Traditional midwives in Botswana.
Botswanan women tend to consciously opt for home deliveries, even in areas where modern maternity care facilities are easily accessible. Approximately 40% of deliveries in Botswana occur outside of institutions (55% in rural areas and 23% in urban areas) and are generally assisted by traditional midwives. To gain more information on this phenomenon, the 175 identified traditional midwives in 2 health regions of Botswana were interviewed. All midwives were female, the majority were over 50 years of age, and 80% were illiterate. 38% were married and 42% were widowed; 67% had 4 or more children. 59% practiced the traditional Tswana religion. 82% of the midwives interviewed indicated they had performed only 5-6 deliveries in the 1 year preceding the survey, suggesting a decline in their level of professional activity. Only 58% received a fee for their services; in most of these cases, the fee was minimal or in kind. Interestingly, 90% of traditional midwives expressed a positive attitude toward cooperation with the modern health care system. A more intensive interview with 59 of these traditional midwives indicated that 81% had no contact with their clients during the prenatal period. 95% showed a total lack of knowledge of the female reproductive system, yet all were able to identify signs of a high risk delivery and willing to refer these cases to a modern health facility. 76% were informed about family planning, although they indicated they refer clients to clinics for supplies, and all were supportive of breastfeeding for at least 1 year. As a group, Botswanan traditional midwives have specific conceptions regarding food taboos during pregnancy (e.g., avoidance of meat and eggs) that can place pregnant women at risk of protein deficiencies. Overall, these findings indicate that the traditional midwife in Tswana society cannot be regarded as a well-defined health worker, as is the case with traditional healers.