Is there a place for traditional midwives in the provision of community-health services?

Traditional midwives (TM) have been involved in delivering babies, and providing a broad range of other services to women, for hundreds of years. They are usually local women with little formal education. As they are well known in their communities they are often called to assist women at the time of delivery. Two opposite views persist about the continuation of their role; some health workers would like to see them trained better and incorporated into the formal health system. Other health workers feel that all deliveries should be attended by either a nurse/midwife or a doctor, and that TM should eventually be phased out. Traditional midwives currently perform > 60% of deliveries in some developing countries and have had their role expanded in some places. Recruiting nurse/midwives and doctors to work in remote areas remains difficult and, even if they were recruited, there is no guarantee that their obstetric services would be used. The evaluation of training programmes has not produced any clear-cut answers in the debate about the long-term role or existence of TM. Rather, the studies have shown that the success of the programmes depends on the resources available, the people involved in the training and how the training is carried out. Some of the lessons learnt from working with TM apply to any two groups of people working together. If TM are going to be offered training, and this must be a local decision made after consultation and an evaluation of prevailing resources and conditions, the training should be a two-way process, with both parties learning from each other.