Pro and Contra Home Birth

Kenya: 57 Year Old Woman Quits 35 Year Long Service as TBA (Traditional Birth Attendant) for Skilled Delivery Advocacy.

This newsletter is full of praise for natural birth, outside of hospitals, in the protecting atmosphere of family or community, accompanied by a midwife or doula. However, in Africa, facing HIV and other risks, governments, and NGOs are trying to stop home deliveries by encouraging the Traditional Birth Attendants to quit their work. Victor Odula, program officer of the Catholic Medical Mission Board (CMMB), describes the work of Mama Penina, an experienced TBA, and how she was convinced to stop her work.

If you ever get pregnant in Kanying’ombe village of Rongo district in Kenya, one name that will be synonymous with that situation is Mama Penina Mbori Wanga. Born in the year 1956, she has been a traditional healer from 1978 who uses traditional herbs to treat minor ailments. In the year 2000, she studied midwifery at Sirati Midwifery School in Tanzania for three years, and was licensed by the Nurses and Midwives Council of Tanganyika. Thereafter, she came back and set up her base in Kenya.

Over the years, she has been supporting women with reproductive health problems, for instance barren women, or those who have difficulty with conception. As she remarked when we visited her, “women who had problems with conceiving used to come here and I gave them herbs. After two months, most of them came back with the good news that they had conceived.” She says that she has perfected her skills over time and also passed them on to her sister in law, a nurse by profession.

Her fame has grown over time and soars beyond Nyanza Province. As she says, no one day would have ended without seeing a woman in labour coming to deliver. This popularity she attributes to her favorable charges for the services she offers, and even pro bono services, for those totally needy women. All these services, she does in her grass thatched hut which also doubles as the delivery and maternity room. Inside the maternity room, there is a delivery bed and a model used to train mothers in Family Planning.

However, in all these instances, Mama Penina undertook the deliveries oblivious of the risks that she poses both to herself, the expectant woman, and the unborn baby. Though she openly admits that she doesn’t have the facilities that might be required to perform a skilled delivery, she had continued with this trade nevertheless. For instance she conducted her deliveries even without putting on gloves!

In December 2012, she met Mary Kenyatta, who would influence her way of doing things. Mary Kenyatta is a CHW engaged in our Global Fund Program in Kanying’ombe Community Unit. In the course of carrying out her home visits, she talked to her about her trade, the advantages, and even the disadvantages. Above all, Mary talked to her on the need for a health facility for expectant women, and the risk of HIV infection for all parties during delivery as she was delivering without gloves. In spite of all these, it took Mama Penina three months to turn around and embrace the new knowledge and practice that was being implored upon her. Nevertheless, she decided to stop conducting any further home deliveries in February 2013, and instead embarked on advising her clients to deliver in the hospitals close to them.

To demonstrate her willingness to change, she ensured that her 25 year old daughter in law, Jennifer Akoth, whose pregnancy was also due in April 2013, underwent a skilled delivery at Rongo District Hospital. Interestingly, Mama Penina had had also trained Jennifer to be a Traditional Birth Attendant. It is worth commenting that Jennifer had her third delivery at the hospital, having conducted the past two by herself at home without any assistance.

In January 2013, Jennifer was referred by Mary Kenyatta and attended a PMTCT outreach for pregnant women that was organized by the program as supported by Global Fund. During the outreach, the women were sensitized on various topics relating to pregnancy, including an introduction to PMTCT, Ante Natal Care, the importance of skilled delivery, referrals and linkages.

During the outreach, they were also given a tour of the MCH facility, which was in sharp contrast to the environment she used to conduct deliveries in at home. With conviction from the outreach, she says, “I had to stop conducting deliveries for women at home because of the risks involved in it.”

It is from such acts based on informed decisions from people like mama Penina and Jennifer that eventually translate to some improvement of indicators of skilled deliveries at the health facilities. As the District Reproductive Health Coordinator for Rongo District, Mrs. Penina Okumu asserts, Rongo District Hospital used to lag behind, having only 70% of skilled delivery, but now it is at 97%. While commending Mama Penina Mbori’s move, she reveals that this is just one of the many steps that many TBAs have made in the district towards turning the tide against unskilled deliveries. A number of traditional birth attendants are now advocating for skilled deliveries.

Mama Penina, however, is now only treating ailments and not performing deliveries which were her major source of income. Her economical situation has become very bad. She is very much interested in keeping dairy cows or indigenous chickens, to make up for the loss of her original work.

Victor Odula suggests that GEN could collect money to sponsor 70.000 Kenyan Shilling (500 Euros) for a dairy cow. Those who want to help, please write to [email protected]

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15.09.2014