This masters thesis presents the stories of Doña Eugdocia and Doña Carmen: two parteras empíricas living and working in the area of Estelí, Nicaragua. The stories were constructed from interviews with the parteras empíricas and are influenced by testimonial life history research methods. The stories, complemented by interviews with Traditional Birth Attendant (TBA) trainers, locally available training manuals, and interviews with other parteras empíricas function as a counter-narrative to global (TBA) discourse revealing the important but little understood contributions these women make to their respective communities and health care systems. The stories demonstrate important parallels between the parteras empíricas narrowing role in Nicaragua and global TBA discourse regarding their practices. The stories also dispel the notion of the traditional as signifying incapable of change. Instead, considering the parteras empíricas story within a postcolonial framework using Jordans (an anthropologist) conceptualization of authoritative knowledge demonstrates that the parteras empíricas positioning of biomedicine as authoritative is a survival mechanism and not a devaluation of their own epistemological orientations.

This masters thesis presents the stories of Doña Eugdocia and Doña Carmen: two parteras empíricas living and working in the area of Estelí, Nicaragua. The stories were constructed from interviews with the parteras empíricas and are influenced by testimonial life history research methods. The stories, complemented by interviews with Traditional Birth Attendant (TBA) trainers, locally available training manuals, and interviews with other parteras empíricas function as a counter-narrative to global (TBA) discourse revealing the important but little understood contributions these women make to their respective communities and health care systems. The stories demonstrate important parallels between the parteras empíricas narrowing role in Nicaragua and global TBA discourse regarding their practices. The stories also dispel the notion of the traditional as signifying incapable of change. Instead, considering the parteras empíricas story within a postcolonial framework using Jordans (an anthropologist) conceptualization of authoritative knowledge demonstrates that the parteras empíricas positioning of biomedicine as authoritative is a survival mechanism and not a devaluation of their own epistemological orientations.

In this thesis, I describe how women who are forced to migrate from Burma into Thailand manage their fertility, unwanted pregnancy and pregnancy loss. The study was initiated by Dr Cynthia Maung, a Burmese medical doctor, herself a stateless person who coordinates a refugee-led primary health service five kilometres inside Thailand. Unsafe abortion is a common problem and much time and resources are taken with the care of women suffering haemorrhage, infection and pain after self-induced abortion in both Thai and Burmese-led health facilities. The thesis examines the characteristics of Burmese women admitted to health facilities with post-abortion complications and their chosen methods of self-induced abortion. Local meanings of abortion and post-abortion care are explored. Lay midwives play a central role in fertility management and some are abortionists. Men’s role in the management of fertility is also presented. The women are generally married with children. Considered illegal migrants, they are employed and work in Thailand without work permits. Many women have a history of escaping human rights abuses and entrenched poverty in Burma. At least a third of women admitted into care with post-abortion complications had induced their abortion with oral herbal preparations, pummelling manipulations or stick abortions. Most of the abortion services were provided by Burmese lay midwives. Reasons for terminating the pregnancy include: poverty, gender-based violence and the local illness of ‘weakness’. In addition, low sexual health knowledge, and difficult access to reproductive health services play a part in mistimed pregnancy. / There is no commonly agreed definition of abortion between formal, informal health workers or women. Most people considered it against cultural lore and in some cases judicial law but still felt it was necessary. Women’s perceptions of the viability of their pregnancy and its outcome prevailed. Men played a limited role in fertility management. I argue that a lack of rights to work and earn a fair wage; to move without fear, a lack of sexual health information, and the ability to safely control fertility increases women’s risk of unsafe abortion. Furthermore, violence perpetrated at the individual and state level contributes to unsafe abortion. Burmese women’s mortality and morbidity associated with unsafe abortion is largely unrecorded by Thai processes and unknown to the Burmese military government. Unwanted and mistimed pregnancy can be avoided through reproductive technologies, education programmes, and access to modern contraceptives. To safely terminate unwanted pregnancies and to treat the complications of pregnancy loss is not only possible but a woman’s right as delineated in the international treaty CEDAW, to which Burma and Thailand are signatories. Yet Burmese women continue to suffer: become sterile, socially vilified, unemployed or repatriated against their will due to their reproductive status. Their sickness and deaths are secondary to the economic imperatives of Burma and Thailand and their human rights continue to be violated.....

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account. / Advanced Nursing Science / D.Lit. et Phil.

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account. / Advanced Nursing Science / D.Lit. et Phil.

