Pregnancy and childbirth complications are a leading cause of death and disability among women of reproductive age in developing countries. Worldwide data shows that, by choice or out of necessity, 60 percent of births in the developing world occur outside a health institution and 47 percent are assisted by Traditional Birth Attendants (TBAs), family members, or without any assistance at all. This thesis argues that TBAs in India have the capacity to disseminate knowledge of beneficial maternal practices to the community. Since the 1970s the training of TBAs has been one of the primary single interventions encouraged by World Health Organisation (WHO) to address maternal mortality. However, since the 1990s international funding for TBAs has been reduced and the emphasis has shifted to providing skilled birth attendants for all births due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Researchers have observed that the shift in policy has taken place without adequate evidence of training (in)effectiveness and without an alternative policy in place. This thesis argues further that two main types of birthing knowledge co-exist in India; western biomedicine and traditional knowledge. Feminist, anthropological, and midwifery theorists contend that when two knowledge paradigms exist, western knowledge tends to dominate and claim authority over local ways of knowing. The thesis used such theories, and quantitative and qualitative methods, to assess whether the local TBA training programmes in Ahmednagar District in India have been successful in disseminating biomedical knowledge in relation to the birthing practices of local TBAs and in incorporating local knowledge into the training. The data revealed that some biomedical knowledge had been successfully disseminated and that some traditional practices continue to be practiced in the community. There is a top-down, one-sided imposition of biomedical knowledge on TBAs in the training programme but, at the local level, TBAs and mothers sometimes follow the training instructions and sometime do not, preferring to adapt to the local perceptions and preferences of their community. The thesis reveals the significance of TBA training in the district but queries the effectiveness of not including local TBA practices into the training programmes, arguing this demonstrates the hierarchical authority of biomedicine over local traditional practices. The thesis highlights the significance of community awareness that accompanies TBA training and makes recommendations in order to enhance training outcomes.

Magister Public Health - MPH / This is a cross sectional survey study that explored determinant factors contributing to home child delivery and influence of traditional birth attendances on place of delivery in Rungwe District, Tanzania.The study focussed on three main aspects namely factors (socio-economic, cultural and knowledge) that influence women to deliver at health facilities and those who deliver ta home. Reasons/factors associated with the acceptability of health services and influence of traditional birth attendaces on place of delivery and whether accessibility to health services and traditional birth attendants influence women to decide the place of delivery. The study was descriptive cross-sectional in nature where a multistage random sampling procedure was used to select 8 wards and 16 villages. A systematic sampling was used to determine household interval in each village. Only one woman with at least one child was chosen in a household using a random sampling. In case of the absence of a woman with at least one child in a house falling in the interval, then the next house was considered. A total of 400 women with at least one child were selected at random from household cluster sample from all four divisions in Rungwe district. They were interviewed using semi-structured questionnaire. The participation rate was 100 % in both divisions. The age of the women ranged from 19-49 years with the mean age of 31 years (Std dev 7.5). Data entry and analysis were done using the quantitative statistics with Epi Info 2002 software. Results were presented using descriptive statistics, figures and tables, and analytical statistics, using Student’s t-test and chi-square. A total of 400 women were interviewed, among them, it showed that there were good attendance for antenatal care 395 (98.75%) and only 5 (1.25%) did not attend antenatal care. However, 243 (60.8%) of women interviewed had incidence of home delivery and 157 (39.3%) had incidence of health facility delivery. Home deliveries in a surveyed area are commonly assisted by unskilled persons, and consequently carry increased risks to the mother and to the new-born baby. Improvement of quality and accessibility of health care services by the health facility should involve harmonic balance between health service provider and beneficiaries in order to change the attitude towards minimizing the practice of home child delivery in Rungwe district, in Mbeya region, in Tanzania as awhole and elsewhere in the world.