Traditional birth attendants in Bangladeshi villages: cultural and sociologic factors

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Abstract
World Health Organization policy for some years has emphasized working through traditional birth attendants as the best path to improving the appalling level of maternal and child mortality and illness in much of the Third World. The universal appropriateness of this strategy has begun to be called into question. Recent research on childbirth in rural Bangladesh, as elsewhere in South Asia, suggests that the concept of the 'traditional birth attendant' in the context of this region needs to be reexamined. The dai typically have tittle training and low status, due to their close association with the removal of birth pollution. A policy based on converting them into modern health professionals faces serious obstacles. In practice, neither the poorly-trained village dai nor such biomedically-trained practitioners as are available at the village level are able to deliver competent health care. Their effectiveness is further compromised by the cultural and material environment within which they operate. A more adequate approach to care for birthing women in the village still has to be developed.