IFGH 2012: Barriers Faced by Community Skilled Birth Attendants to Conduct Deliveries at Home

January 29, 2012


Authors:Khan R., Bilkis S., Blum LS., Nahar Q., Streatfield PK.

Author Affiliations: International Centre for Diarrheal Disease Research, Bangladesh (ICDDR, B)

Option 1– Scientific / Empirical Research Findings Presented as – Poster (unable to present)


Historically, there has been a strong preference for home births with traditional attendants in Bangladesh. Different initiatives have been undertaken by the government of Bangladesh to increase delivery with skilled birth attendance, which is presently at 27% as shown by a recent nationwide survey. A community skilled birth attendant (CSBA) program was launched in 2004 to create a cadre of trained birth attendants to be stationed throughout the country to perform home deliveries and refer women with complications to emergency care facilities. Efforts have focused on training of existing paramedics on birthing techniques.


Nationwide survey (BMMS, 2011), a qualitative assessment was done to understand the role of the CSBAs. Semi- structured interviews were also carried out.


Hardly any differences were noticed in terms of assisting deliveries between the CSBAs who are performing for long time or short time. CSBAs who are relatively new mostly do not live in their service areas. In general, community members still prefer TBAs over the CSBs to conduct deliveries, who are often known and have extensive experience. However, often when the TBA is unable to perform delivery, either TBA or families seek CSBAs’ assistance. Much claimed that nobody supervises the CSBA activities and they are not accountable either to anybody regarding the number of deliveries they are supposed to conduct. Instead, CSBAs who perform a high number of deliveries are often criticized by their management for being more involved in deliveries.


To achieve the goal of CSBA program and too see the impact of it in maternal health, programmers and policy makers should rethink regarding the program. It is important to redefine the responsibilities of CSBA which may require a different cadre and ensure proper monitoring and supervision.



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