Uganda bans traditional birth attendant services

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The Ugandan government has issued a ban on services provided by Traditional Birth Attendants (TBAs), citing their inadequate skills in managing pregnancy-related complications which have resulted in numerous maternal and newborn deaths.

The enforcement of this ban will include severe consequences for those who continue to offer such services, as the government will hold them accountable for any maternal and newborn fatalities.

This directive, articulated in a letter from Dr. Henry Mwebesa, the Director General of Health Services at the Ministry of Health, was sent to Chief Administrative Officers, Resident District Commissioners, and District Health Officers

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The letter stressed the government’s commitment to ending preventable maternal and newborn deaths by 2030.

It reads: “The government of Uganda, through the Ministry of Health, is committed to ending preventable maternal and newborn deaths by 2030.

“While we appreciate the historical role TBAs have played in assisting pregnant mothers within our communities, their knowledge and skills cannot adequately identify and manage pregnancy-related complications.

“This significantly contributes to negative maternal and newborn health outcomes.

“The purpose of this communication is to request all district leaders nationwide to be part of this campaign aimed at ending preventable maternal and newborn deaths by stopping TBAs from delivering pregnant mothers.”

Mwebesa maintained that TBAs lack the necessary expertise to handle pregnancy-related complications, which often lead to fatal outcomes for mothers and infants.

A recent tragic example involved a mother in Buliisa who died after bleeding for over eight hours under the care of a TBA.

While acknowledging the historical role of TBAs, he pointed out that their current knowledge and skills are insufficient to ensure safe maternal and newborn health outcomes.

The letter further called on district leaders to support the campaign against TBA services and suggested repurposing TBAs as referral agents to direct pregnant women to accredited health centres.

During a regional dialogue on post-abortion care and maternal health organised by IPAS, Dr. Richard Mugahi, who is the Acting Commissioner for Reproductive and Child Health in the Ministry of Health, discussed the challenges posed by TBAs, including the spread of diseases due to inadequate hygiene practices.

“Some of the TBAs are infected and don’t even use gloves and likewise, some mothers are infected and this contributes to the spread of diseases. So, as the government, we are moving to ban them,” he said.

He noted that over 80% of health centre IIIs are now operational, with most of the population able to access health services within a five-kilometre radius.

“We are now over 80 per cent in terms of coverage of health centre IIIs where deliveries are happening. More than 80 per cent of our population can access health services in a distance of less than five kilometres,” he added.

Dr. Angela Akol, Director of IPAS Africa Alliance, pointed out the need to address the underlying reasons why women prefer TBAs, such as negative attitudes and mistreatment in some health facilities.

She argued that previous bans, including one in 2008, failed because they did not address these issues. Dr. Akol suggested that the government must improve the quality and friendliness of health services to gain communities’ trust.

Despite a 2010 ban, many women still rely on Traditional Birth Attendants (TBAs) due to gaps in Uganda’s healthcare system in Uganda.

The country continues to experience high maternal and child mortality rates, with up to 191 deaths daily caused by inadequate healthcare access and a heavy disease burden.

However, Mwebesa underlined notable progress in improving access to quality maternal and newborn healthcare, increasing survivability.

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