TITLE PAGE

REASONS AND EFFECT OF TBA'S PATRONAGE IN AJUE

COMMUNITY ODIGBO LOCAL GOVERNMENT, ONDO STATE

BY

OHCHT/CHEW/022/025

ILESANMI BLESSING TREASURE

SUMMITED TO THE

DEPARTMENT OF COMMUNITY HEALTH

OPEN HEAVEN COLLEGE OF HEALTH TECHNOLOGY, LASIA,

ONDO STATE

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

AWARD OF DIPLOMA IN COMMUNITY HEALTH

2025
 CERTIFICATION

This project work is a pure handwork and it's an effort of Ilesanmi Blessing

Treasure with matric number: OHCHT/CHEW/022/025 under the supervision of

Comr. K.M. Ogunleye, of the department of community health. It has never been

submitted for any other type of award. All literature cited are fully acknowledged.

STUDENT

ILESANMI BLESSING TREASURE

Matric number: OHCHT/CHEW/022/025

Signature ____________________

Date___________________________
 APPROVAL PAGE

This research study was read and approved by the project supervisor Comr. K.M.

Ogunleye, under the department of community health, Open heaven college of

Health Technology lasia- ore for the award of Diploma in Community Health.

PROJECT SUPERVISOR H.O.D COMMUNITY HEALTH

Comr. K.M. Ogunleye Name_____________________

Signature___________ Signature____________

Date_________ Date__________

EXTERNAL EXAMINER

Name:_______________________

Signature ____________________

Date:________________________
 DEDICATION

This project work is dedicated to Almighty God for his divine help throughout the

journey of this programme.

 ACKNOWLEDGMENT

All thanks to my creator who has made this journey swift and seamless. For the

opportunity grace, wisdom, knowledge and understanding he has given me to start

this programme and come out safe and sound.

My heartfelt gratitude goes to my amiable supervisor Comr. K.M. Ogunleye, who

held my hand throughout this research and make sure it's one of the best research

ever. You will not lack knowledge in Jesus name. Amen.

My profound gratitude goes to my husband Odusanya Olumide Michael who stood

by me financially, emotionally, spiritually, physically throughout this journey

despite the ups and [Link] type is rare honey and thanks for all you do.

My deep appreciation goes to my mother and Mr Olasehinde Oluwasola who has

been my prayer warrior, encourager, provider throughout the journey and also

contribute immensely. May the Lord grant you long your life to eat the fruit of

your [Link].

I am deeply thankful to my mother in-law who has been a pillar of support as well

throughout this journey.I love you momma. Also to my brother in-law Odusanya

Damilola Oladipupo thanks for all you do man.

I recognized the effort of Past. Dr Esan (Director) [Link] Esan (provost)

Thanks you for all you do for me I pray may the good Lord shower you more

[Link]

My thanks goes to Mrs.S.U [Link] former H.O.D community health. Thank

you for impacting knowledge needed to thrive in this chosen carrier.

Finally,I appreciate all the lecturers and management Mrs. Olaiyapo

Gloria.N(Registrar) Mr.T.J Ola,[Link] Daniel,Mr kayode

ogunleye,[Link], Mr. Femi, Who dedicated their time to impact to our

[Link] bless you. Amen.

 ABSTRACT

Despite governmental and non-governmental efforts to promote skilled birth

delivery, many women in Ajue continue to rely on Traditional birth attendant

(TBAs) during pregnancy and [Link] study investigates the reasons for and

effects of the patronage of Traditional Birth Attendants (TBAs) by pregnant

women in Ajue community, located in Ondo State, Nigeria. Despite government

efforts to promote skilled birth attendance and healthcare facilities, many women

in rural areas still rely on TBAs for maternal care. This research explores the socio-

cultural, economic, and accessibility factors influencing this habit, as well as the

implications on maternal and neonatal health outcomes.

Using a mixed-methods approach, data were collected through

questionnaires,interviews, and focus group discussions involving pregnant women,

TBAs, and healthcare providers within the community. The findings reveal that

major reasons for patronage include affordability of TBA services, cultural beliefs,

proximity of TBA homes, perceived empathy and personalized care, and fear of

formal medical institutions. Additionally, traditional norms and family influences

impact decision-making during pregnancy.

The study also identifies both positive and negative outcomes of TBA patronage.

While many women appreciate the emotional support and cultural familiarity
offered by TBAs, the lack of medical training among TBAs has led to increased

risks of complications such as obstructed labor, hemorrhage, and maternal or infant

mortality in cases requiring skilled medical intervention. Inadequate referral

systems between TBAs and health centers exacerbate delays in emergency

[Link] study concludes that while TBAs play a significant role in rural maternal

health, their integration into the formal health system through training, regulation,

and collaboration could lessen the associated risks. Enhancing healthcare

infrastructure, promoting culturally sensitive care, and increasing community

health education are crucial steps toward improving maternal health outcomes in

Ajue and similar communities.

 TABLE OF CONTENT

Title page........................................................................i

Certification......................................................................ii

Approval page.....................................................................iii

Dedication..............................................................................iv

Acknowledgment...................................................................v

Abstract....................................................................................vi

Table Of Contents.......................................................................vii

List of Tables...............................................................................

Introduction....................................................................................

CHAPTER ONE INTRODUCTION

1.1 Background Of The Study.........................................................1

1.2 Statement Of the Problem........................................................2

1.3 Objectives Of the Study..............................................................3

1.4 Research Questions....................................................................4

1.5 Significant Of The Study.............................................................5

1.6 Scope Of the Study......................................................................6

1.7 Operational Definition Of Terms................................................7

CHAPTER TWO...................................................................................