Maternal deaths in Ethiopia are mainly due to complications of pregnancy and delivery. The socio-cultural contexts under which these pregnancies and deliveries occur that pave the way for these complications and mortality. In Ethiopia, the maternal mortality ratio had been 353/100,000 live births in 2015. Therefore, the purposes of this study were to examine, and describe the socio-cultural determinants and missed opportunities of maternal health care in Eastern Ethiopia. The study was conducted in selected districts of Grawa, Chelenko and Haramaya Woreda, East Hararghe, Oromia National Regional State, Ethiopia. A community-based survey involving pregnant women in their third trimester and women who gave birth in the last five years, husbands, mothers-in-law, sisters-in-law, health workers, religious and community leaders were conducted between September up to December 2017. A systematic sampling technique was used to get a total of 422 study participants for quantitative and 24 FGD participants to qualitative study were adopted using triangulation of data collection. Pre-tested and structured questionnaire was used to collect relevant data. The main instrument used for quantitative data collection was the structured questionnaire, specifically in-depth interview methods. Bivariate and Multivariate data analysis were performed using SPSS version 25.0 and focus group discussion (FGD) was used to collect qualitative information and the information was analysed using thematic analysis method based on Atlas.ti version 8.2 statistical software packages. The study revealed that among 359 (85%) pregnant women who planned for ANC visit, 16 (4.5%) received ANC four or more times during their last pregnancies, the respondents (81.3%) claimed that they were taken care of by skilled delivery attendant during delivery, 18.5% of them said that they delivered at home and 71.1% of them received medical care after delivery (missed opportunity). Women in the age group 15-24 years [AOR: 1.18, 95%CI: 1.18 (0.37, 3.74)], primary school [AOR: 4.09, 95%CI: 4.09(0.96, 15.50)], women intended their last pregnancy [AOR: 3.1, 95% CI: 0.32(0.11, 0.94)], and women living in urban residences [AOR: 1.2, 95%CI: 0.86(0.25, 2.95)] were significant predictors of unplanned home delivery. For optimal and effective interventions of maternal health services utilization, provisions should be made for better women‘s education, family planning, community-based health insurance, health facilities access, job opportunity and women empowerment; provisions should also be made for creating income generating activities to women. Strengthening village women‘s army wing, refreshing and enabling health extension workers and traditional birth attendants. What is more, optimal measures should be taken to discourage traditional practices such as female genital mutilation, polygamy, violence against women and teenage marriage. Finally, free maternal and child health services should be advocated for so that the gap in maternal healthcare services is bridged. / Health Studies / D. Litt. et Phil. (Health Studies)

Traditional Birth Attendants (TBAs) are the primary health care providers for women at the time of childbirth in many parts of the world. In India, particularly in remote areas such as Garhwal, these women play a key role in maternal health. Training programmes for TBAs can lead to dramatic reductions in neonatal mortality as well as in maternal morbidity and mortality, due to improved hygienic practices at the time of delivery. Yet training programmes for TBAs often lack sociocultural relevance, and fail to incorporate an understanding of the TBAs' perceptions of the process of pregnancy and delivery. Understanding more about the role of the TBA as a diagnostician and a decision-maker within a given sociocultural context can make such training programmes more culturally congruent. This research report describes the way in which TBAs (dais) in Garhwal interpret obstetrical complications, and how they make decisions regarding the need for cosmopolitan medical care. TBAs in Garhwal interpret obstetrical complications using a variety of explanatory models, arising from an understanding of health and illness which shows influences of Vedic, Ayurvedic, folk and cosmopolitan medical models. These explanatory models often led to a perception of "danger” and the "dangerous case" which is widely divergent from the cosmopolitan medical model. Specific areas are identified where the dais' interpretation of "danger" was particularly divergent from the cosmopolitan medical model. These areas of conceptual conflict result in diagnoses and treatment procedures which can lead to significant delays in the woman receiving needed cosmopolitan medical care. The third stage of action-research process is the development of a participatory training programme, in which the TBA is an active participant. The aim of the training programme is to move towards a shared perception of risk regarding major obstetrical complications. / Thesis / Master of Arts (MA)

Infant mortality (IM) incidence in health facility systems during or after infant delivery is substantially high in Nigeria. In this quantitative, cross-sectional study, the effects of skill birth attendants (SBAs), prenatal care, and providers of prenatal care on IM in health facility delivery centers were examined. The Mosley and Chen theoretical framework informed this study and was used to explain the relationship between SBAs, prenatal care, and providers of prenatal care and IM. One hundred and sixty infant deaths were examined among mothers who used an SBA versus those who did not, mothers who had prenatal care versus those without, and mothers who received prenatal care from a health facility versus traditional providers. The 2014 verbal and social autopsy secondary data set was analyzed using binary logistic regression technique. There was no significant difference in risk of IM between mothers who had SBA during infant delivery in health facility compared to those without SBA during delivery. Mothers who received prenatal care had a significant higher risk of infant death in a health facility compared to those that did not receive prenatal care. Mothers who received prenatal care from traditional providers did not have a statistically significant risk of IM compared to mothers who received prenatal care from a health facility. The findings could have positive social change implications by encouraging multilevel public health stakeholders to support and promote the use of health surveillance in understanding the barriers and challenges of health facility delivery practices, prenatal care, and use of SBA as it relates to IM to facilitate policy change in maternal and infant care practices in Nigeria.

The registered midwives are engaged in continuous health education lessons In antenatal visits, discouraging antenatal clients from using hannful traditional and cultural practices in an attempt to preserve pregnancy to tenn. Despite the registered midwives' efforts, the clients continue to use hannful cultural methods, which are life-threatening to both the mother and the foetus In utero. The prenatal clients perceive the registered midwives as not being sensitive to their culture. The results of this study revealed that health education in antenatal clinics should be collaborative: that is, the people who have influence over the clients' pregnancy, like me mother-in-law, the traditional practitioners, cUents and their family members, should be involved by the midwives during the preparation of pregnancy lessons and health education lessons on how to preserve pregnancy to term according to· scientifically proven methods. / Health Studies / M.A. (Health Studies)

The purpose of this study was to analyse and describe the factors that influence the choice of site of delivery by pregnant women in Mukono district. By employing quantitative, non experimental research methods, 431 women were interviewed by using structured questionnaires. These women had either delivered at; home, TBA, private or public clinic and 72% had been delivered by skilled attendants. Choice of delivery site was influenced by the attitudes of health workers which were rather poor in public sites, proximity of site, attendance of antenatal clinic at a site, availability of supplies and drugs, plus level of care including emergency obstetric care. / Health Studies / M. A. (Public Health)