Traditional birth attendants in rural India lack basic information about HIV/AIDS and safe delivery practices, according to a study conducted in 144 villages in the Indian state of Karnataka.

Only 12 percent of traditional birth attendants in the study reported awareness of HIV/AIDS, a surprising finding given that the HIV/AIDS epidemic in India is more than two decades old. Of those who had heard about HIV/AIDS, only 72 percent correctly reported that the virus could be spread from mother to child; 74 percent identified unprotected sex as a mode of transmission; and 51 percent correctly said healthy looking people could spread HIV. Just 44 percent knew that infected mothers could lower the risk of transmitting the virus to their infants.

The level of knowledge about safe birthing practices was also low among the traditional birth attendants. Considering that obstetrical hemorrhage and sepsis are still the leading cause of maternal death in India, researchers said it was not surprising that only 13 percent of of the traditional birth attendants referred mothers experiencing excessive bleeding following birth to a medical center, and that only about half sterilized equipment prior to deliveries.

Other unsafe procedures still practiced among traditional birth attendants included sucking secretions out of a baby’s mouth and nose with their mouth, applying cow dung, ghee (clarified butter) and other preparations on the umbilical cord, and inducing vomiting by stuffing hair in a woman’s throat to stimulate contractions of the uterus to clear the placenta.

Even more concerning, traditional birth attendants appeared to have low levels of awareness about when clients should be referred to a hospital. Less than five percent said they would refer a mother to a medical center if the umbilical cord was wrapped around the baby’s head, and just over half (57 percent) would refer the mother if the baby was coming out the wrong way. Most but not all (70 percent) would refer the woman if the baby was stuck inside the birth canal.

1. Madhivanan P, Kumar BN, Adamson P, Krupp K. Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India. BMC Public Health 2010; 10: 570. (open access)