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Reprod Health. 2018 Oct 16;15(1):174. doi: 10.1186/s12978-018-0622-4.

"My job is to get pregnant women to the hospital": a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique.

Author information

Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Department of Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
Honorary Fellow, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Maternal and Child Health Program, Burnet Institute, Melbourne, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, USA.



Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage.


This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30-70 and women of reproductive age participated in the study. Data was collected between June-October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11).


The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births.


This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication.


Community; Maternal health; Misoprostol; Mozambique; Post-partum Haemorrhage; Traditional birth attendant

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