”I use a razor, scissors and thread,” says traditional midwife Peris Machanja, describing part of her work in delivering a baby. ”Sometimes I use gloves, which I disinfect to use for another job — that is, if they are not torn. If they are, I try to get new ones.”
Machanja (55), who lives in the low-income area of Kayole on the outskirts of Kenya’s capital, Nairobi, assists with about five births a month, although this figure can double during busy periods. Her fee for doing so is about $6,50 (about R39).
But, if Kenya is to reach the Millennium Development Goal (MDG) of reducing maternal mortality by three-quarters in the next decade, officials may have to call a halt to the work of this traditional birth attendant — and others like her. The risks of allowing them to ply their trade unhindered, says Kenya’s Department of Health, are simply too great.
According to the 2003 Kenya Demographic and Health Survey, conducted by the health ministry and the Central Bureau of Statistics, the maternal mortality ratio in the East African country currently stands at 414 deaths per 100 000 live births. (The survey is the latest of its kind to be carried out in Kenya.)
This is a far cry from the ratio of 920 deaths per 100 000 births, which the World Health Organisation says is the average for sub-Saharan Africa (giving this region the highest rate of maternal death in the world).
It still compares poorly with the ratio of about 20 maternal deaths per 100 000 births recorded in developed countries, however. This is blamed, in part, on the fact that many women die in the care of traditional birth attendants who lack the skills to deal with complications that can ensue during labour.
Twenty-eight percent of deliveries in Kenya are performed by traditional midwives, according to the 2003 demographic survey.
”At times, things become complicated, and when I sense that I arrange for the patient to be rushed to the nearest health facility,” Machanja says.
However, Josephine Kibaru, head of reproductive health services at Kenya’s ministry of health, claims that this decision is often made too late: ”By the time they refer women to health centres for specialised care, these women are dead.”
Government efforts to train traditional midwives in order to reduce the number of maternal deaths have met with little success, she adds.
”Right now, we do not have a choice. If we are going to meet the Millennium Development Goal of reducing maternal mortality by 2015, we have to do away with the TBAs [traditional birth attendants].”
The government hopes instead to have birth attendants inform Kenyans about other matters related to birth and sexuality, such as the use of contraceptives — and how to prevent transmission of HIV.
Nonetheless, some point out that Kenya simply does not have enough hospitals, clinics and medical personnel to help all pregnant women deliver their babies in an institutional setting.
”There is not enough medical staff, and the most [practical] thing is to try and work with what is there. That is why we are incorporating the TBAs in our programmes,” said Roselyn Gichira of the United Nations Development Fund for Women.
Even Kibaru concedes that staff shortages pose a problem in Kenyan health facilities.
”The government is training midwives but not employing,” she says. ”My department has been lobbying. We have written letters to the Cabinet asking them to recognise the need to employ since the ministry of health is about saving lives, but nothing substantial has been done apart from employing piecemeal.”
Still others point out that the problem of maternal mortality needs to be addressed at a more fundamental level, by helping women avoid the unplanned pregnancies that oblige many to give birth under less than optimal conditions. In practice, this means ensuring that all Kenyan women have access to contraceptives.
Last month, Minister of Health Charity Ngilu acknowledged that her country has some way to go in this regard.
Speaking during the launch of a report gauging the international community’s progress in implementing the MDGs, Investing in Development: A Practical Plan to Achieve the Millennium Development Goals, Ngilu spoke of the need for a ”rehabilitation of health facilities and improving contraceptives’ availability”.
But, this will involve spending more money on health services in Kenya.
At present, only 7,5% of government expenditure is allocated to the public health sector, even though Kenya has joined other African countries in committing itself to spending 10% of the Budget on health needs. This pledge was made in 2000 in Nigeria during the African Summit on HIV/Aids, Tuberculosis and Other Related Infectious Diseases.
Eight MDGs were agreed on by global leaders during the United Nations Millennium Summit in New York in 2000.
In addition to curbing maternal mortality, the goals aim to halve extreme hunger and poverty, achieve universal primary education, promote gender equality, reduce child mortality by two-thirds — and reverse the spread of Aids and other diseases, which take a particular toll on the developing world.
In addition, the MDGs call for strategies to ensure environmental sustainability — and for a global partnership to address the problems of trade barriers, Third World debt and other matters. The deadline for achieving the development goals is 2015. — IPS