Where traditional birth attendants rule

KWALE, KENYA: Binti Mohammed proudly affirms her admiration for her community’s traditions that still retain the age-old practice of giving birth at home instead of going to hospital as recommended by health authorities. “Delivering at home has been the norm in our family,” she says.

She is a resident of Kwale County where traditional birth attendants (TBAs) command a lot of influence and respect. The proud mother of five happily admits all her children were delivered at home with the assistance of traditional mid-wives.

As the old adage goes, traditions die hard. As far as she can recall, her family has always used the services of TBAs and no birth-related complications have ever arisen. 

“It’s part of our culture which no one in the family is about to discard. All my deliveries at home were safe and free of any complications.”

No need

According to Ms Mohammed, traditional mid-wives have always been part of the community’s life and she sees no need to do away with them as they play a critical role in assisting expectant women in rural areas where proper health services are often lacking.

“In fact, traditional birth attendants deserve to be appreciated for the services they render in the community instead of being ridiculed and vilified,” she says.

Another mother, Mwanaidi Faki concurs. “I delivered at home with the assistance of a traditional mid-wife after suddenly going into labour while at the village,” she says.

According to Ms Faki, the majority of women in the region still deeply steeped in traditional cultural practices prefer to give birth at home instead of going to modern hospitals as advised by health officials.

Their role is however frowned upon by conventional reproductive health service providers who have campaigned to the community to embrace government-provided medical services. This situation has led to endless battles between the conventional reproductive health services and traditionalists who are not willing to cede ground for fear of losing their source of income.

“Home deliveries expose mothers and their babies to risks that could culminate in death and should be avoided now that the Government’s free maternity care policy is in place,” says Mwanaisha Gakurya, the senior nurse in charge at Kwale Hospital.

Dangerous trend

Ms Gakurya says that this trend of home deliveries has persisted despite the introduction of free maternity services seven months ago. She also says that this exposes pregnant mothers and their newborn babies to numerous health risks that could be avoided or minimised if they sought hospital services.

According to Ms Gakurya, complications arising during childbirth could be greatly reduced if delivery is done at the hospital. She says reliance on TBAs had on many occasions proven risky, especially during complicated births forcing such cases to be referred to hospitals for specialised care. 

Recently, a 4kg baby who was delivered with the assistance of a traditional midwife died due to birth complications while the mother was rushed to the hospital due to a retained placenta at Chirimani village in Tsimba Location.

Officials of Kwale Hospital blamed outdated cultural beliefs and practices and ignorance for the preference for home deliveries in the area.

Medical reports show that the number of hospital deliveries remains high even after introduction of free maternity services in public hospitals.

Some local women prefer delivering at home for fear of being tested for HIV/AIDS at the early stages of their pregnancies at the hospital, according to health officials.

Another factor is high poverty levels which encourages home deliveries as majority of the residents cannot afford the cost of prenatal services.

Sharing beds

Health officials have been holding public awareness campaigns to encourage women to seek safe deliveries in health facilities but the response has not been very enthusiastic.

Fatma Koba, prefers hospital deliveries, though she admits it comes with challenges such as poor services characterised by negligence and overcrowding which sometimes forces patients to share beds. 

— KNA