Training urban traditional birth attendants: Balancing international policy and local reality : Preliminary evidence from the slums of India on the attitudes and practice of clients and practitioners

This paper reviews the development of an international policy to train traditional birth attendants. The paper discusses the need for adaptation of this policy to the local circumstances. The discussion starts with an introduction to urban health in developing countries and the effects of urbanization on women. Slum improvement is discussed as a means of upgrading women's health. This is followed by a case study of urban TBAs in a slum improvement project in Visakhapatnam, Andhra Pradesh, India. The importance of understanding the local perspective and context of the TBA and her client is discussed. Conclusions and areas for further research focus on the need to improve the professional status of TBAs in the context of diverse high technology options in urban areas and the need to ensure that the economic autonomy of the TBA is not jeopardized by her training and association with allopathic services.