“SHE KNOWS ME, I TRUST HER, AND SHE PRAYS FOR ME”: TBA AND COMMUNITY HEALTH WORKERS' ROLE IN ADVANCING SRHR/FP SERVICES IN NIGERIA
1
Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
2
University of Global Health Equity, Butaro, Rwanda
3
Department of Public Administration, Faculty of Social Sciences, University of Calabar, PMB 1115, Calabar, Nigeria
4
Department of Human Psychology, Ebonyi State University, Abakaliki, Nigeria
5
Equality, Diversity, and Inclusion Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Traditional Birth Attendants (TBAs) and Community Health Workers (CHWs) are relied upon by many women in rural and peri-urban regions. They serve as significant actors in advancing SRHR and FP services1. TBAs are influential due to their interpersonal familiarity, cultural alignment, and the spiritual dimension while CHWs are more integrated into the formal health system, often depending on their perceived trustworthiness, empathy, and ability to navigate local customs2. This evidence synthesis critically examines the role of TBAs and CHWs in shaping access to and utilization of SRHR/FP services in Southern Nigeria.
METHODS:
A pluralistic design synthesizing 38 studies, reports, and evaluations published between 2004 and 2024 was adopted3. PubMed, African Journals Online (AJOL), CINAHL, and Google Scholar were searched using these terms: “Traditional Birth Attendants Nigeria,” “community health workers and reproductive health,” “trust and family planning,” and “SRHR service uptake Nigeria.” Grey literature, including NGO program evaluations, government policy briefs, and faith-based health reports, was included to capture under-documented insights from field programs.
RESULTS:
Women described TBAs as “mothers,” “sisters,” or “aunties” who know their histories and provide culturally aligned advice. CHWs often draw on similar trust-based relationships but are sometimes seen as the health system’s “extensions” rather than independent allies. However, there was improved SRHR and FP utilization where CHWs worked in tandem with TBAs. Women emphasized not just physical access but emotional safety, familiarity, and spirituality as core factors influencing where and from whom they seek care. Programs that failed to engage these community actors reported low SRHR uptake and increased mistrust in clinic-based services.
CONCLUSIONS:
Care provided by TBAs and CHWs is both therapeutic and transformative, especially for socially marginalized women. They also depend on trust and relational ties to provide care. Proximity alone is insufficient; effective care must be rooted in trust and spiritual connection.
Traditional Birth Attendants (TBAs) and Community Health Workers (CHWs) are relied upon by many women in rural and peri-urban regions. They serve as significant actors in advancing SRHR and FP services1. TBAs are influential due to their interpersonal familiarity, cultural alignment, and the spiritual dimension while CHWs are more integrated into the formal health system, often depending on their perceived trustworthiness, empathy, and ability to navigate local customs2. This evidence synthesis critically examines the role of TBAs and CHWs in shaping access to and utilization of SRHR/FP services in Southern Nigeria.
METHODS:
A pluralistic design synthesizing 38 studies, reports, and evaluations published between 2004 and 2024 was adopted3. PubMed, African Journals Online (AJOL), CINAHL, and Google Scholar were searched using these terms: “Traditional Birth Attendants Nigeria,” “community health workers and reproductive health,” “trust and family planning,” and “SRHR service uptake Nigeria.” Grey literature, including NGO program evaluations, government policy briefs, and faith-based health reports, was included to capture under-documented insights from field programs.
RESULTS:
Women described TBAs as “mothers,” “sisters,” or “aunties” who know their histories and provide culturally aligned advice. CHWs often draw on similar trust-based relationships but are sometimes seen as the health system’s “extensions” rather than independent allies. However, there was improved SRHR and FP utilization where CHWs worked in tandem with TBAs. Women emphasized not just physical access but emotional safety, familiarity, and spirituality as core factors influencing where and from whom they seek care. Programs that failed to engage these community actors reported low SRHR uptake and increased mistrust in clinic-based services.
CONCLUSIONS:
Care provided by TBAs and CHWs is both therapeutic and transformative, especially for socially marginalized women. They also depend on trust and relational ties to provide care. Proximity alone is insufficient; effective care must be rooted in trust and spiritual connection.
| eISSN: | 2654-1459 |
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