Review Of Related Literature..............................................................

2.0 Introduction....................................................................................8

2.0 Chapter Two: Literature Review....................................................9

2.1 Who are Traditional Birth Attendants?..........................................10

2.2 Why Women Choose TBAs..........................................................11

2.3 Effects of TBA Patronage.............................................................12

2.4 Theoretical Framework.................................................................13

2.5 Summary of Literature Review..........................................................14

3.0 Chapter Three: Research Methodology............................................

3.1 Study Design.......................................................................................15

3.1.1 Study setting .....................................................................................16

3.2 Study Population ..................................................................................17

3.3 Sample Size and Sampling Technique................................................18

3.4 Method of Data Collection...................................................................19

3.5 Instrument of Data Collection.............................................................20

3.6 Method of Data Analysis.................................,...................................21

3.7 Data Analysis .........................…...........................................................22

4.0 CHAPTER FOUR:

Results and Discussion.........................................................................23

4.1 Presentation of Data..........................................................................24

4.2 Analysis of Findings...........................................................................25

4.3 Discussion of Findings.......................................................................26

5.0 CHAPTER FIVE:

SUMMARY, CONCLUSION AND RECOMMENDATIONS AND

SUGGESTIONS

5.1 Summary of Findings.......................................................................40

5.2 Conclusion.........................................................................................41

5.3 Recommendations.............................................................................42

5.4 Suggestions for Further Studies......................................................43

References ...............................................................................................44

Appendices...............................................................................................45

Questionaire...............................................................................................50
 CHAPTER ONE

1.0 Introduction

1.1 Background of the Study

Maternal health remains a critical issue in many developing countries, particularly

in sub-Saharan Africa where access to skilled care during pregnancy and childbirth

is limited. According to the World Health Organization (WHO), maternal mortality

rates in Nigeria remain among the highest globally, with many of the deaths being

preventable through access to skilled birth attendants and timely medical

intervention. In rural communities such as Ajue, located in Ondo State, Nigeria,

traditional birth attendants (TBAs) continue to play a prominent role in maternal

and child healthcare despite the presence of modern healthcare facilities.

Traditional Birth Attendants are individuals, usually women, who assist mothers

during childbirth using knowledge and practices passed down through generations.

These attendants are often embedded in the cultural and spiritual fabric of their

communities, making them highly trusted figures. They typically do not have

formal medical training but are known for their experience, personal attention, and

familiarity with local customs and spiritual practices. In many rural areas where

health infrastructure is weak or inaccessible, TBAs provide an essential service—

filling a gap that formal healthcare systems have yet to adequately bridge.
In Ajue community, as in many other rural Nigerian settings, a significant

proportion of women still prefer to utilize the services of TBAs during pregnancy,

labor, and postpartum care. Several reasons have been identified in various studies

to explain this preference. These include cultural compatibility, affordability,

geographic proximity, and a perception of emotional support and personalized

care, which many women believe are lacking in formal health settings.

Additionally, experiences of poor attitude, long waiting times, or lack of empathy

from health professionals in hospitals have further discouraged the use of skilled

birth attendants.

While TBAs are accessible and culturally aligned with the beliefs of many women

in Ajue, their patronage raises concerns about the safety and quality of care

provided. TBAs often lack the ability to recognize and manage complications,

delay necessary referrals to hospitals, and rely on unscientific methods that can

endanger both mother and child. Maternal and neonatal morbidity and mortality

rates in such contexts are often higher due to inadequate infection control,

unsupervised labor practices, and lack of emergency obstetric care. These effects

highlight the need to better understand the dynamics of TBA patronage to improve

maternal health outcomes.

At the same time, there is growing recognition that TBAs are not inherently

harmful and, if properly trained and integrated into the formal healthcare system,
can contribute positively to maternal health. In some countries, successful models

have emerged in which TBAs are trained to identify danger signs, refer cases

appropriately, and work collaboratively with skilled health workers. Nigeria’s own

health policies have at times acknowledged the presence of TBAs and proposed

strategies for monitoring and engaging them constructively.

This study, therefore, aims to explore the specific reasons why women in Ajue

community continue to patronize TBAs and to analyze the associated effects on

maternal and child health. Understanding these factors is critical for developing

policies and programs that are culturally sensitive, accessible, and capable of

reducing maternal and neonatal mortality in underserved regions. By focusing on

Ajue, this research will contribute to the broader discourse on rural maternal

healthcare and offer practical insights for improving health outcomes in similar

communities.

1.2 STATEMENT OF THE PROBLEM

Despite efforts by the Nigerian government and international organizations to

promote maternal health through skilled birth attendance, a significant number of

women in rural areas like Ajue community still rely heavily on Traditional Birth

Attendants (TBAs) for delivery and maternal care services. This persistent

patronage occurs even in the face of available primary healthcare centers, which
raises critical [Link] continuous preference for TBAs is often linked to

cultural beliefs, accessibility, affordability, and dissatisfaction with hospital

services. However, TBAs typically lack the professional training and equipment

needed to handle complications during pregnancy and childbirth, thereby

increasing the risk of maternal and neonatal morbidity and [Link] problem

this study seeks to address is: why do women in Ajue community continue to

patronize TBAs despite the potential health risks and the presence of formal

healthcare services? Additionally, the study aims to explore the consequences of

this trend on maternal and child health in the community.

1.3 OBJECTIVE OF THE STUDY

[Link] the key factors that influence women's preference for TBAs in Ajue

community.

