|
Traditional Birth Attendants |
Providing safe delivery at home
Family Planning Association
of India
(FPAI) is well recognized for its quality reproductive health services across
the country. Their office in Bhandara, Maharashtra,
proposed the training of 30 Traditional Birth Attendants (TBAs) across 15
tribal villages in the forest belt of the district. The training proposal
highlighted that majority of the deliveries in this area were conducted at home
by untrained persons leading to several complications for the mother and the
new born, a large majority of which could be easily prevented through
appropriate training of birth attendants. Statistics from National Family
Health Survey (1998-99) show that the national infant mortality figures of 68
per 1000 live births is lower than the project area figures of 79 deaths per
1000 live births. Similarly, the maternal mortality statistics in the area were
also much higher than the national figures. The proposal also mentioned that
though the government primary health infrastructure was in place, it could not
meet all the health needs of people. In addition, transport was not uniformly
accessible throughout the year. These facts convinced the reviewing AID
chapters, Johns
Hopkins University
and Virginia Tech, of the need for this training. Practical hands-on training
in the hospital, post-training support mechanisms, specifically, follow-up and
problem solving sessions once very quarter for at least one year and
FPAI-Bhandara's extensive experience in training 242 TBAs indicated that the
training project was well thought out. The proposal also outlined a monitoring
plan through village committees comprising of 4-5 members from panchayat,
self-help groups and mahila mandals. The site-visit report further ensured that
the organization had high credibility in the local communities and good working
relations with government counterparts.
The project was approved in September, 2003 and the first
training program was conducted in February, 2004. Since then, four additional
rounds of follow-up and problem solving have been conducted. Feedback from the
trained TBAs suggests that it has been a worthwhile initiative.
The trained TBAs are not only very appreciative of the
training they received, but also very proud of their newly acquired skill-set.
"...We used to cut the cord with sickle, now I use a new blade," says Bayabai
from Sarpewada village and Laxmi from Davva. "..Now I can judge the position of
the baby," says Sayabai from Salerbardi. These skills are likely to decrease
the complications during delivery. Bhagirtha and Bayabai now know that rather
than waiting for three days to put the baby to mother's breast, doing so
immediately after delivery is beneficial for both the mother and the child.
Traditional birth attendants learn that correct hand-washing is a requirement for clean delivery.
Some of these new skills can be life-saving. Bhagirtha from
Chikhalabody village says that, " ...I can now recognize danger signs in the
mother and refer her in proper time."
Fifty-five years old Laxmi from Davva village, Saraswata
from Navegoan and Ananada from Koka village are able to conduct clean
deliveries through regular use of delivery kits. The delivery kits contain a
packet of blades, thread, cotton, gauze, scissors, soap, plastic sheet and
antiseptic lotion. These are replaced by FPAI. Furthermore, there is a plan for
the government to provide delivery kits to the TBAs on a regular basis.
The training of the TBAs has also made an impact on village
communities. Commenting on her "new working style" Leela from Surewada village
explained to her relatives that her training was beneficial for both the child
and the mother. Bayabai from Sarpewada village has a interesting way of
dealing with the relatives of her clients; she threatens to withdraw her
services saying ".. If you will apply some material over cord, I will not come
to conduct the delivery." Laxmi from Davva says that she conducts deliveries
not only in her own village but she is in demand in the neighboring villages
too. Clearly the community values the services offered by the TBAs.
Since the first round of training and follow-ups, the TBAs
have voiced a need for more training, specifically hands-on sessions on
managing deliveries. They have shown a special interest in wanting to learn
about herbal medicines and identifying and managing common illnesses.
For more information on the project, click here
---
Compiled in the field by Dr Leena Joshi,
FPAI.
Contributed by Anubha Dhasmana and Melody George, AID JHU
|
