“She Is My Neighbor": The Persistence of Traditional Birth Attendants in Poor Urban Areas of Cairo

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

As cities become more populated and also more inequitable, ensuring access to quality health services is becoming a critical urban health challenge, in particular addressing the underutilization of facility-based deliveries by urban poor women due to a range of supply-side and demand-side barriers. In Cairo, Egypt, home to one of the largest slum populations in the world, urban poor women continue to rely on traditional birth attendants (TBAs) despite the proximity of health centers. To better understand this phenomenon, the Brussels-based organization Mothers at Risk (MAR) and the Association for the Development and Enhancement of Women (ADEW) in Cairo, partnered to gather qualitative data from two of Cairo’s largest informal settlements. The survey consisted of 22 focus-group discussions with 388 urban poor women and semi-structured interviews with 26 TBAs. The foremost barrier to delivering in a facility, according to the women surveyed, is disrespectful provider-patient interactions and overall poor quality of care, including abuse, neglect and humiliation. In contrast, the TBAs are largely perceived as competent, accessible, caring and culturally and socially sensitive. However, the survey makes evident that TBAs are untrained and unequipped to deal with obstetric emergencies, and most lack the necessary formal links with health facilities to guarantee timely and effective referrals and transfers of the mothers. This creates a dangerous gap in the continuum of care of mother and baby. Targeted interventions to improve patient care at facility-based deliveries are essential to promote the uptake of these services by poor urban women in Cairo. In parallel, TBAs should be trained for new roles in community health promotion and as a bridge between expectant mothers and the health system. Such efforts will contribute to consolidating Egypt’s undisputed progress to reducing maternal mortality and morbidity.