I would not hesitate to claim that our intuitions about the ban being unjust are only characteristic of that which deters us as a people from making substantial progress: our rigidity when necessity demands making some conceptual paradigm shifts in our enterprises both as a nation as well as as individuals. It is incontestable that giving birth at a public health centre is safer, with minimal risks as contrasted with giving birth at the TBA. Generally the health centre is in this case more superior in terms of quality assurance unlike the TBA and hence logically it ought to be given greater preference over TBA’s. The two are incomparable. Thus holding all factors constant preference falls on the public health centres.
However the fact that the factors are not held constant does not raise the TBA’s over the public health centres. We concede that not everyone has immediate access to public health centres. Nevertheless one can still contend that in dire circumstances of acutely suffering from other diseases or medical complications all people in our remotest areas still endeavour to ensure that in one way or the other they get to a public medical facility in utter defiance of the long distances to be covered in getting there. This is where the opposition to the TBA’s ban manifests the problem of our unfounded reluctance to make a paradigm shift when there is every sufficient, efficient, and motivating reason to do so.
In our arguments over this pertinent matter we have to firstly bear in mind that the events and process leading to child birth are neither accidental nor unforeseeable. As such it is improper to regard a woman’s going into labour as though it totally ambushes with raw suddenness the mother-to-be, her family, and her community. The expectant mother’s advancing in days towards the day of delivery is, except for some isolated cases, of some other complications is something that is both anticipated and predictable. In any case this is why in our wisdom laden Malawi society we rightfully and meaningfully call a pregnant woman as expectant. Expectations co-exist with preparedness and the requisite fore-planning. Given the significant risks of giving birth at TBA’s planning in advance about being at the nearest health centre for delivery is the key that prudence would demand if indeed we are as mindful about the merits of giving birth at a health centre. If we see conventional public health centres as being an indispensable and crucial avenue towards the reduction and ultimately elimination of the immoral and unacceptable high infant and maternal mortality rates then embracing the public health centre, of course with its cost, must be the noble thing to pursue. It is not that health centres are in every local community’s immediate reach. However there is just nothing wrong or impossible with expectant mothers relocating to the nearest health centre or any place close by around two weeks or a week before the baby is due. Aren’t the consequent costs worthwhile? If indeed we place great value and un-paralleled preference in the health centre’s services such should seem a worthwhile alternative. Were the whole community (neighbours, relatives, chiefs, religious leaders etc.) to be collectively and actively engaged in ensuring safe child delivery by making sure that they do what is within their capacity to ensure that the expectant woman is taken to a health centre in time given the distance challenges among others, the unsafe and risky deliveries at the TBA’s would never pose as an indispensable option in safe maternity discourse. Essentially this is a matter of our community’s commitment to safe motherhood which if it be told, has a cost. The cost essentially demands a paradigm shift where upon appreciating the role TBA’s have played in our society we should still be able to exploit the greater opportunities and security guaranteed by their alternative. We must all aspire to have our mothers deliver at health centres no matter the cost. All we need to attain this are not health centres in every village. From the available dispersed health centres we can safe child deliveries if we have the will. Hasn’t the force of will power ever landed man on the moon, a once universally long-held impossibility?