“We Treat, Jesus Heals” Exploring Transformative Diakonia with Traditional Birth Attendants in Crisis-Affected Rural Madagascar

This article explores how a Malagasy diaconal project promoting safe motherhood seeks to improve rural maternal health by training traditional birth attendants (TBAs), or matrons, amid health crisis. Specifically, the study examines the practices of TBAs and how their services are received by local communities. Applying an extended Theory of Planned Behaviour (TPB), which includes its three core components-attitudes, subjective norms, and perceived behavioural control- alongside individual norms, this qualitative study investigates the factors behind behavioural change leading to a decline in high-risk homebirths. The study draws on data from eight in-depth interviews with matrons and three focus group discussions involving young mothers, mature mothers, and key stakeholders. The findings provide a nuanced understanding of rural residents’ motivations for behavioural change, highlighting the complexity of maternal health decisions. The study suggests that the mere provision of public health facilities is insufficient to persuade rural populations to abandon unsafe birthing practices. Instead, factors such as attitudes, social norms, individual religious convictions, and external constraints-including economic hardship and geographical barriers-must be considered on a case-by-case basis. The research identifies diaconal training of local matrons as a crucial strategy for fostering transformative behavioural change and improving maternal health in Malagasy rural communities, even in crisis situations. The study’s contribution comprises offering an example of transformative diakonia in challenging contexts. Its findings contribute to the ongoing discourse on the renewal of diaconal practices aimed at enhancing the well-being of rural women. Moreover, it suggests that diaconal training may play a critical role in fostering the acceptance and establishment of safe birth facilities in countries like Madagascar, where maternal health urgently needs improvement.