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Purposive sampling followed by snowballing was used from January to December 2023 across rural communities in all six regions. Thematic analysis shows a shifting role from pregnancy care and childbirth, including FGM/C, toward acting as trusted mediators improving access to professional maternal and reproductive services. Conclusions support integrating TBAs within a broader midwifery-led model for cost-effective, equitable care aligned with universal health coverage goals.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/unlocking-the-potential-of-traditional-birth-attendants-in-somaliland-a-qualitative-study-on-healthcare-system-integration/434935/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/unlocking-the-potential-of-traditional-birth-attendants-in-somaliland-a-qualitative-study-on-healthcare-system-integration/434935.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What did the study aim to explore about traditional birth attendants in Somaliland?","Question",{"text":112,"@type":113},"It explored the past and current roles and practices of traditional birth attendants from their own perspective, especially in relation to the formal healthcare system.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the study conducted and what time period did it cover?",{"text":117,"@type":113},"An exploratory qualitative design used purposive sampling followed by snowballing from January to December 2023 across Somaliland’s rural communities in six regions.",{"name":119,"@type":110,"acceptedAnswer":120},"What main shift in traditional birth attendants’ role did the study find?",{"text":121,"@type":113},"Traditional birth attendants increasingly function as vital links and trusted mediators between communities and the formal healthcare system, supporting access to professional maternal and reproductive health services.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434935,1790905966,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Open access Original research  \n Unlocking the potential of traditional  \nbirth attendants in Somaliland: a qualitative study on healthcare system integration  \nJama Ali Egal  ,1,2 Amina Esse,3 Fatumo Osman  ,4 Kerstin Erlandsson,5 Marie Klingberg-Allvin6  \nTo cite: Egal JA, Esse A, Osman F, et al. Unlocking the potential of traditional birth attendants in Somaliland: a qualitative study on healthcare system integration. BMJ Open 2025;15:e097956 . doi:10 . 1136/ bmjopen-2024-097956  \n► Prepublication history for this paper is available online. To view these files, please visit the journal online ([https://doi](https://doi). org/10 . 1136/bmjopen-2024- 097956) .  \nReceived 13 December 2024 Accepted 05 December 2025  \n© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.  \n1Health and Welfare, Birmingham City University  \n-Edgbaston Campus, Birmingham, UK  \n2Faculty of Nursing and Midwifery, University of Hargeisa College of Medicine and Health Sciences, Hargeisa, Please select, Somaliland  \n3Faculty of Nursing and Midwifery, University of Hargeisa College of Medicine and Health Sciences, Hargeisa, Woqooyi Galbeed Region, Somaliland 4Dalarna University, Falun, Sweden  \n5Dalarna University, Falun, Dalarna, Sweden  \n6Karolinska Institutet, Stockholm, Stockholm, Sweden  \nCorrespondence to  \nDr Jama Ali Egal; [jaa@du.se](jaa@du.se)  \nABSTRACT  \nObjectives The roles and functions of traditional birth attendants in the community and in relation to the formal healthcare system have to the best of our knowledge, not previously been explored in Somaliland. This study aimed to explore the past and current roles and practices of traditional birth attendants from the traditional birth attendants’ perspective.  \nDesign An exploratory study was conducted using purposive sampling technique first followed by snowballing technique from January to December 2023.  \nSetting Somaliland rural communities in the six regions of the country.  \nParticipants Traditional birth attendants from all six regions of Somaliland were interviewed. Thematic analysis inspired by Braun and Clarke was used to analyse the data.  \nResults Traditional birth attendants were historically involved in pregnancy care, childbirth and the practice of female genital mutilation/cutting. Their role has undergone a significant shift in recent years. Traditional birth attendants are increasingly acting as vital links between the community and the formal healthcare system. They report that they have maintained strong trust within their communities, which positions them as effective mediatorsin promoting access to professional maternal and reproductive health services.  \nConclusion Traditional birth attendants are becoming trusted intermediaries between the community and the formal healthcare system. In the pursuit of universal health coverage and the goal of delivering high-quality, equitable care for all, leveraging traditional birth attendants as part of a broader midwifery-led care model offers a costeffective strategy in the Somaliland context.  \nINTRODUCTION  \nBetween the 1970s and 1990s, to reduce maternal deaths, the WHO invested in training traditional birth attendants (TBAs) which was successful in reducing stillbirths and perinatal and neonatal deaths, but unsuccessful in reducing maternal deaths.1 2 The operational definition of a TBA in this study is in accordance with the joint WHO/UNFPA/UNICEF  \nSTRENGTHS AND LIMITATIONS OF THIS STUDY   \n⇒ Native-language, open-ended interviews by native researchers enhanced data reliability and captured rich personal and contextual insights.  \n⇒ Purposeful regional sampling ensured diverse experiences; thematic saturation was reached with recurring key themes.  \n⇒ Lack of data triangulation (eg, midwives, health officials, service users) reduced trustworthiness and limited the holistic understanding of traditional birth attendant (TBA) roles. ","cbCaiuZUTMygd6pj","https://ap.wps.com/l/cbCaiuZUTMygd6pj","pdf",294827,"English","# Abstract\n## Objectives\n## Design\n## Setting\n## Participants\n## Results\n## Conclusion\n# Strengths and limitations of this study\n## Data collection approach\n## Sampling and analysis\n## Limitations","[{\"question\":\"What did the study aim to explore about traditional birth attendants in Somaliland?\",\"answer\":\"It explored the past and current roles and practices of traditional birth attendants from their own perspective, especially in relation to the formal healthcare system.\"},{\"question\":\"How was the study conducted and what time period did it cover?\",\"answer\":\"An exploratory qualitative design used purposive sampling followed by snowballing from January to December 2023 across Somaliland’s rural communities in six regions.\"},{\"question\":\"What main shift in traditional birth attendants’ role did the study find?\",\"answer\":\"Traditional birth attendants increasingly function as vital links and trusted mediators between communities and the formal healthcare system, supporting access to professional maternal and reproductive health services.\"}]","Unlocking the potential of traditional birth attendants in Somaliland - a qualitative study on healthcare system integration | PDF",1790671166,23]