[Link] the perceived benefits and challenges associated with using TBAs.

[Link] the impact of TBA patronage on maternal and child health outcomes.

[Link] strategies for improving maternal healthcare services in the community.

1.4 RESEARCH QUESTIONS

[Link] are the major reasons why women in Ajue community patronize

Traditional Birth Attendants?

[Link] benefits do women perceive in using TBAs compared to formal healthcare

providers?

[Link] are the effects of TBA patronage on maternal and child health in the

community?

[Link] measures can be taken to improve the utilization of formal maternal

healthcare services in Ajue?

1.5 SIGNIFICANCE OF THE STUDY

[Link] Development: It will provide useful insights for government agencies and

healthcare policymakers to design culturally sensitive and community-based

maternal health programs that address the unique needs of rural women.

[Link] Healthcare Delivery: Understanding why women prefer TBAs can

help health workers and institutions improve their approach, attitude, and service

delivery to encourage greater use of skilled birth attendants.

[Link] Education: The findings will be useful for awareness campaigns

aimed at educating women on the risks and limitations of relying solely on TBAs,

especially during complicated deliveries.

[Link] Contribution: The study will add to the existing body of knowledge on

maternal health in rural Nigeria and serve as a reference for future research in

related areas.

[Link] for TBAs: It may also highlight the potential role TBAs can play if

properly trained and integrated into the formal health system.

1.6 Scope of the study

This study focuses on investigating the reasons and effects of Traditional Birth

Attendant (TBA) patronage among women in Ajue community, located in Ondo

State, Nigeria. It covers women of reproductive age, particularly those who have

used the services of TBAs during pregnancy and childbirth.

1.7 OPERATIONAL DEFINITION OF TERMS

1. Traditional birthd Attendant (TBAs): Individuals, often without formal

medical training, who assist women during pregnancy, labor, and delivery,

using traditional methods and knowledge passed down through generations.

2. Patronage: The act of choosing or seeking the services of someone in this

case, the consistent use of TBAs for maternal healthcare services.

3. Maternal Health: The health of women during pregnancy, childbirth, and the

postpartum period.

4. Neonatal Health: The health and wellbeing of newborns during the first 28

days of life

5. Reproductive Age: The age range typically considered suitable for

childbearing, usually between 15 and 49 years.

6. Primary Health care: Basic or general health care traditionally provided by

general practitioners, nurses, or community health workers in clinics or health

centers

7. Skilled Birth Attendant (SBA): A trained health professional such as a

midwife, doctor, or nurse who is competent to manage normal pregnancies and

childbirth and identify coplication

8. Referral Practice:The process by which a TBA or healthcare provider directs

a woman to a higher-level or formal medical facility for emergency or

specialized care.
9. Birth Complication: Any unexpected medical issue that arises during

pregnancy or childbirth, such as prolonged labor, hemorrhage, infection, or

neonatal asphyxia.

10. Postnatal Care:The care provided to a mother and her baby immediately after

birth and during the first six weeks of life, including check-ups and education

on newborn care

11. Home Delivery:A birth that takes place outside of a formal health facility,

typically assisted by a TBA or a family member.

 CHAPTER TWO

LITERATURE REVIEW

2.1 INTRODUCTION

This chapter reviews the concept of the reasons and the effect of Traditional birth

Attendant patronage by pregnant women.

2.2 Who Are Traditional Birth Attendants?

Traditional Birth Attendants (TBAs) are community-based, non-professional

health workers who provide maternal care during pregnancy, childbirth, and the

postpartum period. They are often trained through apprenticeships and pass down

knowledge from older generations. TBAs are generally trusted in their

communities for their familiarity with local customs and traditions, and their

services are often considered more accessible, particularly in rural areas with

limited access to formal healthcare.([Link].)

2.2 WHY WOMEN CHOOSE TRADITIONAL BIRTH ATTENDANT

(TBAs)

According to Okarfor, C.B (2020) "Women in rural and underserved communities

often choose Traditional Birth Attendants (TBAs) for several interrelated reasons.
These reasons can be grouped into cultural, economic, logistical, and healthcare

system-related factors"

[Link] and Trust: TBAs are usually members of the community who share

the same language, traditions, and cultural practices. Women often feel more

comfortable with someone they know and trust.

[Link] Rituals: TBAs often incorporate traditional rituals, herbal remedies,

and spiritual elements into their care, which aligns with local beliefs about

childbirth. (B.O Ojelade etl)

[Link] and Community Influence: Decisions around childbirth are frequently

influenced by elders or community norms that favor traditional methods.

[Link] Cost: TBAs typically charge much less than formal health facilities,

making them more accessible to low-income families.

[Link] Payment Options: TBAs often accept payment in kind or allow

delayed payments, which is helpful in cash-strapped households.

6. Proximity: TBAs usually live within the community, reducing the need for

long-distance travel during labor.

2.3 EFFECT OF TBAS PATRONAGE BY PREGNANT WOMEN.

The continued patronage of Traditional Birth Attendants (TBAs) by pregnant

women, particularly in rural and underserved areas, has a complex set of

implications. While TBAs play a culturally significant role in many communities,

their use has been linked to both beneficial and adverse outcomes in maternal and

neonatal health. This section outlines the effects of TBA patronage based on

cultural, health, and systemic perspectives.

Preservation of Tradition: TBAs help preserve local customs and childbirth

rituals, which fosters cultural identity and continuity (Okunade, 2020).

Community Trust and Emotional Support: The strong relationships TBAs have

within communities foster trust and emotional security for expectant mothers

(Smith & Nwankwo, 2019).

Limited Knowledge and Resources: TBAs generally do not have access to sterile

equipment or modern medical training, increasing the risks of infections such as

puerperal sepsis and neonatal tetanus (World Health Organization, 2021).

Delayed Referral and Emergency Response: TBAs often lack the skills to

identify and manage obstetric complications. This can result in delayed referrals,

which may lead to preventable maternal and neonatal deaths (Oluwaseun &

Akinyemi, 2021).
High Maternal and Neonatal Morbidity: Studies indicate higher rates of

maternal mortality and poor neonatal outcomes in communities where TBAs are

the primary birth attendants (Johnson & Green, 2020).

2.4 Effects and Outcomes of TBA Use

1. High maternal and neonatal risks: Untrained TBAs may not detect

complications, leading to delays in referral and increased maternal mortality. In

Ilorin, 19.8 % of women delivering with TBAs experienced complications; 7.7 %

of these were referred but the rest were managed at risk.

2.4.1 ECONOMIC CONSEQUENCES

Lower Short-Term Costs: Many women choose TBAs due to affordability and

flexible payment terms (Okafor, 2020).

High Long-Term Costs: Complications arising from unskilled birth practices may

lead to long-term healthcare expenses and loss of productivity for families

(Johnson & Green, 2020)

2.4.2 SYSTEMIC AND POLICY IMPACTS

Gap in Health Service Coverage: High TBA patronage often highlights systemic

weaknesses in healthcare delivery, such as inadequate infrastructure and staff

shortages in rural areas (Smith & Nwankwo, 2019).

Challenges for Health Integration: Efforts to integrate TBAs into the formal health

system are challenged by regulatory, training, and supervision constraints (WHO,

2021).

2.4 .3. THEORETICAL FRAMEWORK

This study on the patronage of Traditional Birth Attendants (TBAs) by pregnant

women is anchored on two key theoretical perspectives: the Health Belief Model

(HBM) and the Theory of Planned Behavior (TPB). These frameworks provide

insight into the individual and social factors influencing maternal health-seeking

behaviors.

2.4.4 HEALTH BELIEF MODEL (HBM)

The HBM suggests that individuals are more likely to take health-related actions if

they perceive a threat to their health and believe that a particular course of action

will reduce that threat. The key constructs of the HBM include:

[Link] Susceptibility: Many women may not perceive themselves at risk for

complications during childbirth, especially if previous births with TBAs were

uneventful.

[Link] Severity: If the perceived severity of childbirth complications is low,

women may not prioritize skilled birth attendance.

[Link] Benefits: Women may view TBAs as more beneficial due to emotional

support, cultural alignment, and affordability.

[Link] Barriers: Distance, cost, and fear of hospitals may discourage women

from using formal health facilities.

[Link] to Action: Community norms and family influence can serve as triggers for

choosing TBAs.

2.4.5 THEORY OF PLANNED BEHAVIOR (TPB)

TPB posits that an individual's intention to perform a behavior is the primary

predictor of that behavior. Intention is influenced by:

[Link] toward the behavior: Women may have positive attitudes toward TBA

services due to personalized care and cultural familiarity.

[Link] norms: Social pressures from family or community may support the

use of TBAs.

[Link] behavioral control: Women may feel they lack the power or means to

choose formal healthcare due to

By applying these theories, this study examines how beliefs, social norms, and

perceived control shape women’s decisions to patronize TBAs, and how these

factors can be addressed through health education and system improvements.

2.6 SUMMARY OF THE LITERATURE REVIEW

The literature review demonstrate that while TBAs play a crucial role in rural

maternal care, their services come with significant risks. The continued patronage

of TBAs can be attributed to a combination of cultural, economic, and accessibility

factors. However, the health risks associated with using TBAs, especially in

complicated deliveries, are well-documented. This study aims to build on the

existing research by examining the specific factors influencing TBA patronage in

Ajue community and their impacts on maternal and child health.

 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 INTRODUCTION

This chapter emphasize on the research design,area of the study population of the

study, sample size determination, sampling technique, instrument/method of data

collection and methods of data analysis to be used for this work.

3.2 STUDY DESIGN

This study will adopts a descriptive survey research design to explore the reasons

and effects of traditional birth attendant (TBA) patronage among pregnant women

in the Ajue community. This design is suitable because it allows the collection of

data from a large number of respondents in a natural setting.

3.2.1 STUDY SETTING

Ajue is a rural community located in the Odigbo Local Government Area of Ondo

State, in southwestern Nigeria. It is situated along the Ore-Benin expressway,

making it somewhat accessible despite its rural setting.

Ajue is a rural community in Odigbo. As of the recent data collected, Ajue has a

population of approximately 3,740 residents, with a nearly equal distribution

between males (1,873) and females (1,868). The community spans an area of about
0.711 square kilometers, resulting in a population density of approximately 5,261

people per square [Link] median age in Ajue is 19.8 years, indicating a

predominantly young population. Ajue is part of the larger Odigbo Local

Government Area, which has experienced significant population growth. While the

2006 census recorded a population of 232,287 for Odigbo, more recent estimates

suggest that the population has surpassed 600,000 by 2020, driven in part by

migration and urbanization.

The community is predominantly inhabited by the Yoruba ethnic group, although it

has become increasingly cosmopolitan due to its proximity to major transit routes.

The primary occupations of the residents are farming, petty trading, and artisanal

[Link] is characterized by limited infrastructure, including basic road

networks, underdeveloped healthcare facilities, and inadequate access to potable

water and electricity. Ajue is surrounded by small villages under them like: Oke

agbo, Igbekebo, Ilepa,Aso ajue,Erusu,Ibada,owo ajao.

3.3.0 STUDY POPULATION.

Population of this study comprises of Pregnant women and women of reproductive

age (15–49 years) residing in Ajue who have used or are currently using TBAs for

childbirth or antenatal care.

3.3.1 INCLUSIVE CRITERIA

pregnant women living in the Ajue community, whether currently pregnant or

having been pregnant within the last 12 [Link] of Reproductive Agee

women between the ages of 15 and 49 years, as this is the typical reproductive age

range, and they are most likely to have experience with pregnancy and

childbirth,women who have used or are currently using Traditional Birth

Attendants (TBAs) for childbirth, antenatal care, or postnatal care will be

included,women who voluntarily consent to participate in the study.

3.3.2 EXCLUSIVE CRITERIA

Women who have never used the services of Traditional Birth Attendants (TBAs)

for childbirth or any related maternal care will be excluded from the study,Women

outside the reproductive age range of 15 to 49 years will be excluded from the

study,women who do not provide informed consent or who express unwillingness

to participate in the study will be excluded.

3.4 SAMPLE SIZE

A sample size of 100women will be selected for this study focusing on those who

have experience with TBAs.

3.5 SAMPLING TECHNIQUES

The sampling technique to employed in this study is purposive sampling, a non-

probability sampling method that focuses on selecting participants who meet

specific criteria relevant to the research objectives.

3.7 METHOD OF DATA COLLECTION

For this study, qualitative data collection methods will be employed to explore the

reasons behind the patronage of Traditional Birth Attendants (TBAs) and the

effects of such practices on maternal and neonatal health in Ajue community. The

method selected will ensure in-depth understanding of participants' experiences,

beliefs, and [Link]-structured in-depth interviews will be conducted

with the selected participants. The interviews will allow for open-ended

discussions that provide rich, detailed insights into the women’s experiences with

TBAs, their reasons for choosing TBAs, and the perceived outcomes (both positive

and negative).
 CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION

INTRODUCTION

The data analysis for this study will be conducted using a qualitative data analysis

approach. Given the nature of the study and the type of data collected (in-depth

interviews, focus group discussions, and observations), thematic analysis will be

employed to identify, analyze, and report patterns or themes within the data.

4.1 Data presentation

This chapter presents the data collected from respondents in Ajue community

through structured questionnaires. A total of 100 questionnaires were distributed,

and 100 were properly filled and returned, representing a 100% response rate. The

data is organized into tables under the below headings for clarity of the reasons and

effect of TBAs patronage in ajue community.

TABLE 4.2 Demographic characteristics of the respondents

AGE FREQUENCY PERCENTAGE %

15_19 0 0

20_24 16 16

25_29 34 34

30 above 50 50

Total 100 100%

The above interpretation show that most majority of the women were in the age

range of 25__30 above. 15_19 0%, 20_24 16.2%, 25_29 34.2%, 30 and above

49.5%.

TABLE 4.3 EDUCATIONAL LEVEL

Educational level Frequency Percentage

No formal education 0 0

Primary 42 42

Secondary 44 44

Tertiary 14 14
Total 100 100

Interpretation: the table above show the respondent educational level. 42% finished

primary school, 44% of the respondents finished secondary school, 14% of the

respondents attended tertiary institution while 0% of the respondents had no

formal education which connote the level of illiteracy in the community is low.

TABLE 4.4 OCCUPATION

OCCUPATION Frequency Percentage

Trading 65 65%

Farming 27 27%

Civil servant 8 8%

100 100%

Interpretation: Most of th respondents were majorly traders 65% while others are

farmers 27% and the lowest percentage were civi servant 8%.

4.5 MARITAL STATUS

Marital status Frequency Percentage

Married 73 73

Single 0 0

Divorced 1 1

Widow 16 16

100 100%

This table above show the marital status of the respondents.73% are married, 1%

divorced, 16% widowed,0% single.

Section B

TABLE 4.3. REASONS FOR TBA's PATRONAGE

Why did you choose to Respondence Percentage

deliver with TBA's

Not far to home 0 0%

Affordable service 42 36.7%

Emotional and support 18 15.3%

care

Cultural and traditional 15 11.2%

preference

Bad experience at hospital 15 15.3%

Influenced by 10 5%

family/community

Total 100 100

Interpretation: The table above shows that most common reasons for choosing

TBAs in ajue community includes affordability,42% chose affordability, 18% of

the respondents emotional care, and 15% experience bad attitude at the hospital

which makes them patronize traditional birth Attendant more than formal health

care services.10% of the respondents are infliuenced by family and

community,15% are infkualuenced by cultural and traditional references.

TABLE

Have you ever deliver Frequency Percentage

with TBA's?

Yes 80 80%
No 20 20%

Total 100 100

Interpretation: out of the 100 respondents 80% of the respondents had given birth

with traditional birth Attendant while 20% of the respondents deliver with

traditional birth Attendant.

Section C

4.5 EFFECT OF TBA'S PATRONAGE

Effect Frequency Percentage

Experienced No 67 67%

complications

Yes 33 33%

Total 100 100%

Interpretation: Table 4.5 above shows that majority of the respondents had no

complications after using traditional birth Attendant in ajue community showing

the highest percentage 67% while 33% experienced complications with traditional

birth [Link] referral solely increase to the risk in TBAs patronage in

ajue community.
TABLE 4.5.1

Have you or your baby Frequency Percentage

had health problems after

delivery with TBA?

Yes 13 13

No 63 63

I don't know 24 24

Total 100 100%

Interpretation: The table above interpreting the effect of TBA patronage in ajue

community it shows 13% experience problem during the patronage of TBA's and

63% experience no problem during TBAs patronage in ajue community.

Section D

4.6 Preferences and Attitudes

If both services were free and available nearby, which Frequency Percentage

would you choose?

TBA 30 30%
Hospital /health center 13 13%

Both 57 57%

Total 100 100%

Interpretation: The table above shows majority 30% of women in ajue community

support improved formal healthcare access but still see value in integrating TBAs,

while 13% chose health center and 57% choose both. This connote the people want

implementation of traditional birth Attendant into health care deliveries.

TABLE 4.6.1

How would you describe Frequency Percentage

the cleaniness of TBA?

Clean 71 71%

Dirty 10 10%

Very clean 13 13%

Very dirty 6% 6%

Total 100 100%

Interpretation: The table above shows 71% of women in ajue community

experience clean delivery from the traditional birth Attendant,while 10%

experiencedirtiness with traditional birth Attendant.

TABLE 4.6.2

Would you support training TBAs to work with Frequency Percentage

nurses and midwives in clinics

Yes 79 79%

No 7 7%

Not sure 14 14%

Total 100 100%

Interpretation: The table above shows 79% majority of women in ajue community

support traditional birth Attendant to be properly trained by the formal health care

provider for proper knowledging in handling maternal and child health. 7%

perxcentage of the respondents chose not to support traditional birth Attendant

while 14% of the respondents are nitbsureot sure

TABLE 4.6.3

What improvement would you encourage you to use Frequency Percentage

formal health care services instead of TBA

Better staff 45 45%

More privacy 21 21%

Lower costs 27 27%

Other 7 7%

Total 100 100%

Interpretation: Table 4.6.2 above, 45% of the respondents support better staff

attitude by the formal health care provider, while 27% of the respondents support

Lower costs, 21% support more privacy by the formal health care services which

could improve the patronage of formal health care services by the pregnant

women.

TABLE 4.6.4

Do you believe TBA should be formally trained Frequency Percentage

and certified by the government

Yes 85 85%

No 15 15%

Total 100 100%

Interpretation: The tables above 85% majority of women in ajue community

support improved formal healthcare access but still see value in integrating TBAs
into the formal health care services. Also suggest the improvement in the formal

health care services by the health care providers. while 15% chose no.

TABLE 4.6.5

Would you recommend TBA services to another Frequency Percentage

pregnant woman?

Yes 55 55%

No 13 13%

Depending on the situation 32 32%

100 100%

Interpretation: The tables above shows 55% of women in ajue community support

traditional birth Attendant in the maternal and child health deliveries.13% chose no

4.7 Summary of the data analysis

The analysis of data collected from 100 respondents in Ajue Community revealed

important insights into why pregnant women continue to patronize Traditional

Birth Attendants (TBAs) and the impact of that choice on maternal and child

health.

1. Demographic Characteristics:
Most respondents were women aged 24__ 30 and above, with a significant number

engaged in farming and trading. Few proportion had no formal education,

indicating that low literacy and rural living conditions.

2. Reasons for Patronage

The most commonly cited reasons in this study for choosing TBAs included

affordability (79.8%), emotional support and care (36.6%), and bad experience at

the hospital(15.3%). Cultural beliefs and negative perceptions of formal healthcare

also played a role.

3. Attitudes and Preferences

Despite their reliance on TBAs, the highest level of respondents said they would

prefer a hospital and if accessible and affordable. Additionally, majority supported

the idea of formally training TBAs, and 55% would recommend them to others

indicating that TBAs are seen as valuable but imperfect.

4.8 CONCLUSION OF THE DATA ANALYSIS

Most women express willingness to embrace formal healthcare if barriers like

distance and cost and better staffing are addressed. This highlights the need for
community-based maternal health reforms and better integration of trained TBAs

into the formal health system.

 CHAPTER FIVE

DISCUSSION, SUMMARY, CONCLUSION, AND RECOMMENDATIONS

5.1 DISCUSSION OF FINDINGS

This study explored the reasons behind the continued patronage of Traditional

Birth Attendants (TBAs) by pregnant women in Ajue Community, as well as the

effects of this practice on maternal and neonatal health outcomes. Findings from

the field data indicated that affordability, proximity, cultural compatibility, and

emotional support were the key factors driving TBA patronage. The majority of

respondents cited TBAs as more financially accessible and emotionally supportive

than formal healthcare providers.

However, despite these perceived benefits, a significant number of respondents

reported experiencing complications during delivery, and few were referred to

hospitals in emergency situations. These findings suggest that while TBAs are

deeply trusted and culturally rooted, their lack of formal training and medical

resources limits their capacity to handle obstetric emergencies. This reinforces

concerns found in earlier literature regarding the risks associated with unskilled

birth attendance. Interestingly, the study also showed that a large proportion of

women would prefer delivering at a hospital if services were affordable, nearby,

and offered respectful care. This indicates that the continued reliance on TBAs is
not necessarily due to a rejection of modern healthcare, but rather a response to

socioeconomic and infrastructural barriers. Furthermore, most respondents

supported the idea of training TBAs and integrating them into the formal

healthcare system, presenting a unique opportunity for safer maternal care through

collaboration.

5.2 Summary

Chapter Five highlighted the major findings of the research, drawing connections

between cultural, economic, and systemic factors that influence maternal

healthcare choices in Ajue Community. While TBAs remain integral to childbirth

practices in the community, their limitations pose significant health risks to

mothers and [Link] findings revealed a strong desire among women for

accessible and affordable healthcare, as well as community openness to integrating

TBAs into the formal health system. The chapter emphasized the need for a multi-

pronged strategy, including training, policy reform, and infrastructure

development, to address these challenges effectively. The study revealed that many

women in Ajue Community desire accessible and affordable healthcare. There is a

strong community interest in integrating TBAs into the formal health system. This

openness presents an opportunity for collaboration between traditional and modern

healthcare [Link], the study concludes that sustainable maternal

healthcare in Ajue Community requires bridging traditional practices with modern

medical systems through inclusive, community-based solutions.

Earlier chapters detailed the study’s background, objectives, and methodology,

highlighting the cultural and socioeconomic factors shaping maternal health

decisions.

This chapter expanded on the key findings, emphasizing how deeply cultural

beliefs, economic realities, and systemic limitations influence women’s

preferences for TBAs over modern healthcare facilities. Despite TBAs playing an

essential and trusted role in childbirth, their practices often lack the medical rigor

necessary to prevent complications, posing significant health risks to mothers and

infants. This openness presents an opportunity for collaboration between

traditional and modern healthcare structures.

To address the identified challenges, the research advocates for a multi-pronged

strategy, including:

Training programs for TBAs to enhance safe delivery practices.

Policy reforms to officially recognize and regulate TBAs.

Infrastructure development to improve access to quality maternal healthcare

services.
5.3 Conclusion

This study has demonstrated that the patronage of Traditional Birth Attendants in

Ajue Community is primarily influenced by cultural values, economic constraints,

and limited access to skilled health services. Although TBAs offer emotional

support and are embedded in local traditions, their lack of medical expertise

presents clear health risksDespite this, many women remain open to using health

facilities if systemic barriers—such as distance, cost, and unfriendly staff attitudes

—are addressed. The community’s support for TBA training and integration offers

a viable path forward to improve maternal health [Link] conclusion, a

collaborative and culturally sensitive approach, which includes health education,

training for TBAs, improved health infrastructure, and policy reforms, is essential

for reducing maternal and neonatal morbidity and mortality in Ajue and similar

rural communities.

5.4 Recommendations

Based on the findings of this study, the following recommendations are made:

1. Improve Accessibility to Healthcare Facilities: Establish or equip primary health

centers closer to rural areas like Ajue.

2. Subsidize Maternal Health Services: Offer affordable or free maternal health

services for low-income families

3. Train and Certify TBAs: Equip TBAs with basic healthcare knowledge,

hygiene practices, and emergency referral skills.

4. Integrate TBAs into the Health System: Form partnerships between TBAs and

formal health workers to bridge the gap in care.

5. Conduct Health Education Campaigns: Educate communities on the risks of

unskilled delivery and benefits of facility-based births.

6. Involve Community Leaders: Leverage the influence of traditional and

religious leaders to promote safer delivery practices.

7. Improve Attitude of Health Workers: Train healthcare staff in respectful,

culturally sensitive care to encourage facility use.

8. Provide Mobile Health Clinics: Deploy outreach services to remote areas for

antenatal and delivery care.

9. Implement Maternal Incentive Programs: Use motivation strategies like

delivery packs or transport vouchers to encourage hospital use.

10. Strengthen Emergency Referral Systems: Ensure clear and effective referral

links between TBAs and nearby hospitals.

11. Regulate and Monitor TBAs: Introduce guidelines and routine inspections for

practicing TBAs.
12. Encourage Male Participation: Educate husbands and male relatives on their

role in supporting maternal healthcare decisions.

13. Promote Female Education: Invest in long-term strategies like educating the

girl child to empower future generations.

14. Support Maternal Health Research: Encourage continuous community-

based research to assess changing maternal health needs.

15. Foster Public–Private Collaboration: Partner with NGOs and private

organizations to provide technical and financial support.

16. Women empowerment: Encourage education, employment, and decision-

making autonomy to shift decision-making power to women.

17. Health system strengthening: Ensure PHCs are well-staffed, equipped, and

culturally sensitive especially during emergencies and at night.

5.4 DELIMITATIONS

This study is limited to AJUE community, a rural settlement. Findings may not be

generalizable to urban or peri-urban populations or other communities with

different cultural or healthcare dynamics.

The study focuses primarily on women of reproductive age (15–49 years) who

have had at least one childbirth experience in the last five years, as well as

Traditional Birth Attendants (TBAs) and local healthcare providers within the

community.

The study is restricted to data collected within a specific period—typically within

the last five years to ensure relevance to current maternal healthcare trends and

practices in ajue.

The study is conducted in English and local dialects spoken in AJUE.

Interpretations are based on the cultural norms and beliefs specific to this setting,

which may limit external validity.

 REFERENCES

Ameh, C. A., & van den Broek, N. (2015). Making It Happen: Training healthcare

providers in emergency obstetric and newborn care.

[Link]

Byrne, A., & Morgan, A. (2011). How the integration of traditional birth attendants

with formal health systems can increase skilled birth attendance.

International Journal of Gynecology & Obstetrics, 115(2), 127–134.

[Link]

Choguya, N. Z. (2014). Traditional birth attendants and policy ambivalence in

Zimbabwe. Journal of Anthropology, 2014, 1–9.

[Link]

Ebuehi, O. M., & Akintujoye, I. A. (2012). Perception and utilization of traditional

birth attendants by pregnant women attending primary health care clinics in a rural

Local Government Area in Ogun State, Nigeria. International Journal of Women’s

Health, 4, 25–34. [Link]

Eliason, S., Baiden, F., Yankey, B. A., & Awusabo-Asare, K. (2014).

