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NAIROBI, Jul 26 2010 (IPS) - The government of Kenya has been encouraging women to deliver in hospital. Home deliveries by traditional birth attendants are considered to be a major contributor to maternal deaths.
TBAs are said to be ill-equipped to notice danger signs that could be fatal. The government has proposed banning traditional midwives altogether.
According to the last demographic health survey, released by the government in 2009, Kenya has one of the highest maternal death rates in the world at 448 per 100,000 live births. Home deliveries are believed to be a major contributor.
“When a woman goes into labour in the middle of the night in Mathare slums,” Elizabeth Sibuor, a traditional birth attendant in Nairobi, “the option of getting a taxi is out of question due to the cost and insecurity.
“Such women end up delivering with the help of TBAs. Pregnancy and labour is a matter of life and death, I will not sit back and let a woman and her baby, die if I can offer assistance.”
The 2009 demographic health survey shows less than half of women deliver under the care of a skilled attendant in Kenya. Fifty seven percent give birth at home with 28 percent assisted by a traditional birth attendant.
She often remains unpaid by her clients; of those who do, many settle their bill in small installments or in kind through gifts. Some cannot afford to make any payment, but she says she turns no one away.
Dr Isaak Bashir, the head of Reproductive Health in Kenya’s Ministry of Public Health and Sanitation, is emphatic the government should not recognise TBAs and that women should give birth with support from medical practitioners.
“For anyone to be recognised as a qualified birth attendant they must have commensurate papers from a recognised medical training college. The country is not short of qualified nurses and midwives. Institutions of higher learning are churning out enough candidates, what needs to be done is hire new people,” Bashir says.
But Monica Ogutu the executive director of Kisumu Medical and Education Trust (K-MET) says the health system has failed the women of Kenya.
“No woman wants to deliver at home. The health system is failing women. When a woman is in labour, she needs someone to listen to her and offer comfort. One midwife attending to 10 women at once will not have time for such a woman. This is one of the various reasons why women are opting for the services of traditional birth attendants,” says Ogutu.
While the government’s ban on TBAs may be well-intentioned, Ogutu says the move is dangerous.
Instead of demonising them, Ogutu argues the government should reinvigorate previous efforts to train TBAs as a bridge between the community and the public health system.
“For hundreds of years, TBAs have helped birth our nation and they are highly regarded in some communities, especially rural areas. Banning them will not make women who seek their services go to give birth in hospitals,” Ogutu says.
Sibuor insists that government – and women – have nothing to fear from traditional birth attendants.
“I have lost count of the number of women I have assisted during delivery in my over 20 years experience and no woman has died under my care,” she says. “When I notice danger signs, I accompany the woman to the nearest health centre.
“I encourage the women to attend clinic and also take their children for vaccination. I also insist they must get tested for HIV and if they are positive, I do not agree to deliver – they must go to a health facility.”
Sibuor says women such as Okoth will continue to rely heavily on TBAs. Instead of being perceived as incompetent, she wants the government to identify credible TBAs and help them to improve their service.
“The reality for a woman in Mathare slums is different from that of a woman in an affluent background. Because labour comes at anytime and could progress very fast, the woman in Mathare will continue needing my services. I will continue birthing this nation.”
It will be essential to accurately assess the quality of care given by women like Sibuor, and find an appropriate place within the country’s public health system.
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