Undergraduate Honors Theses

Thesis Defended

Spring 2011

Document Type



International Affairs

First Advisor

Dr. Melinda Cain


Currently Uganda has one of the highest maternal mortality rates in the world at 550 deaths per 100,000 births. Many different factors combine to create this health situation including poverty, common misconceptions about delivery and family planning, cultural and social factors, and traditional birth attendants (TBAs). Much is known about the clinical and structural factors influencing this high maternal mortality, but less is known about the influence of tradition, culture, and TBAs. The main objective of this study was to examine the factors influencing maternal mortality to determine the key factor. More specifically, the study aimed to determine the impact of traditional beliefs and TBAs on women’s health and health-seeking behavior. Thaddeus and Maine’s three phases of delay were used to ground the research and interpret the data results in terms of factors delaying women from seeking and utilizing health care services. The area of study was the Nyakayojo sub-county in Mbarara District, Uganda. The main methods used were semi-structured interviews with women, local leaders, experts in the field of public health and medicine, health workers, and traditional birth attendants; and two focus group discussions held with traditional birth attendants. The study found that structural factors such as lack of transportation and poverty greatly influence the ability and decisions of women to access a health center. Common misconceptions surrounding the perceived complications of family planning cause large family sizes and also put women at a greater risk of mortality and morbidity. Many women also believed that going to the hospital is for those with complications and that there is no need to deliver in a health center if a woman has had a normal pregnancy or good deliveries in the past. There are also many cultural beliefs such as bravery associated with home deliveries and the lowered status of women in the society that pose challenges to improving maternal health. TBAs are still helping women to deliver in the villages and are playing an important role in the health of many mothers, giving good care to women. Deliveries with TBAs can pose risks, but the most dangerous deliveries occur at home with a close relative or without any assistance. The persistence of home deliveries poses the reatest challenge to changing the maternal mortality rate. TBAs can play an important future role as mobilizers to encourage women to go to health centers for antenatal care (ANC) and delivery. In the meantime, more TBAs should be trained to handle emergency cases when accessing a health center is not possible. There is also a need for more health education and sensitization for women to reduce misconceptions affecting their willingness to deliver in health centers.