December 2015 Dispatch

Dispatch 8, December 2015

MAISHA Working with Traditional Birth Attendants in Migori County In November the MAISHA team embarked on a new initiative to work with Traditional Birth Attendants (TBAs) from the communities it partners with in Migori County. TBAs have a long history performing deliveries at home and providing pregnant women with counsel and treatment in rural areas. Even though the Kenyan government outlawed home deliveries by TBAs in 2010, they continue to practice in some areas of the country. TBAs and home deliveries occur for a number of reasons, such as: tradition, distance to facilities, and comfort. In order to address all the factors affecting maternal health MAISHA has taken the lead to include TBAs in both the discussion and promotion of MNCH. Maternal health indicators, such as antenatal visits and percentage of facility deliveries in Migori County are among the lowest in Kenya. One factor contributing to these outcomes is the practice of TBAs. As mentioned above the challenges surrounding TBAs are complicated.

While the existence of TBAs is not entirely indicative of poor maternal health indicators, it can retract from women seeking maternal health attention and education at the facility level. Facility births are encouraged for a number of reasons including the utilization of critical antenatal visits

and the 15% chance that a birth will have complications, which cannot be adequately managed by an unskilled birth attendant. Simply put, deliveries conducted by skilled birth attendants at a facility reduce maternal and infant mortality.

Since the prohibition of home deliveries by TBAs in 2010 the TBAs have been ‘driven underground’. There is often tension between TBAs and health workers since the former have the potential to undermine facility-based care. Given this complicated dynamic MAISHA’s first aim was to gain the trust of TBAs. In order to do so TBAs were invited to take part in a sensitization day in the town of Migori. The sensitization meeting was one of the first times the TBAs had been brought together in a nonhierarchical setting to openly share their experience and interact with the Ministry of Health. The MAISHA team was overjoyed that 44 TBAs willingly attended the sensitization. However, it was clear that the TBAs were weary of the potential implications of the meeting.

Fortunately the meeting and subsequent training, led by Canadian facilitator Catrina Ziesman, emphasized inclusion over accusation – something which the TBAs had not experienced in some time!

Dispatch 8, December 2015 The goal of the TBA training was to inform and include TBAs in MAISHA’s maternal health work. The first day of training emphasized interactive activities that empowered the TBAs to openly share their experience and to introduce some basic maternal health information such as the importance of four antenatal (ANC) visits. Among the activities Catrina lead were exercises on communication and interconnections (bottom left photo). Since a number of TBAs are illiterate the training focused on simple, key messages. Unlike MAISHA’s FEMOC or CHV training there were no PowerPoint presentations or manuals to guide the training! Instead the team relied on a more holistic approach of discussions, singing, and dancing.

The second day of the training introduced more technical education including topics on postnatal visits, danger signs in both a mother and infant, and exclusive breastfeeding. In addition MOH facilitators, Charles and John (seen in the bottom right photo) delighted the TBAs with a role-play on myths and traditions common to TBA practice. This opened up an honest discussion about commonly held beliefs and allowed the TBAs to ask direct questions. For example, myths include that if a pregnant woman wears a tight skirt her baby will be born with the umbilical cord around its neck. While these myths may seem curious to some, it was critical that John and Charles regarded each inquiry with respect and sincerity.

Indeed, the success of MAISHA’s work with the TBAs is largely due to the emphasis the team placed on trust, respect and communication. Ultimately, we all share the same goal to ensure mothers and babies live healthy and happy lives!

In early 2016 MAISHA will bring together all the key stakeholders to discuss the new role of TBAs (which may take the form of pregnancy companions, maternal health advocates, etc.). It will be critical for CHVs, community members, and facility staff to recognize one another as equal and integral actors for the promotion of the maternal and newborn health. The MAISHA team looks forward to facilitating this monumental engagement and the subsequent improvements for maternal health!

Upcoming activities: The first three months of 2016 mark the last quarter of Year 4 for the MAISHA project and as always the team will be busy!

January 2016:  Income Generating Activities Training with CHV groups February 2016:  Male Focus Groups on Maternal Health Perspectives  TBA Multi-Stakeholder Meeting and facility visits in Migori March 2016:  Year 4 Reporting and Year 5 Planning