The traditional birth attendant: a reality and a challenge.

The traditional birth attendant (TBA) is an institution as old as the birthing process in the human species. Generally a female, in the absence of a better alternative, continues to deliver two thirds of the world's babies. A number of studies generated international interest in training TBAs. A review of TBA training and utilization programs in more than 70 countries over the past three decades revealed that there are very limited examples of their successful utilization. If unsupervised the TBA tends to slide back into her old ways and if unsupported she is rendered helpless when a killer strikes during child birth. The impact of trained TBAs on maternal mortality ratios is not palpable because of other factors such as accessibility of essential obstetric services. The challenge for the policy makers is to make the best use of this available human resource but simultaneously plan and implement a definite replacement strategy.