Traditional Birth Attendants and the State: the mediating effect of Evidence Informed Policy Making (EIPM) on maternal health policy in Uganda

• In Event: STS Africa: Biomedicine

Abstract

The arrival and rise to dominance of allopathic care in the colonies entailed the denigration of indigenous healing systems, branding them as ineffective and anachronistic. Conversely, many rural and remote areas remained outside the structures and reach of formal healthcare systems. During the postcolonial era, collaborative partnerships with indigenous healers were sought in order to reach remote rural peoples. By the 1950s, the World Health Organization (WHO) together with national governments had set up collaborations with a group of healers, who became universally categorised as ‘traditional birth attendants (TBAs)’ assisting in the delivery of maternity care. By the 1990s – coinciding with the rise of the evidence-based medicine and policymaking (EIPM for short), there was growing concern that the integration of TBAs was not achieving the desired outcomes in reducing maternal mortality rates. This led to the promotion of a new category, ‘skilled birth attendants (SBA)’ – defined to exclude TBAs. With this shift, TBA services were discouraged, banned and even criminalised. Yet despite the issuance of threats of arrest, our ethnography in Luwero, Uganda, observed the syncretic, and yet secretive utilisation of both TBAs and formal care amongst the community. TBAs were always an artificial category created to service biomedical interventions; designated practitioners did not identify with it, nor did they legitimate their practices through it. Consequently, TBAs remain a statistical anomaly that is difficult to organise, account for and govern - they do not map onto the processes of EIPM. However, their persistent use by communities brings to light the uneven and ambiguous relationship between global health science and policymaking and the health care needs and practices of targeted communities.

Author

• Emmanueil Benon Turinawe, Makerere University, College of Humanities and Social Sciences