The Role of Traditional Birth Attendants in Improving Maternal Health Outcomes in LMICs

IN A NUTSHELL
Author's note
…The work of Zinure Women’s Health Foundation in Nigeria prioritizes bridging the gap between traditional and modern healthcare systems by promoting capacity-building training for traditional birth attendants (TBAs) and community health workers, fostering partnerships with local health facilities, and promoting community awareness on safe pregnancy and postpartum care. By empowering TBAs with the knowledge, tools, and networks they need, we not only honor their cultural significance but also ensure that no woman is left behind when it matters most…

By Yvonne Akukwe

Maternal Health Advocate

Co-Founder & CEO, Zinure Women’s Health Foundation

Washington, Columbia District, USA

The Role of Traditional Birth Attendants in Improving Maternal Health Outcomes in LMICs

 

According to the World Health Organization, approximately 92% of all maternal mortalities in 2023 occurred in low- and middle-income countries. Furthermore, Sub-Saharan Africa alone accounted for about 70% of these global maternal deaths. Most maternal mortalities are preventable and are primarily due to a lack of adequate emergency obstetric care and skilled healthcare providers.

Obstetric emergencies such as postpartum hemorrhage, sepsis, unsafe abortions, and eclampsia can be properly managed in health facilities with skilled birth attendants; however, in rural and underserved areas, traditional birth attendants (TBAs) are the first, and oftentimes, only source of care for women during pregnancy, childbirth, and postpartum.

Traditional birth attendants, sometimes referred to as traditional midwives, are well-respected and trusted community-based birth workers that assist mothers during pregnancy, deliver babies, and support postpartum care. Their skills are not acquired through formal medical school training but instead through informal apprenticeships, learning from other TBAs, or experience gained as a caregiver. For many women in low-resource settings who may not have access to or can’t afford formal health systems for care, the ability of TBAs to recognize complications early and refer women to health facilities can make the difference between life and death.

Linking Tradition & Evidence-Based Practices

When engaged effectively, TBAs can play a crucial role in improving maternal health outcomes. By providing TBAs with evidence-based training on safe delivery practices and emergency management – especially in managing postpartum hemorrhage, sepsis, and eclampsia – they can become valuable resources. Training modules that emphasize early warning signs and complications, safe delivery and good hygiene practices, respectful maternity care, and clear referral protocols can empower them to provide safer care.

Equally as important is integrating maternal mental health support into these trainings. In addition to the physical care provided, TBAs also have emotional access to women during the perinatal period, yet many lack the skills to recognize the signs of perinatal mood and anxiety disorders (PMADs).

Educating them on basic psychosocial support strategies ensures that mothers receive holistic care that addresses both their physical and emotional wellbeing.

The Power of a Strong Referral Network

Historically, TBAs have operated independently, disconnected from formal health networks. In times of obstetric emergencies, weak referral systems and the inability to access health facilities in a timely manner often result in adverse maternal health outcomes. Creating structured communication channels, such as WhatsApp-based networks or referral cards, can ensure women experiencing complications are sent to facilities well-equipped to manage emergencies. By leveraging their influence within the community, TBAs can encourage women to seek specialized care at health facilities once a potential obstetric complication is identified, therefore decreasing the likelihood of emergency situations and subsequently mortality. A strong referral system not only strengthens collaboration but also helps foster mutual respect between community-based and health facility-based providers.

Zinure Women’s Health Foundation’s Vision

 At Zinure Women’s Health Foundation, we believe that every woman—regardless of her socioeconomic status or geographic location—deserves a safe, healthy, and fulfilling motherhood journey. Achieving this vision requires uniting key community stakeholders around a shared mission: improving maternal health outcomes through education, empowerment, and partnership.

Currently, our work in Nigeria prioritizes bridging the gap between traditional and modern healthcare systems by promoting capacity-building training for TBAs and community health workers, fostering partnerships with local health facilities, and promoting community awareness on safe pregnancy and postpartum care. By empowering TBAs with the knowledge, tools, and networks they need, we not only honor their cultural significance but also ensure that no woman is left behind when it matters most.

Sources

  • World Health (2025, April 7). Maternal Mortality. WHO Website. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
  • Rutledge J.D., Kiyanda A., Jean-Louis C., Raskin E., Gaillard, J., Maxwell, M., et al. Recommendations for Integrating Traditional Birth Attendants to Improve Maternal Health Outcomes in Low- and Middle-Income International Journal MCH AIDS. 2024; 12:e019. Doi: 10.25259/IJMA_16_2024. 

 

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Biography

Yvonne Akukwe, MPH, PMP is a public health practitioner with almost a decade of experience leading the development and implementation of health projects across corporate, government, and non-profit entities. She studied Biology at George Mason University and obtained a Master of Public Health degree at The George Washington University. Throughout her career, she has successfully led global multi-disciplinary teams to develop strategic, locally driven solutions that drive scalable impact. She is the Co-Founder & CEO of Zinure Women’s Health Foundation, a nonprofit organization determined to improve maternal health outcomes through advocacy, education, and community engagement.