Chapter 1: Introduction and literature review
Chapter One has provided the background of the dissertation, the history of traditional birth attendants and the practices they offer to women. The chapter describes the research problem and questions, theoretical framework, and provides a summary of the chapters. The chapter also presents a literature review to validate, evaluate and argue the findings of the present study.
The literature covers international, national and provincial studies that have focused on TBAs and the role that they play within their communities to support and analyse responses and to better understand cultural groups and their conceptualisation and meanings attached to pregnancy and the health seeking behaviour of pregnant women. The chapter discusses the background of TBAs and the role that they have played in reproductive health care in developing countries, the traditionally based practices and rituals they offer and the worldview of the women that they offer them to. The chapter discusses traditional practices that have had to change in the last decade as a result of the encroaching western health care system that regards their traditionally based knowledge and practices as backward and unsafe. The chapter explores the responses of TBAs when assisting peri-urban African women who appear to be resistant to their traditional based knowledge and practices or show low adherence. Finally, the chapter mentions areas of possible conflict between the traditionally based approaches to reproductive health care and the so-called western approaches practised in clinics and hospitals.
Chapter 2: Research methodology
Chapter Two describes the research design and methodology of this study. The chapter outlines in detail the process and use of life histories which were used to gather a range of data. The chapter explains the analysis, coding and interpretation of the data, as well as the process of choosing the population of the sample. The ethical considerations and challenges faced by the researcher during the research will be discussed, including the process of gaining permission into gated communities and the importance of following protocols.
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Chapter 3: Journey to becoming traditional birth attendants
Chapter Three presents a thick description of the background of the participating TBAs. It provides insight into their motivation for becoming TBAs and their journeys to start and become practising TBAs. The chapter demonstrates the journey through ubizo explaining what led them to realise that they were called to become traditional healers, the training they received and how they were influenced to go back to their communities to assist and heal people, especially pregnant women. The chapter gives a thick description of the lives of TBAs, their life experiences as traditional healers and how they see and feel about their journeys and selection by the ancestors to become healers. The chapter works through the life stories of the TBAs and considers their role in society which has broken gender roles through the taking on of previously male-dominated roles such as leading rituals, communicating with the ancestors, assisting during the birthing process and conflict resolution among families.
Chapter 4: Traditional practices offered by traditional birth attendants to pregnant women Chapter Four discusses the traditional practices that the TBAs have learned through their various training methods. The chapter gives a thick description of the practices and their efficacy during pregnancy and how they are contributing to the lives of women who believe in them and those that attend TBAs. The chapter describes the health seeking behaviour of women during pregnancy and their reasons for selecting the health care systems they used when pregnant. It also focuses on the reasons why some women still prefer the assistance of TBAs as opposed to health care facilities with trained medical personnel that are considered ‘safe’.
The encroachment into traditional medicine by western medicine has meant that the practices, and knowledge of the TBAs has had to change so to meet the ‘safe’ standards of the western scientific practices. The chapter considers these changing practices that are required of TBAs.
Chapter 5: Traditional birth attendants’ responses to the attitudes and views of peri-urban women regarding their services
Chapter Five discusses the responses of TBAs towards peri-urban African women who appear to be resistant to their traditional based practices or show low adherence to their advice. The chapter also looks into the perceptions of and attitudes of 15 African (five rural, five peri-urban, five urban) women towards the practices and rituals that TBAs offer, their preferences for the health care systems they select during their pregnancies and the driving force behind those preferences.
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Chapter 6: Conflict between the traditional and western approaches to reproductive health Chapter Six discusses the areas of possible conflict between the traditional approaches to reproductive health and the so-called western methods practised in clinics and hospitals. The chapter discusses the attitudes of both TBAs and medical personnel towards each other and their practices. It considers the opinions of the TBAs as their traditionally based practices are seen as backward and unsafe and as they are forcefully being introduced to new systems regarded as scientifically proven to be safer than those of the TBAs. The chapter also discusses the possible solutions that TBAs and medical personnel feel may address the challenges within the reproductive health care system. Discussions around the inclusion of TBAs within the reproductive health care systems are also included.
Chapter 7: Conclusion and recommendations
The final chapter offers a summary of the findings of the present study and notes important contributions of this research. The chapter also offers suggestions for further research on TBAs and the contribution of their practices in reproductive health care in South Africa which may have an influence on policy formulation and the development of the reproductive health care system in the country.
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