Experiences and beliefs of Malawian women who have delivered with a traditional birth attendant.

OBJECTIVE: To explore the beliefs and experiences of Malawian women who have delivered with a traditional birth attendant (TBA). METHODS: In a qualitative study, 20 face-to-face in-depth interviews and three focus group discussions were conducted between February and May 2013. Women aged 18 years or older and who had a history of delivery with a TBA were recruited from three health centers in Lilongwe District. Their responses were independently coded, and content analysis was used to develop themes and subthemes. RESULTS: A total of 46 women participated. Most participants cited difficulties relating to transport and/or unsupportive or unavailable husbands as factors that prohibited their delivery at a health facility. Most had not had a specific delivery plan. The participant responses indicated a discordance between knowledge and practices for safe delivery. CONCLUSION: Strategies to decrease deliveries with TBAs should focus on helping women to develop delivery plans to cope with the potential social or situational obstacles of getting to a facility. Women desire health facilities that provide quality care, emotional support, and personalized care during labor and delivery.

Evaluating the benefits of incorporating traditional birth attendants in HIV prevention of mother to child transmission service delivery in Lilongwe, Malawi.

The objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman's arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities.