The traditional birth attendant versus the hospital : a study of the factors which contribute to the choices made by pregnant women in obstetric services utilization in Port-Harcourt, Nigeria

High maternal mortality rates in developing countries have been of great concern. For over two decades WHO has encouraged member countries to train their traditional birth attendants (TBAs). This process has produced some results but has not reduced the high maternal mortality rates in view of current figures published by WHO and UNICEF. The unorthodox methods of obstetric practice by TBAs are deemed dangerous by the medical profession but their services continue to be utilized by women in the Third World. Health services utilization may be influenced by the structure of the health care system, the behaviour or perceptions of health care providers as well as the actions of potential patients. This research presents patterns of patronage and perceptions of women and care providers regarding the utilization of obstetric services in Nigeria and the city of Port-Harcourt specifically. The 1990 Nigeria Demographic and Health Survey was analyzed. In addition 700 hundred women, five obstetricians, five nurse/midwives and five TBAs from five zones of Port-Harcourt were interviewed. Reasons given for TBA patronage are; "massage", normal delivery, "affective behaviour", and flexible modes of payments. TBAs maintain that their good services advertise them with references from previous patients to new ones. The only compounding problem all TBAs acknowledge to have was one of inadequate accommodation.The study thus confirmed the continued usage of TBA services as primary health care providers. The present high maternal mortality rates in Nigeria may not be unrelated to this pattern of use. This raises questions regarding the adequacy of the approach by international health organisations regarding the solution being in TBA training per se. There should be a change of focus from the TBA to the mode and adequacy of modern health services provision at least in Nigeria.