The Birth Attendants (TBA) Program 

In Bangladesh today over 80% of women give birth without the assistance of trained health personnel. In the rural areas this figure rockets to 92%. Deliveries usually occur at home with either no assistance or the assistance of TBAs –Traditional Birth Attendants. TBAs are courageous women who, for usually little or no payment at all, take on the role of supervising deliveries in their areas. They learn their skills from each other and those who have passed on their experience. Unfortunately not all of their well-meaning practices are healthy or useful in the difficult and often dangerous work of delivering newborns.

The Bangladesh Government committed to reduce maternal and child mortality in 2000 as part of its commitment to achieving the Millennium Development Goals. One of the government goals is that all pregnant women will have the support of skilled birth attendants.

The Symbiosis Traditional Birth Attendants Program employs an experienced midwife to train village TBAs in the care of mother and baby before, during and after delivery, improving safety and reducing complications. She has also taught three Trainers to work with TBAs in the districts where they work and live. The work of the midwife and her Trainers in 3 of 12 Symbiosis districts is to increase and improve antenatal care and teach good “risk management”, that is, pre-empting emergencies and recognising situations that require referral before they become life-and-death situations.




Lipi's Story

Lipi is a Symbiosis Community Worker who has been trained by Symbiosis’ TBA Project. Tracing the screams of the laboring mother that she could hear from her home, Lipi set out one night to help. Her knocks on the door of the hut were eventually met with the scowl of the elderly woman who opened it a crack. “We are fine!” she said, but Lipi pushed in, propelled by the memory of her own obstructed labour and stillborn child several years before.

The young girl in labour was lying on the bed, clearly very weak and exhausted, her hair matted with sweat and strewn across her face, confirming Lipi’s suspicion that her hair had been thrust down her throat as helpers often did to trigger the gagging they believed would help her force the  baby out.

“How long?” Lipi asked.

“Three days… but she will deliver here.” The lady at the door swiftly crossed the room and roughly pushed Lipi’s away. But Lipi was not to be deterred. “It is too long. There is a problem. The only chance is if you take her to the Mother and Child Hospital”. This time the lady at the foot of the bed joined in to push Lipi away. “She will deliver normally – here”. Lipi’s own sad experience was backed up by the new knowledge she was learning from Bani, the Symbiosis midwife, and she stood her ground undeterred.

Eventually successful in her persuasion, Lipi’s intervention that night saved the life of the baby boy and perhaps his 17 year old mother as well. The work of the Symbiosis midwife and her trainers is invaluable in bringing new life safely into the world.