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Are traditional birth attendants good for improving maternal and perinatal health? Yes

BMJ 2011; 342 doi: (Published 14 June 2011) Cite this as: BMJ 2011;342:d3310
  1. Joseph Ana, former commissioner for health, Cross River State, Nigeria
  1. 1Calabar, Nigeria
  1. jneana{at}

Joseph Ana argues that the shortage of skilled health workers means traditional birth attendants have a valuable place, but Kelsey A Harrison (doi:10.1136/bmj.d3308) believes they do more harm than good

The use of traditional birth attendants has generated a lot of heated debate over the decades, especially among health professionals. But the facts strongly support their use.

All over Africa, governments are introducing (or announcing) free healthcare for pregnant women and children under 5 years in the rush to meet the United Nation’s millennium development goals on reducing maternal and child mortality. Maternal mortality in sub-Saharan African countries varies widely, ranging from 800 to 2500 per 100 000 live births. Infant mortality ranges from 100 to 150 per 1000. Surely, all trained health hands must be on deck to deal with this emergency, including the hands of trained and monitored traditional birth attendants? Not to do so is unethical.

The causes of the poor health outcome for pregnant women and children are many, but the most important reason is the severe shortage of trained and skilled health workers. In some countries fewer than 20% of births are attended by skilled health workers.1 The problem is worsened by health …

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