Sitting on a hospital bed at the Entasopia Health Center, Tipaiya Nadoonyek smiles weakly as she cuddles her lastborn. After a long and difficult labor, she is now the proud mother of a bouncing baby boy weighing 4 kilograms. This is the first time that 45-year-old Tipaiya has delivered at a health facility.
Her other children were delivered at home with the help of Pesi, a traditional birth attendant. As maternal health statistics indicate, every minute a woman in Africa dies during child birth. Tipaiya is lucky to be alive, unlike many women in her community who have died while delivering at home often unattended or with the aid of unskilled traditional birth attendants.
In the traditional African setup, the roles of traditional birth attendants are deeply entrenched within the community's culture and cannot simply be wished away. Among the Maasai for example, they are held in high esteem and validated by the boma setup where the elderly women are called upon to handle exclusive female issues such as delivery. Their bonds with pregnant women are extremely rigid and they ultimately decide where a woman delivers.
Sadly, traditional birth attendants cannot prevent the maternal deaths that occur during and after childbirth as they are often not able to effectively handle birth-related complications, such as excessive bleeding and fetal distress.
To address this matter, the Ministry of Health under its National Health Strategic Plan 2005-2010, directed that all women deliver under the watch of a skilled health worker. To reach this goal, AMREF is re-training traditional birth attendants and training midwives across Kenya. In the Magadi division, we have gone on to train over 120 traditional birth attendants with a view to sensitizing and enabling them to take on new roles of referral.
At one such training, traditional birth attendant Pesi got to learn about the dangers of home deliveries and the importance of pre-natal clinics for pregnant women. With encouragement from Pesi, Tipaiya, her client, dutifully began to attend pre-natal care, where she was found to be malnourished and subsequently placed on a feeding program run at the Entasopia Health Center. When the time came for Tipaiya to deliver, Pesi accompanied her to the hospital and was right beside her during the whole process as the baby was safely delivered.
"In their new role, traditional birth attendants now provide an important link to the formal health care system in much the same way as community health workers," says Josephine Lesiamon, project manager at AMREF's Maternal Newborn and Child Health Project in Magadi. "The new arrangement also factors in a stipend for the traditional birth attendants for every referral made," she adds.
However, a lack of qualified health workers is not solely responsible for maternal deaths among the Maasai, as well as other peoples in Sub-Saharan Africa.
Distances to health facilities and unfriendly health facility staff have been cited as some of the reasons behind home deliveries. Tipaiya, for example, lives 5 miles away from the nearest health center. It was not easy walking to and from the health center in her condition. During the just ended long rains, a pregnant woman drowned as she attempted to cross a river on her way to the health center. The tales are sad and numerous and the deaths needless - but these are concerns that health care partners have to grapple with in order to comprehensively address issues pertaining to safe motherhood.
Although the impact of training traditional birth attendants in referral roles has not been measured, it is hoped that it will go a long way in reducing maternal and child deaths and ultimately contribute to the achievement of the health-related Millennium Development Goals 4 & 5 in Africa.