Determinants of Antenatal Care and Skilled Delivery Services in Ghana. BMC

Pregnancy and Childbirth, 14(1), 409. [Link]

Johnson, R., & Green, E. (2020). Challenges in accessing skilled birth services in

Nigeria.

Global Health Review, 8(1), 44–59.

[Link]

National Population Commission (NPC) [Nigeria] and ICF (2019).

Nigeria Demographic and Health Survey 2018.

[Link]

Okafor, C. B. (2020). Why women prefer traditional birth attendants in Nigeria:

Cultural and economic factors. Journal of Maternal Health Studies, 14(2), 85–93.

[Link]

Ogunyomi, M. T., & Ndikom, C. M. (2016). Perceived factors influencing the

utilization of traditional birth attendants’ services in Akinyele Local Government,

Ibadan, Nigeria. Journal of Community Medicine and Primary Health Care, 28(2),

40–48.

[Link]

Sialubanje, C., Massar, K., Hamer, D. H., & Ruiter, R. A. (2015). Reasons for

home delivery and use of traditional birth attendants in rural Zambia: a qualitative
study. BMC Pregnancy and Childbirth, 15(1), 216.

[Link]

Oluwaseun, A., & Akinyemi, K. (2021). Impact of traditional birth attendance on

maternal and neonatal outcomes in Southwestern Nigeria.

National DHS data from 2013 reinforce that low maternal education (aOR 1.75),

poor wealth, rural dwelling, unemployment, and large family size increase

likelihood of TBA delivery [Link]

 QUESTIONAIRE

OPEN HEAVEN COLLEGE OF HEALTH TECHNOLOGY,

LASIA, ODIGBO LOCAL GOVERNMENT AREA,

ONDO STATE.

Dear Respondent,

I am a final year student of the above named institution conducting a research on

the topic INVESTIGATION ON REASON AND EFFECTS OF TBA's

PATRONAGE BY PREGNANT WOMEN IN AJUE [Link]

LOCAL GOVERNMENT AREA, IN ONDO STATE. I hereby solicit for your

cooperation in completing the questionnaire, all information provided by you will

only be used for academic purpose and all responses will be considered

confidential.

Thank you

Yours faithfully,

____________________

Ilesanmi Blessing T.
 INVESTIGATION INTO THE REASONS AND EFFECT OF

TRADITIONAL BIRTH ATTENDANT PATRONAGE AMONG

PREGNANT WOMEN IN AJUE COMMUNITY.

Section A: Demographic Information

Age:

1.(a) 15–19 (b) 20–24 (c) 25–29 (d) 30 and above

[Link] Level:

(a)No formal education (b) Primary (c) Secondary (d) Tertiary

[Link] Status:

(a)Single (b) Married (c) Divorced (d)Widowed

[Link]:

(a)Farming (b) Trading (c)Civil servant (d) Others (please

specify):___________

5. Religion:

(a) Christianity (b) Islam (c) Traditional ☐(d)Others

Section B

Reasons for Patronizing Traditional Birth Attendants (TBAs)?

6. Have you ever delivered a child with the help of a Traditional Birth Attendant

(TBA)?

(a)Yes (b) No

[Link] yes, how many times?

(a) Once (b) 2–3 times (c) More than 3 times

[Link] did you choose to deliver with a TBA? (You may tick more than one)

(a) Close to my home

(b) Cheaper than the hospital

(c) Kind and supportive

(d) I trust the TBA

(e) Culture believe.

(e) Negative past experience with hospital staff

[Link] affordable was the TBA’s service compared to hospital delivery?

(a) Very affordable (b) Affordable (c) Not affordable (d) I don’t know
[Link] your family or community influence your decision to use a TBA?

(a) Yes (b) No

Section C

[Link] you feel emotionally supported by the TBA during your delivery?

(a)Yes (b) No

[Link] any complications experienced during delivery with the TBA?

(a)Yes (b) No

If yes, please describe briefly: ___________________________

[Link] the TBA refer you to a hospital when complications arose?

(a)Yes (b) No (c) Not applicable

[Link] would you describe the cleanliness of the delivery environment?

(a)Very clean (b) Clean (c)Dirty (d)Very dirty

[Link] you or your baby ever had a health problem after delivery with a TBA?

(a) Yes (b)No

If yes, please specify: ___________________________

Section D: Suggestions and Preferences

[Link] both services were free and available nearby, which would you choose?

(a) Hospital/Health Center (b) Traditional Birth Attendant (c) Both

[Link] improvements would encourage you to use health centers instead of

TBAs?

(a)Better staff attitude

(b) Lower costs

(c)Closer location

(d)More privacy and care

Others: ______________________

[Link] you support training TBAs to work with nurses and midwives in clinics?

(a)Yes (b) No (c) Not sure.

19. How long did it take you to reach the nearest TBA compared to the nearest

health center?

(a) TBA is closer (b)Both are the same (c) Health center is closer
[Link] you ever received antenatal care (ANC) from a hospital or clinic before

delivery?

☐ Yes ☐ No

If yes, did you still deliver with a TBA? (a Yes) (b) No

[Link] you believe TBAs should be formally trained and certified by the

government?

(a) Yes (b) No (c) Not sure

[Link] you recommend TBA services to another pregnant woman?

(a)Yes (b) No (c) Depends on the situation

Thank you for your participation. Please your responses will be kept confidential

and used only for academic research purposes.