Traditional midwives turn to champions for safe births

On a bench outside Charidende hospital in Bura, Tana River County, 42-year-old Shamsia Ali sits pensively while holding tight to a water bottle. Occasionally, she groans in pain. She is in labour and tired.

To get to the hospital, which is 29km away from her village, she had to use a boda boda to navigate the rough terrain. Coming to the hospital for delivery is a new experience for Shamsia. With the births of her other seven children, the situation was totally different. She gave birth at home with the help of a traditional birth attendant (TBA).

According to the World Health Organisation (WHO), a traditional birth attendant (TBA) is an individual who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or by working with other TBA.

Before the advent of modern obstetric facilities, women depended on the services of TBA but even as maternity hospitals mushroomed in different parts of the country, some quarters continued to seek the services of TBA.

In the midst of the pain, Shamsia shares that this particular pregnancy was a difficult one. “Unlike my other pregnancies, this came with a lot of pain and I have high blood pressure. The doctors who’ve been seeing me during my antenatal clinic said it would be risky to give birth at home,” she says.

But even without the doctor's input, Shamsia had long made the decision that she would give birth in the hospital having seen and heard of the dangers that come with home delivery. “It is a game of chance.” Her husband had reservations but she insisted.

Statistics from Tana North sub-county health coordinator Samuel Hidavu show that there has been an improvement in the uptake of skilled health delivery in 2022 compared to last year.

“For instance, in Chewele dispensary, there were 18 TBA deliveries last year but the number dropped to just three this year,” he says adding that some women seek antenatal clinics but don’t go to hospitals when due.

The livelihoods of Tana River North residents are tied to pastoralism and sometimes the search for green pastures drives them miles away from maternity hospitals.

However, when Healthy Nation engaged different women in the region who had previous deliveries at home, they complained about the long walk to the local clinic. Some said the health centre lacks adequate medical facilities while others cited traditional views, religious fallacy, poor road conditions, patriarchy, and lack of transportation means to reach the nearest health facility. Apart from these,  locals also prefer home delivery due to a lack of knowledge and awareness about service delivery points, fear of an increased chance of having a cesarean delivery at a hospital, and lack of female doctors in the local health care facilities.

According to the Ministry of Health, Kenya had one of the highest maternal mortality rates in the world— 488 maternal deaths per 100,000 live births in 2013. In that same year, access to maternal healthcare was made free with the goal to save lives by encouraging women to deliver their babies in hospitals. Although Kenya has made significant progress in reducing maternal and child mortality in the last decade, skilled birth attendants remain a great challenge, especially in rural areas.

In 2018, Tana River County government started an initiative to involve TBAs in interventions to curb maternal deaths. 

The TBAs are trained to enlighten pregnant women on the dangers of home deliveries. They also debunk myths and stereotypes about hospital deliveries. Further, the TBAs  encourage the women to adhere to both pre-natal and post-natal care.

In 2020, Kenya Red Cross partnered with the county government, supporting three health facilities to train TBAs to curb maternal deaths. The TBAs are given incentives for every referral. Women who choose to give birth in hospitals are also rewarded.

The training of the birth attendants has also helped in preventing mother-to-child transmission of HIV.

Kenya Red Cross is also running an initiative to increase awareness of reproductive health services in Kilifi County. According to Nicholas Sewe,  programme manager, they are working with 30 TBAs in Kilifi and 36 in Tana River.  

“Skilled hospital delivery has lowered maternal and neonatal mortality rates. We are also seeing an increased uptake of family planning, and child spacing enabling families to take part in economic development activities, which reduces their financial dependency and vulnerability.”

For more than three decades, Esha Nadiva has been devoted to helping women give birth. She has lost count of the number of manyattas she has entered, mostly at the wee hours of the night to help facilitate delivery.

“I gave birth to all my seven children, although one is deceased, at home. The birthing skill was passed on to me by my grandmother. Because of being at it for many years, I know when the baby is in a breech position and how to return them to the right path. However, home deliveries are wrapped with many challenges. There are cases of infections, excessive bleeding and as a TBA, you have to nurse the new mother back to health, which can be overwhelming,” she says.

Comparing the two experiences, Esha says that it is best to give birth at the hospital because of the availability of drugs, medical supplies, and aftercare services. “At home, all you have is your mind and herbal medicine. Also, in the event that something goes wrong, you can be blamed or lose clients. I was taught about the dangers of home deliveries and tasked to bring expectant mothers to the hospitals. I check on them after their first antenatal clinic and ensure that I accompany them to the hospital when they are due. I take about five women to the hospital every month,” she says.

“Two of the most common causes of maternal death in Kenya are hypertension and haemorrhage. We encourage women to give birth in an equipped medical facility to curb such deaths,” says Mr Hidavu.

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