Conference validates contribution of traditional birth attendants

The University of KwaZulu-Natal (UKZN), in partnership with the Department of Higher Education, Science and Technology (DHEST), hosted the first-of-its-kind conference on the critical role played by traditional midwives, known as Traditional Birth Attendants (TBAs). It drew TBAs from communities around the country and representatives from various developing countries.

The two-day conference, held in the first week of June, was themed Restoring African Dignity through Traditional Birth Attendants. The aim was to pave the way for "mapping the knowledge and skills of TBAs, and for developing norms and standards against which their competencies can be assessed, thereby contributing to the formal recognition of the discipline". This follows requests from TBAs to the government to formally recognise their work.

According to the DHEST, while the majority of births in SA take place in hospitals, traditional birth attendance continues to play a significant role in the lives of many rural communities, and forms an important part of indigenous knowledge-based sexual and reproductive healthcare systems. Despite this, the practice continues to suffer widespread marginalisation.

The conference offered TBAs from around the country an opportunity to share knowledge, skills and experience regarding the challenges they face in carrying out their work, and to protect, promote and develop indigenous knowledge systems.

The DHEST is the custodian of the protection, promotion, development and management of the Indigenous Knowledge Bill, which is expected to be enacted by the sixth Parliament. It aims to protect, archive and develop SA's vast storage of indigenous knowledge.

In her welcome address, Professor Busisiwe Ncama, the deputy vice-chancellor and head of the UKZN's College of Health Sciences, said the role of TBAs cannot be over-emphasised as they provide basic healthcare, support and advice to pregnant women in their communities, especially in rural and remote areas where health services are under-resourced. She added that they bring with them rich knowledge and years of experience gained from their ancestors.

Ncama commended the DHEST and the university's Centre in Indigenous Knowledge Systems (CIKS) for organising the conference and for challenging the marginalisation of TBAs.

Challenges raised by TBAs included the shortage or delay of ambulances as some call centres take long to respond; a lack of supplies and resources; the ill-treatment they suffer at the hands of health workers when they take the mother and baby to hospital after the birth; and lack of compensation for their work.

The rise in teenage pregnancies is another reason a number of young people are giving birth at home, as they are either too embarrassed to visit health clinics or want to hide the pregnancy from their parents.

Dr Mlungisi Cele from the DHEST thanked the TBAs for being part of the conversation, and for their commitment and dedication to their work. He noted that many communities still rely on indigenous knowledge system methods to survive, and that TBAs in rural areas and informal settlements are part of that knowledge.

Cele added that the conference would, hopefully, assist in ensuring that TBAs were formally and professionally recognised, like nurses and doctors, and that this depended on all stakeholders working together. He said the department would continue to monitor the implementation of the agreed norms and standards that were finalised at the conference.

Dr Andrea Mason, from the Harmonic Connection Plus Institute in the USA, spoke about reclaiming and embracing the knowledge of TBAs and of African practices in the diaspora. She praised TBAs for holding on to tradition and observed that African-American traditional midwives had been stripped of their culture and family traditions. She said that while legislation is important, holding on to traditions and protecting indigenous knowledge systems is just as significant.

Olive Tengera, from the School of Nursing and Midwifery at the University of Rwanda, looked at the challenges and prospects for TBA education in African higher education. She said the lack of support, as well as the lack of other resources, were some of the challenges faced by TBAs in Rwanda. She noted the need for linkages between TBAs and the health system, and for countries to get together to share best practices.

Regarding the way forward, the DHEST will consolidate the challenges noted during the conference and facilitate the discussion with other partner departments.

Given that the norms and standards were validated during the conference, the DHEST will continue to launch the Recognition of Prior Learning pilot process in KwaZulu-Natal. In addition, the finalisation of the norms and standards in all provinces will continue, noting the budgetary constraints.

Words: Sithembile Shabangu