Training of traditional birth attendants: An examination of influence of biomedical frameworks of knowledge on local birthing practices in India

Pregnancy and childbirth complications are a leading cause of death and disability among women of reproductive age in developing countries. Worldwide data shows that, by choice or out of necessity, 47 percent of births are assisted by Traditional Birth Attendants (TBAs), family members, or without any assistance at all. This thesis argues that TBAs in India have the capacity to disseminate knowledge of beneficial maternal practices to the community.

 After two decades of TBA training intervention, international funding on TBAs has been reduced since 1990s and shifted to providing skilled attendants for all women during delivery. TBAs have been criticised for causing maternal and new born deaths with their unhygienic and harmful practices, lacking the capacity to take advantage of the training and for deterring and delaying referrals. Researchers have observed that the shift in policy has taken place without adequate evidence of training (in)effectiveness and without an alternative policy in place.

 This thesis argues that the effectiveness of the training design and content is in including relevant community practices and knowledge. The thesis used the theory of ‘authoritative knowledge’, and quantitative and qualitative methods, to assess whether the local TBA training programmes in Ahmednagar District in India have been successful in disseminating biomedical knowledge in relation to the birthing practices of local TBAs.

 The data revealed that some biomedical knowledge had been successfully disseminated and that some traditional practices continue to be practiced in the community. The training content mainly consists of biomedical knowledge and a general omission of local knowledge. TBAs and mothers sometimes follow the training instructions and sometime do not, preferring to adapt to the local perceptions and preferences of their community. The thesis highlights the significance of community awareness that accompanies TBA training and makes recommendations in order to enhance training outcomes.