Should India Reconsider the Role of Traditional Midwives?
Does India need to train traditional midwives in modern childbirth practices and equip them to handle complications? A 2013 Unicef-funded study in India documented “serious, persistent gaps in safe delivery capacity at the primary level, especially subcenters and remote primary health centers.” According to an article in the “India Ink” column in the New York Times by Malavika Vyawahare, January 13 2013, “with more than 55,000 women in India dying from pregnancy and childbirth-related complications each year, health experts and nongovernmental organizations are now pushing the government to re-incorporate midwives into the strained health care system by training them in modern childbirth practices and equipping them to handle complications. ‘Community needs are at a point that if you suddenly remove all of the traditional birth attendants and home-based attendants, there will be no alternate for a lot of people,’ said Dr. Rajiv Tandon, a pediatrician and public health and nutrition expert.”
In 2005, “a government review clearly showed that a majority of the traditional birth attendants, like untrained midwives, could not identify birth complications, which delayed treatment that could have saved women’s lives.” However, getting traditional midwives to adopt modern lifesaving practices in childbirth and to give up some of their harmful practices will not be easy, nor will getting women to go to village clinics with trained providers rather than relying on these traditional attendants that they know and trust.
Using traditional birth attendants (TBAs) to improve childbirth outcomes is controversial – many studies in developing countries showed that giving TBAs some training, usually in hygiene (hand-washing, using a clean instrument to cut the umbilical cord, etc), was not improving the maternal and infant death rates, as these attendants still had no knowledge in the recognition and management of high-risk conditions or situations in which women needed to be referred to a trained provider. Major organizations such as the World Health Organization recommended replacing these village women with trained providers, mostly midwives. However, there are just not enough of these trained providers in many developing countries. Until more professional midwives are educated, giving traditional midwives or village health workers some training may be a useful stop-gap measure.