-configured into two contradictory system embodied by rural women who have to navigate them to access maternity care. I conclude that policy towards TBAs is highly un-social, top-down, overly medicalized, and fails to address the underlying reasons for the existence of TBAs, perhaps precisely because of their marginalisation within the health system structure. The policy draws from a global menu that is insensitive to local peculiarities and as a result tends to reproduce and by default work in tandem with the broader goal of access to health for the vulnerable in the community.