Seeking to improve maternal health, child mortality

Nine months into pregnancy, Florence Joseph was home alone with her two toddlers when she began feeling pains and noticed she was bleeding. The hospital was some distance away and she couldn’t reach there by herself. She went to the first place that came to her mind, the ‘lady’ at the Christ Apostolic Church nearby […]

Nine months into pregnancy, Florence Joseph was home alone with her two toddlers when she began feeling pains and noticed she was bleeding. The hospital was some distance away and she couldn’t reach there by herself. She went to the first place that came to her mind, the ‘lady’ at the Christ Apostolic Church nearby who had given her a ‘hospital’ card at the early stages of her pregnancy. This ‘lady’ gave her two white tablets to swallow to stop the bleeding.
Her situation grew worse and the ‘lady’ shooed her to a hospital. Surgery was carried out to remove the already dead baby which was resting outside her ruptured womb. Ruptured from the prescribed two white tablets she took, the doctor explained, which also led to the death of her child.
With a dejected look and uncontrollable tears pouring down her cheeks, Joseph violently ripped the ‘hospital’ card to pieces in a silent response to the doctor’s comments.
Titilayo Omodara had successfully had her first child at a mission house run by a prophetess who also doubled as a TBA. Going there for the delivery of her second baby was natural. However, this wasn’t a pregnancy as easy as the first. She was attended to by an assistant to the prophetess who did something but it didn’t relieve her pain. Luckily, the prophetess came back and realised that Omodara was under an ‘attack’ which had caused her baby to be breached. As a result of never attending antenatal sessions during her pregnancy, the situation wasn’t diagnosed.
Knowing that she wasn’t equipped to handle the situation, Omodara was taken to a hospital where surgery was carried out and the baby safely delivered. Three days after, she was discharged. Mother and child went home hale and hearty.
The challenges of TBAs versus proper health professionals and facilities are issues health bodies are contending with across Africa and beyond. Ondo State isn’t an exception.
It was on account of this that Hala Nigeria, a product of the International Centre for Journalism (ICFJ), brought together TBAs, nurses, doctors and other health experts to a town hall meeting at the Babafunke Ajasin Auditorium in Akure, the Ondo State capital, on best practices to clearly outline the role of TBAs in maternal health and child survival, last Tuesday.
Conceived from the desire to find sustainable solutions to the barrage of problems pregnant women and new borns are exposed to, the one-day forum treated various angles to the issue while supporting arguments with compelling medical data from surveys carried out over time and first-hand testimonies of those who have been dealt major blows due to overwhelming cultural norms and practices.
Tagged: ‘The Role of Traditional Birth Attendants in Maternal and Child Survival,’ a significant part of this gathering was the media which Cece Fadope, coordinator, Hala Nigeria said needed to start reporting to include the voices of the communities and not just the officials.
“Our project is a journalism media project but it is also a health project engaging communities to participate more in health news. TBA is a very serious issue in Ondo State that everyone has an opinion about but they’ve never really been able to voice it,” Fadope said.
Passionate about maternal and child survival because maternal and child health is the really bases of primary health care, Fadope said there are many health challenges facing humanity: “When the babies and mothers are healthy, families are healthy and they can go about taking care of their families.”
Noting that Ondo offers free maternal and child health care, she added that: “There are not many states in Africa that have free care for everyone. So it is a big step that should be emulated.”
One of the elements of Ondo State’s ‘Abiye’ Pregnancy and Maternal Health project is the integration of TBAs into the hospital system with a requirement to refer their clients to hospitals. They receive a token N2, 000 from the state government for every pregnant woman referred and also acquire vocational skills in soap-making, baking, tie and dye. They are barred from continuing the practice of delivering the babies themselves. Regardless, many women still patronise TBAs.
Speaking on why many women still consider TBAs and mission homes relevant, Dr. Martins Iwunze of Centurion Health Mission, attributed illiteracy as the biggest conspirator because most of the women, especially those residing in rural areas, are not educated and perceive TBAs as safe havens.
Accessibility to proper health facilities is another factor he said, especially where traditional birth attendants are community based people who are readily available.
Other factors which promote the validity of such practices, Iwunze added, are the fear of Caesarean operation, cultural and religious values and beliefs which also play a key role in seeing TBAs as the only messiahs in child delivery.  
“With them in the community, there is a personal and intimate relationship built over time with each mother and infant under the TBAs’ care. The paucity of skilled personnel and medical facilities in rural, remote and hard to reach areas don’t help,” he said.
“While some traditional midwives earn the trust and confidence of members of their communities over the years, pressures from the family and community, opinion and religious leaders can influence a pregnant woman to seek traditional midwives.
“The socio-economic status of these midwives is compatible with the women they serve, and this encourages these women to consider traditional birthing a natural process,” Iwunze stated.
Dr. Dayo Adeyanju, Ondo State commissioner of health, discussing the ‘Role of Traditional Birth Attendants in Safe Childbirth in State and regional efforts to improve Mother and Child Survival,’ said Ondo had the worst maternal death record in the country with 756 deaths out of 100,000 births, which prompted the introduction of the ‘Abiye: Safe Motherhood’ programme, with a view of reversing the trend.
Others programmes introduced in that direction include Mother and Child Hospital, Emergency Medical Services/Trauma Centre, kidney Care Centre and Festival of Surgery, the commissioner added.
With emphasis on every pregnant woman coming out alive, Adeyanju queried cases where child or mother dies or both of them do: “How do we eradicate such calamity? Women should come to where delivery matters!”
Sighting records of pregnant women and tracking them down as one best practice, he said: “We realise that only 16 percent will come back while 84 percent goes elsewhere. To ensure that these pregnant women have safe delivery, the state government set up health rangers/vanguards who monitor them so that they can deliver in the right places, facilities were improved, along with renovations of five existing basic health centres.”
With measures in place to meet their goals, Adeyanju revealed that in the last four years, government has succeeded in reducing maternal deaths to 180 in 100,000 child births compared to 390 in 2012 and 317 in 2013.
Aiming to achieve zero maternal death level in the state, the TBAs and MHBAs, Adeyanju, hinted have a role to play, even in the light of incessant doctors’ strikes, but this ends at referral to proper health services.
The forum clearly suggested that the role of TBAs should be gradually phased out or completely banned in order to prevent pregnant women from untimely deaths and stillbirths.
Although, all seems to have been put in place to ensure best practices and service delivery, a lingering question is: Are the now ‘unemployed’ TBAs pleased enough with their new skills and token to leave their life long passions of being TBAs?
Amidst cheers and applause from the TBAs in contrast to the calm but deep countenance of the nurses sitting across as a video showed one Bayelsa TBA shake and massage a new born, a ‘former’ TBA who wanted to remain anonymous queried: “Who go buy our soap? Where light to bake the cake? How many of us want to be making tie and dye? [sic].”
She added: “What the government is doing is good because truly many of the women die in our hands especially in difficult pregnancies. But they for do us better, like training us to work with other nurses in hospital. That for pay us pass. [sic]”
Not out rightly admitting that she would continue or discontinue the practice, the respondent made it clear that the compensations by the government were not palliative enough.