An Outlawed Profession Gets New Life

According to the 2009 Kenya Demographic Health Survey, 56% of births in Kenya still take place at home. In many cases, women deliver at home with traditional birth attendants. However, since the Kenyan government outlawed home deliveries by traditional birth attendants, many Kenyans—especially those in low income areas—have had to adjust.

The banning comes after the Ministry of Health concluded that home deliveries by traditional birth attendants are a major contributor to maternal deaths. The government indicated that these birth attendants are often ill-equipped to notice danger signs during delivery that could be fatal. Their lack of delivery equipment also increases the possibility of HIV transmission.

While the adjustment has been challenging—both for women used to delivering at home and to the birth attendants who relied on home deliveries for income--some traditional birth attendants are already embracing a different lifestyle. Monica—a traditional birth attendant from 1998 to 2008—has overseen more than 60 deliveries. Though none of her clients ever died in her care, Monica recognizes the broader impact of this practice on maternal and child health. She now works as a companion for pregnant women in her community, linking and encouraging them to visit health facilities.

Monica's change of heart comes as a result of trainings received from the government with the support of Pathfinder's USAID-funded APHIA II project.* She is now a community health worker and an advocate against home delivery. The people in Monica's community trust her and continue to call on her during labor. Monica still answers their calling, but instead of charging for services as a birth attendant, Monica now offers her advice and companionship free of charge. She provides counsel, emphasizes the importance of visiting a health clinic, encourages saving money that may be needed during delivery, and educates women on breastfeeding.

When Monica's neighbor Lydia went into labor, the first person she called was Monica, who quickly got a taxi and accompanied Lydia and her husband to a nearby hospital. There, Lydia was examined and sent back home with a prescription saying that her pains were normal and not a sign of imminent delivery. Unconvinced, Monica told the couple that she would not switch off her phone in case they needed her. As feared, at 4:00am, Lydia's husband called saying that the pains were increasing. Not wanting the woman to deliver her first child at home, Monica rushed them to the hospital again. This time, Lydia was hurried to the delivery room, where she delivered a healthy baby. Since delivery, Monica has been following up to ensure Lydia takes the child for immunizations and breastfeeds exclusively.

Although many women in Kenya still prefer to give birth at home with a traditional birth attendant, encouraging examples like Monica demonstrate the path to change. The more traditional birth attendants that are mobilized, and offered the education to become community health workers, the more comfortable communities will become with changing traditional home birth practices—and the more lives that will be saved as a result.

*APHIA II has now transitioned in a new project known as APHIAplus.

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