Despite the tremendous resources invested in training Traditional Birth Attendants (TBAs) over the past two decades, scientific evidence from around the world has shown that training TBAs has not reduced maternal mortality. Any improvement observed when TBA training programs have been introduced was because of the associated supervision and referral systems, and the quality of essential obstetric services available at first referral level. Conversely, evidence has shown reduced maternal and perinatal morbidity and mortality when women have a “Skilled Attendant” (a qualified health care provider who has midwifery or obstetric skills) present at every birth. Thus, national safe motherhood programs, including in Kenya, are now focusing on increasing the number of Skilled Attendants, whether a woman delivers in a facility or at home. Since TBAs are highly regarded by their communities, it is critical that they still be enabled to play a role in improving maternal health. As noted in this brief, the continued preference for TBAs in Western Province can be attributed to their proximity to the woman’s home, respectful attitude toward women, and flexible modes of payment. Problems can arise, however, when TBAs delay seeking skilled care for women in difficult labor.
"Traditional birth attendants in maternal health programmes," Safe Motherhood Policy Alert. Nairobi: Population Council, 2003.