No more giving birth at home for women in Kenya

Former traditional birth attendant Jane Mukuyi who is now an advocate of hospital deliveries.
Nine years ago, Jane Mukuyi was one of the traditional birth attendants (TBA) that the Ministry of Health reached out to, in response to a World Health Organisation (WHO) policy.

The WHO wanted TBAs trained on emergency child birth and transform them into birth companions who would advocate for hospital deliveries.

When Jane received this training, it was an eye opener for her as she knew no other way to tend to and deliver expectant mothers other than what she has learned from her grandmother.

“That is when I realised we were conveyors of ill health and not of life as I had previously thought,” she says.

Jane’s journey into a traditional birth attendant started when she was a 12-year-old growing up in the backwaters of Chepkara in Busia County. Her grandmother was by then a renown TBA and because Jane was very close to her, she would assist the elderly woman perform her vocation.

“She would send me for things while I watched her deliver pregnant women. When I got married at the age of 21, and moved to a nearby location, I too, started practising. My grandmother’s reputation had preceded me and they assumed rightly that I was likewise gifted and inclined,” she says.

While Jane was actually a nursery school teacher, pregnant women sought her out and she gladly volunteered her services — helping women through pregnancy and delivery.

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“I would wake up at around 6am to find them waiting outside my house, most of them not having even washed their faces. They wanted me to touch their bellies and let them know the progress of their babies. They would come for me to massage them with oil, or just because they had woken up from an uncomfortable night,” she says.

Jane says many of these woman came in as many times as thrice a week during their pregnancies, effectively turning her home into some kind of clinic.

“In the latter parts of their pregnancy, I would massage them to ensure the baby was presenting well. Sadly, I have since learned that this could actually mess things up for the baby and the mother,” she says.

Not only was Jane’s home a clinic, it would also sometimes become a labour ward and a maternity ward. She explains:

“When a woman went into labour, depending on our agreement and her condition, I would either go to her house or she would come to mine. In mine they would deliver in the kitchen. In theirs, it depended on how many rooms they had. The idea was that men could not be part of the process. If there was only one house, they would make themselves scarce.

When a woman was due, I would prepare a herbal concoction to rub her with during labour. She was not supposed to have had a bath before then. At the point of child birth, she would get down on her knees, legs apart, and I would guide her to push down the baby.

Twice there were complications that led to the babies coming out leg first, but thankfully I successfully managed all such cases without a single fatality. I never delivered a child that was in breach. In a normal situation, I would wait for the head of the baby to present, then using my thumb nail, cut her down there to allow the baby to come out. Once the baby was out, we would use one of the mother’s garments, normally a dirty one, to cover it. We would cut the cord using the bark of a sugar-cane.

The woman had to stay indoors for three days. She would not bath. She would use an item of clothing that she had worn to get to my house to catch her flow. It was all very dirty and unhygienic, and yet I knew no other way”.

It was for this reason that TBAs like Jane, were incorporated into promoting safe deliveries by teaching them a better way to handle pregnancy related issues and child birth.

Save The Children Behaviour Change Communications Coordinator Abraham Wanyonyi says the role TBAs play cannot be ignored.

“More than 50 per cent of unskilled deliveries are conducted by these women. Their availability has had a negative impact on efforts to have women deliver in hospitals under sanitised conditions and the only way to reverse this was to rope them into our efforts,” he says.

Wanyonyi notes despite their being a National Health Policy (2007 – 2012) that required all TBAs to  stop providing child birth services and instead accompany pregnant mothers to health facilities, there had been minimal gains made.

“We found that this law was not giving us the required outcome. It was nothing more than a statement and we had to do more to make it a reality,” he says.

This is where the partners came in. They use the training curriculum adapted from AMREF’s Linda Afya Mama Na Mtoto to reorient traditional birth attendant on their roles. They also give them a small reimbursement towards transport and have monthly meetings with them.

“For many of these women, this is a calling. I remember when HIV became widespread many TBAs in Western and Nyanza provinces were wiped out by it. You can imagine the hygiene issues, the infections, I mean many health facilities are still struggling with hygiene control. These challenges are more than doubled in a poor old woman’s house,” Wanyonyi says.

Thanks to the training she received, Jane is now an unrelenting firebrand with regard to getting women to attend clinic and deliver in health centers.

From being the one sought out to offer clinics, she now accompanies them to hospital and seeks out those who are resistant sometimes to the point of having interventions that involve the husband or the chief to get the women to go.

“They are tough but I am tougher. I go with them for their initial clinic, then for the fourth of the five mandatory times, and then for delivery. I will ride with the woman on the bodaboda ambulance, and will only deliver her if there is a roadside emergency. Otherwise, I go with her to the health center, and stand by her taking care of her needs throughout labour. I act as the link between her and the health facility staff on how far she has gone, and also alert them if I sense there is trouble. I will also accompany her back for post-natal clinic,” she says.

Violet Nyongesa, a nurse at Bunyala Sub-County Hospital, says the role Jane and her fellow TBAs play is invaluable.

“They have really helped raise the number of women giving birth in health centres from 30 to about 100 in a month. We are normally understaffed with about three nurses on duty at any one given time so their presence also makes life easier for us.

When they come in with the mothers in labour, they stay with them, they get them water to shower, clean them after delivery and give them clean linen. They are also usually much better able to communicate with the women than we are. They are really part of the team,” she says.

Donning the Birth Companion A

apron in solidarity with Jane for this interview, Violet, however, laments that these women’s role is thankless in terms of remuneration.

“With all they do, we are not even able to offer them a cup of tea,” she says.

Outlining the importance of hospital delivery, the nurse says the newborn is kept warm, the environment is hygienic because it is sterilised, and they are also better placed to quickly respond to any emerging challenges.

“When a child does not cry at birth, we are able to resuscitate them. It is also easier to register a child who has been born in a health center,” she says.

Jane now makes a living from her farm and also receives support from her four grown children of whom she is very proud.

“The training that the partners have given us have earned us renewed respect within the community. The uniforms they have provided make us stand out in a good way. We are also involved in Table Banking. I love that I am now helping give life the healthy way,” she says.

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