Traditional Birth Attendants and Bone Setters: Roles, Evidence and Safety
Traditional birth attendants and bone setters are trusted community practitioners in parts of Africa. Their roles, research on training and complications, and when to seek urgent care.
Content last updated . This page has not been medically reviewed.
Start with safety
Childbirth and broken bones can both become emergencies quickly. The World Health Organization (WHO) says severe bleeding after birth can kill a healthy woman within hours if she is unattended, and that care by skilled health professionals before, during and after childbirth can save the lives of women and newborns. [1] For injuries, the UK National Health Service (NHS) warns that sudden, severe pain, swelling, numbness or tightness can start after an injury or if a bandage or plaster cast is too tight, and that this needs emergency treatment. [2] In the United States, call 911 for an emergency. This page describes two community roles with respect and then reports what research has found. It gives no instructions for delivering a baby or treating a fracture.Who they are
Traditional birth attendants (TBAs) are community members who assist women at childbirth outside the formal health system. Bone setters (also written bonesetters) treat fractures, joint dislocations and limb deformities using traditional methods. [3] Both roles differ between peoples, regions and countries, and the sources we read cover only some places, mainly Nigeria and Uganda. We do not generalize to the whole continent.Traditional birth attendants: roles and why families choose them
Researchers in Nigeria found that many pregnant women still rely on TBAs, that clients have developed confidence and trust in their services, and that efforts to phase them out have been firmly resisted. In interviews with 85 people in three states, community preference and cultural and religious practices that TBAs build into childbirth were reasons women used them. [4] In Mayuge District, Uganda, 12 women who had delivered with TBAs named affordability, emotional support, privacy and flexible payment as benefits. They also described health system barriers such as poor access, transport problems and mistreatment by health workers, while recognizing risks, including delayed referral and lack of emergency support. [5] These are small qualitative studies; they show why families choose TBAs, not how safe each birth is.What research shows about TBAs
| Question | What the source found | Strength of evidence |
|---|---|---|
| Does training TBAs improve outcomes? | A 2012 Cochrane review of six trials (about 57,000 births) found one cluster trial with lower perinatal death (adjusted odds ratio 0.70) in areas with trained versus untrained TBAs, but said overall evidence was insufficient to establish the potential of TBA training. [6] | Promising but limited |
| Does training lower deaths in newer pooled data? | A 2024 meta-analysis of six studies found lower perinatal and 7-day newborn mortality with trained TBAs but no clear effect on stillbirth, and rated the certainty low to very low. [7] | Promising but limited |
| Can TBAs handle serious complications? | WHO lists severe bleeding, infections, high blood pressure in pregnancy and delivery complications as the major causes of maternal death and urges that all births be attended by skilled health professionals. [1] The Nigerian interviews found that TBAs often do not refer clients early to formal facilities. [4] | Mixed; delayed referral is a documented risk |
The Cochrane authors note that WHO promoted TBA training from the 1970s to the 1990s as one way to reduce maternal and newborn deaths. [6] The Nigerian researchers suggested incentives for early referral and better links between TBAs and health centers. [4]
Bone setters: roles
A qualitative study of four bone setter centers in Nigeria found that the practice is kept as a family practice, training is by apprenticeship, records are kept by oral tradition, and there is no prescribed fee. Fractures were diagnosed by physical assessment and experience, reduced by closed methods and held with an external traditional splint. [8] The authors report that patronage is high, which is why the question of safety matters. [8]What research shows about bone setting
| Question | What the source found | Strength of evidence |
|---|---|---|
| Outcomes for simple closed fractures | The Nigerian study reported good results for closed fractures of the shaft of the upper-arm, forearm and shin bones, and poor results for fractures near joints and open fractures. [8] | Traditional use only (observational, not a controlled trial) |
| Serious complications | The same study found non-union, malunion, bone infection and limb gangrene to be the common major complications. [8] In Ibadan, of 25 patients seen with complications, 14 needed surgery for non-union or malunion and 2 needed amputation for gangrene. [3] | Evidence of harm in hospital series |
| Amputations | In a five-year review of 132 amputations in Kano, Nigeria, bone setter gangrene was the second most common reason (31.8 percent), and the three deaths occurred in patients who had had bone setter treatment. The authors judged most amputations avoidable. [9] | Evidence of harm in hospital series |
A caution for reading these numbers: all three are from hospitals, so they describe people whose treatment went wrong and reached a surgeon. They do not show how often bone setting goes well. No trial has compared bone setters with hospital care, and we did not find one. A published case report describes a child whose forearm was left in a tight splint despite pain, with a foul odor a week later and severe bone damage. [10] After any splint or cast, from any provider, the NHS warning signs above apply: severe pain, swelling, numbness or tightness. [2] A foul smell, as in that case report, is also a reason to be seen at once.
