Walking together Pairing tradition and modernity to improve maternal health care

A study carried out in pastoral communities in Kenya shows that maternal health outcomes can be improved by encouraging traditional birth attendants (TBAs) to work with skilled health workers.

The two-year study, a collaboration between Amref Health Africa, the University of Melbourne, Australian Aid and the Anglican Church of Kenya’s Mothers Union was carried out in the semi-arid Laikipia and Samburu countries.

It sought to find out the roles of traditional and skilled birth attendants; the attitudes of TBAs towards their own practice and towards skilled health workers, and vice-versa; community attitudes and experiences in relation to pregnancy and delivery care; and how to improve collaboration between the traditional and skilled birth attendants for the benefit of pastoralist women and newborns.

Speaking at the launch of a film and booklet on the study, Amref Health Africa’s Interim CEO Dr Lennie Kyomuhangi-Igbodipe challenged governments to consider what role TBAs might play in improving maternal health if they were well trained and linked to formal health system.
“TBAs can be effective care-takers and an important link to formal health facilities. Governments should use find ways of using all resources at their disposal to improve the health of communities, and TBAs are one example of such resources,” she said.

In comparing maternal health services provided by the two groups, the study found out that mothers preferred to be cared for by TBAs because they provided comfort and care during delivery including massage; were available, affordable and accessible; and provided extended post-natal care (2-3 weeks) including doing household chores and cooking for the mother, washing her and caring for the baby so that the mother could rest. However they were unable to handle complications in delivery, were unhygienic and gave poor dietary advice.

Skilled health attendants, on the other hand, were able to perform safe and hygienic deliveries, had valuable technical knowledge and could manage complications, and were able to refer the mothers who needed a higher level of care. But they were reputed to be physically and verbally abusive, left mothers alone during the labour process, and mothers were forced to deliver in environments that did not offer privacy or comfort.

Dr Michelle Kermode of the University of Melbourne’s Nossal Institute for Global Health said preliminary outcomes of the study indicated that by building trust, successful collaboration is possible between the skilled and traditional birth attendants. Ways in which they could work together include having joint antenatal visits, during which the TBA accompanies the mother for her appointments with the health worker, and also for the TBA to escort the labouring mother to the health facility, where the skilled health worker conducts the delivery and manages any complications.

In addition, said Dr Kermode, the TBA can stay with the mother as a birth companion at the health facility, making sure she is comfortable and well taken care of, and then she can provide post-natal care when at home. Development of pastoralist-friendly health facilities would encourage more women to seek skilled deliveries. Final results of the study will be released in the next three months.

The launch was attended by the Australian High Commissioner in Nairobi, Mr John Feakes, the head of the Anglican Church in Kenya, Archbishop Eliud Wabukala, and Dr Patrick Amoth, Head of the Division of Family Health, Ministry of Health Kenya.