TRADITIONAL BIRTH ATTENDANTS AND MATERNAL MORTALITY IN GHANA

Maternal mortality is high in most African countries, particularly in rural areas where access to formal health care is limited. The sociopo litical and economic environment complicates the medical factors direc tly responsible for this high rate. Since the 1970s many African count ries have addressed this problem by training traditional birth attenda nts (TBAs) in health promotion and in the basics of safe delivery and referral. The Danfa Rural Health Project in Ghana has trained and supe rvised TBAs since 1973. It is located relatively close to the health s ervices of the capital city of Accra, providing an ideal environment f or the practice of trained TBAs. Thirty-seven trained TBAs currently p ractice in the area. Most provide patient education and encourage wome n to go to the health center for preventive services. However, many re port routinely performing the high risk deliveries that they have been taught to refer to higher level care and that when they do refer, the ir patients may not go. Reasons for referral refusal frequently cited by TBAs include financial limitation or lack of transportation and the patients fear of disrespectful or painful treatment from medical pers onnel. In the rural environment, the trained TBA's greatest contributi on to lower maternal mortality rates may lie in the area of health pro motion rather than disease intervention.