Qualifications and regulation
In the Nigerian study, bone setter training was by apprenticeship. [8] The Ibadan authors wrote in 2004 that traditional bone setting is practiced in Nigeria and most developing countries without government regulation, and called for legislation. [3] We did not find a regulator's own page for TBAs or bone setters, so we cannot say how either role is regulated today in any country; check with your national or regional health authority. See how traditional medicine is regulated by country.Questions worth asking
- Is there a plan to move quickly to a hospital if something goes wrong, and how far away is it?
- Who in the community vouches for this person, and have they worked with the local clinic?
- For a bone injury: has an X-ray been advised, and what are the warning signs if the splint is too tight?
See choosing a qualified practitioner and traditional healers and modern health systems. In pregnancy, read therapies in pregnancy.
Related pages
African traditional medicine overview and when traditional healing delays needed medical care.Frequently asked questions
Are traditional birth attendants safe?
It depends on training, access to emergency care and timely referral. WHO says all births should be attended by skilled health professionals, and Nigerian research found TBAs often do not refer clients early. [1][4]
Does training traditional birth attendants save lives?
It may. A Cochrane review found one trial with lower perinatal deaths, but called the overall evidence insufficient, and a 2024 meta-analysis found low to very low certainty benefits. [6][7]
Why do families choose traditional birth attendants?
Women in Uganda named affordability, emotional support, privacy and flexible payment, and cultural alignment, alongside poor access and mistreatment at facilities. [5]
Can bone setters treat fractures safely?
In a Nigerian study, results were good for some closed shaft fractures and poor for fractures near joints and open fractures, with gangrene, infection and non-union as major complications. [8]
What are the warning signs after a splint or cast?
Severe or worsening pain, swelling, numbness, weakness or tightness can mean dangerous pressure in a limb. The NHS advises emergency care. [2]
References
- WHO: Maternal mortality fact sheet. Read 2026-10-22.
- NHS: Compartment syndrome. Read 2026-10-22.
- Traditional bonesetters in south western Nigeria - friends or foes? West Afr J Med 2004. Read 2026-10-22.
- Demand and supply side factors that drive delayed referrals from traditional birth attendants to public primary healthcare facilities: three states in Nigeria. PLOS Glob Public Health 2024. Read 2026-10-22.
- Perspectives and lived experiences of postpartum women seeking health services from traditional birth attendants (TBAs) in Mayuge District, Eastern Uganda. Discov Soc Sci Health 2026. Read 2026-10-22.
- Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database Syst Rev 2012. Read 2026-10-22.
- Maternal and Child Health Training of Traditional Birth Attendants and Pregnancy Outcomes: A Systematic Review and Meta-analysis. J Epidemiol Glob Health 2024. Read 2026-10-22.
- The role of the traditional bonesetter in primary fracture care in Nigeria. S Afr Med J 2004. Read 2026-10-22.
- Indications and complications of major limb amputations in Kano, Nigeria. Ghana Med J 2013. Read 2026-10-22.
- Acquired boneless forearm as a complication of traditional bone setting. Orthopedics 2008. Read 2026-10-22.