Solving delayed referrals of childbirth cases from unskilled to skilled birth attendants in Nigerian urban communities: A case study exploration of new frontiers

Delayed referrals of women from untrained traditional birth attendants (TBAs) to formally trained health personnel in primary healthcare centres and hospitals contribute to maternal and child mortality in Nigeria. Reasons for these delays could be shaped by beliefs and practices that are not obviously apparent. This study delved deeper than the often cited reasons of health system inefficiencies, to look at the unexplored causes of delayed referrals.

Using a case study approach, the team found four overlapping issues causing, and reinforcing delayed referrals: (a) TBAs in high demand and considered more experienced because they conduct more volume of childbirths (b) spiritual description of pregnancy by clients and TBAs (c) fear of diabolic tendencies of some TBAs by clients, and (d) income of TBAs rely on the duration of the childbirth process and not necessarily the outcome.

Addressing delayed referrals caused by TBAs is therefore beyond regular health system structural factors that are amenable to capacity building and resource-based interventions, and other approaches should be considered.

Read the full article here: Solving delayed referrals of childbirth cases from unskilled to skilled birth attendants in Nigerian urban communities: A case study exploration of new frontiers

Prince Agwu, Francis Poitier, Chinyere Mbachu, Obinna Onwujekwe; Midwifery, Volume 146, 2025, 104397, ISSN 0266-6138,