“We Only Escort Women to the Health Facility”: Traditional birth attendants and the performance of indicator-driven care in rural Tanzania

Abstract

Global health regimes have reversed the role of traditional birth attendants (TBAs) from partners in the fight against maternal and child mortality to barriers to indicator-driven care. In rural Tanzania, widespread fear of government surveillance and punishment for non-compliant individuals and organizations that climaxed during the presidency of the late John Magufuli (2015–2021) put increased pressure on TBAs. To negotiate tensions, TBAs adopted the position that they only escort women to health facilities for birth. We argue that TBAs’ insistence on this only both occludes and protects their multiple caring roles and responsibilities in a context of harsher home birth penalties, yet limited efforts to improve systemic shortages in the rural health system. TBAs’ performance of “we only escort women” operates both as the sedimentation of policies, a way to resist them, and means to hold space for TBAs in the wake of ambiguous global and national health policies.