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Effect of Shifting Policies on Traditional Birth Attendant Training


  • Sue Kruske CNM,

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    • Sue Kruske, CNM, B Hlth (Hons), is a nurse-midwife, currently undertaking her PhD at the University of Technology, Sydney. Her area of interest is improving health services for marginalized groups through improving the health professionals' acknowledgment and respect of different worldviews.

  • Lesley Barclay CNM, PhD

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    • Lesley Barclay, CNM, PhD, is Professor and Director of the Centre for Health Services Development at the Charles Darwin University and has extensive experience in research, technical advice, and health consultancies in Asia and the South Pacific.

Centre for Health Services Development, Charles Darwin University, Casuarina Campus, Casuarina, NT 0909, Australia. E-mail:


Traditional birth attendant (TBA) training commenced in many places in the non-Western world in the 1970s, supported by the World Health Organization and other funding bodies. By 1997, senior policy makers decided to refocus priorities on the provision of “skilled attendants” to assist birthing women. The definition of skilled attendants excluded TBAs and resulted in the subsequent withdrawal of funding for TBA training globally. A review of the health and sociological literature and international policy documents that address TBA training revealed how international policy and professional orientation are reflected in education programs designed for the TBA. Policy makers risk ignoring the important cultural and social roles TBAs fulfill in their local communities and fail to recognize the barriers to the provision of skilled care. The provision of skilled attendants for all birthing women cannot occur in isolation from TBAs who in themselves are also highly skilled. This article argues a legitimacy of alternative worldviews and acknowledges the contribution TBAs make to childbearing women across the world.