There was in interesting editorial in the Ghanaian Chronicle this morning (yes, I read these things), which quotes a public health nurse from the Cape Coast Region in Ghana that argues that Traditional Birth Attendants are the cause of high levels of maternal mortality in the country. I speculate a bit, but the crux of her argument is that their presence gives false hope to expectant mothers, making them feel like they are in good hands, but in fact if anything were to go wrong, the TBA would be unable to help them. Because the TBA is available, then they don’t go to a clinic.

The argument made is a controversial one…the problem in trying to evaluate it is what is the counterfactual situation for most poor rural women? In the absence of a TBA, would they be better off? Would the Ghana Health Service be more likely to provide services to her area? Would she be more likely to seek out services? Do they really add no value? Hard to say.

For those interested in this question, I’ll throw out two articles. The first, which suffers from some very significant methodological issues, argues that training of TBAs is not helpful. The second, a randomized experiment in Pakistan (one of the few such experimental research designs), argues that training can have a big impact. Of course, this last study looks only at the effect conditional on having chosen to invest in TBAs. This is a great area for future research.

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