Solving delayed referrals of childbirth cases from unskilled to skilled birth attendants in Nigerian urban communities: A case study exploration of new frontiers
Year: 2025
Type: article
Abstract: PROBLEM: Delayed referrals of women from untrained traditional birth attendants (TBAs) to formally trained health personnel in primary healthcare centers and hospitals contribute to maternal and child mortality in Nigeria. BACKGROUND: Reasons for delayed referrals by TBAs could be shaped by personal beliefs and diabolical practices, which are not apparent. AIM: Our study went beyond the usual rhetoric of health systems inefficiencies alongside economic and educational deficits as responsible for delayed referrals to underscore other unexplored nuances. METHODS: Data were collected using a case study approach via in-depth iterative interviews with service users, TBAs, and primary healthcare workers. FINDINGS: Four overlapping issues caused and reinforced delayed referrals: (a) TBAs in high demand and considered more experienced because they conduct more volume of childbirths (b) spiritual description of pregnancy by clients and TBAs (c) fear of diabolic tendencies of some TBAs by clients, and (d) income of TBAs rely on the duration of the childbirth process and not necessarily the outcome. DISCUSSION: Therefore, addressing delayed referrals caused by TBAs is beyond regular health system structural factors that are amenable to capacity building and resource-based interventions. CONCLUSION: Incentives and sanctions targeting identified nuanced subjectivities, including spiritism in the practices of TBAs that have shaped their relationships with pregnant mothers, should be considered by governance and health promotional interventions.
Source: Midwifery
Institutions: University of Nigeria, University of Dundee
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,630
Award: G6699072367
OpenAlex ID: W4408836946