title: Stakeholder views on the incorporation of traditional birth attendants into the formal health systems of low-and middle-income countries: a qualitative analysis of the HIFA2015 and CHILD2015 email discussion forums.
abstract: BACKGROUND
  Health workforce shortages are key obstacles to the achievement of the health-related Millennium Development Goals. Task shifting is seen as a way to improve access to pregnancy and childbirth care. However, the role of traditional birth attendants (TBAs) within task shifting initiatives remains contested. The objective of this study was to explore stakeholder views and justifications regarding the incorporation of TBAs into formal health systems.
  
  
  METHODS
  Data were drawn from messages submitted to the HIFA2015 and CHILD2015 email discussion forums. The forums focus on the healthcare information needs of frontline health workers and citizens in low - and middle-income countries, and how these needs can be met, and also include discussion of diverse aspects of health systems. Messages about TBAs submitted between 2007-2011 were analysed thematically.
  
  
  RESULTS
  We identified 658 messages about TBAs from a total of 193 participants. Most participants supported the incorporation of trained TBAs into primary care systems to some degree, although their justifications for doing so varied. Participant viewpoints were influenced by the degree to which TBA involvement was seen as a long-term or short-term solution and by the tasks undertaken by TBAs.
  
  
  CONCLUSIONS
  Many forum members indicated that they were supportive of trained TBAs being involved in the provision of pregnancy care. Members noted that TBAs were already frequently used by women and that alternative options were lacking. However, a substantial minority regarded doing so as a threat to the quality and equity of healthcare. The extent of TBA involvement needs to be context-specific and should be based on evidence on effectiveness as well as evidence on need, acceptability and feasibility.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, UK. onikepe.owolabi@lshtm.ac.uk.
authors.forename: Onikepe Oluwadamilola
authors.initials: OO
authors.lastname: Owolabi
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.forename: Simon
authors.initials: S
authors.lastname: Lewin
authors.forename: Neil
authors.initials: N
authors.lastname: Pakenham-Walsh
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008880:Midwifery / Q000458:organization & administration*; D011247:Pregnancy; D011295:Prenatal Care; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012424:Rural Population; D000078329:Workforce