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.
| Identifer | oai:union.ndltd.org:ADTP/265804 |
| Date | January 2008 |
| Creators | Saravanan, Sheela |
| Publisher | Queensland University of Technology |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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