In the rural areas of Tanzania, traditional birth attendants (TBAs) found themselves in a tough spot. They used to be key players in the fight against maternal and child deaths. But things changed when global health rules shifted their role. Now, they were seen as obstacles to achieving certain health goals. This shift was especially tough during the presidency of John Magufuli (2015-2021). There was a lot of fear around government checks and punishments for not following the rules.

TBAs had to find a way to deal with this pressure. They started saying they only help women get to health facilities for birth. This statement does a couple of things. It hides some of their traditional roles and responsibilities. It also protects them in a system where home births are heavily penalized, but there aren't enough resources in rural health facilities.

So, why did TBAs choose this approach? It's a way to cope with strict policies and resist them at the same time. It's also a way for them to keep their place in the health system. The system is full of confusing rules and policies. TBAs are trying to navigate this complex landscape while still providing care to their communities.

The role of TBAs is more than just escorting women to health facilities. They have a deep understanding of local customs and traditions. They provide emotional support and practical help during childbirth. This is something that modern healthcare systems often overlook. TBAs are trying to balance their traditional roles with the demands of a changing health system.

The situation in rural Tanzania highlights a bigger issue. It shows the tension between traditional practices and modern health policies. It also shows the challenges faced by TBAs in a system that doesn't always support them. The statement "we only escort women" is a way for TBAs to survive in this complex environment.

The government and global health organizations need to recognize the value of TBAs. They need to support them instead of pushing them aside. This could mean providing better training, resources, and integration into the formal health system. It's time to see TBAs as partners, not barriers. This would help improve maternal and child health in rural areas.

TBAs: Between Tradition and Policy in Rural Tanzania

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