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Birth companions aiding pregnant Maasai mothers deliver safely in hospitals

MOTHER

Enock Simel and his wife Sylvia Simel during an interview on Mother-to-Mother Support Group on August 30, 2021. EVANS HABIL

Summary

  • According to the Health ministry report on Oltepesi Dispensary, the number of women attending clinics increased from 166 in 2017 to 440 in 2020.
  • The number of pregnant women completing antenatal care visits increased from 17 in 2017, to 277 in 2020 while live births increased from six in 2017 to 261 in 2020.

It is almost midday on a slow Monday morning. Joyce Nkalo, from Embolei, is reporting at the Oltepesi Dispensary — Oltepesi Community Health Unit in Kajiado West sub-county, Kajiado County, ready to bring in her new client.

Ms Nkalo is a former traditional birth attendant with more than 47 years of experience. However, two years ago she became a birth companion.

Unlike before where she was tasked with helping pregnant women in surrounding villages deliver at home, her current role involves mostly referring these women to access hospital services at the centre, before, during and after delivery.

Her patient is Lenkoi (not her real name), a 25-year-old from deep inside Oltepesi who is due to give birth in a few days.

“This is my fourth child, but it is the first time I will be giving birth in the hospital. My other children were delivered by a traditional birth attendant,” she explains.

Ms Nkalo has been doing this for two years now. She brings up to five pregnant women to the facility daily. This, she says, was unthinkable years back as traditionally Maasai women have always sought the services of traditional midwives during childbirth.

According to Mami Kiperati, a birth companion in Oltepesi, at first it was not easy.

“But since we have had experience as traditional midwives, we have won trust among many women in Oltepesi, such that when someone is almost due, they don’t hesitate to call.”

The birth companions are usually available throughout the pregnancy and often an expectant mother seeks their services for several reasons such as fear of health workers, a lack of transport means to reach the health centres or even advice from close relatives.

Apart from ensuring pregnant women deliver their babies in the hospital, the work of a birth companion includes household visits to assess danger signs during pregnancy, as well as provide relevant information on maternal and newborn child health.

Their services also extend past the delivery stage. They follow up on the women and their babies for months, ensuring that they attend the antenatal clinics.

“We are also tasked with teaching the new mothers the importance of exclusively breastfeeding for six months,” adds Ms Kiperati.

She says exclusive breastfeeding for six months is a new phenomenon among the Maasai.

“Traditionally, immediately after birth, a baby is normally given a special crème from goat, sheep or cow milk that is meant to keep the baby healthy throughout. Also, there is another type of crème given to the baby twice a day, to prevent the child from feeling hungry, enabling the mother to carry out her normal chores,” she explains.

Pregnant Maasai women delivering in the hospital has not been fully accepted here but this idea of converting these traditional birth attendants into birth companions has changed the minds of many, without creating cultural conflict.

“As much as we wanted to bring change, we didn’t want to conflict with the community.

“We decided to use the people that the community trusts the most as far as issues to do with pregnancy and delivery are concerned. You cannot force them, otherwise, you will lose the fight,” says Martha Nyagaya, Nutrition International Kenya country director.

However, the project does not just end with the birth companions. It also comprises a father to father (Baba Anzilisha) and mother to mother (Mama Anzilisha) initiatives. The Baba Anzilisha initiative involves a group of men in the area tasked with ensuring that pregnant women in the area deliver their children in hospital.

Enock Simel and Isaac Ngongoni, 36, from Oltepesi have been going around villages doing what a while ago would have been unthinkable of a Maasai man.

They are members of the Baba Anzilisha project where part of their work has been to encourage men to take up the responsibility and ensure that their pregnant wives attend prenatal and antenatal clinics.

“We also encourage them to take their children to clinics and finish their immunisation,” says Mr Simel.

As they campaign on reproductive health issues, they have been teaching mothers about nutrition during pregnancy and after birth. They also train the women how to prepare healthy meals for their children.

“Traditionally, our staple foods revolved around meat and milk. For this reason, women here didn’t know much about the importance of including fruits and vegetables in their diets. We have taught them to include this in their everyday diet,” adds Ngongoni.

This joint initiative has had a massive effect here. According to Sheila Wambui, a nurse at the Oltepesi Dispensary, the number of pregnant women attending clinics has increased, with attendance in the past few years rising by 70 percent.

“This is because through sensitisation, now they understand the importance of doing so,” she adds.

According to the Health ministry report on Oltepesi Dispensary, the number of women attending clinics increased from 166 in 2017 to 440 in 2020.

The number of pregnant women completing antenatal care visits increased from 17 in 2017, to 277 in 2020 while live births increased from six in 2017 to 261 in 2020.

Also, in terms of nutrition, there have been changes.

According to Godfrey Ogembo, Kajiado West sub-county nutrition officer, due to an increase in health-seeking behaviours like antenatal attendance, iron and folic acid supplementation intake has continued to soar.

“Proportion of pregnant women who received combined iron or folate supplements increased to almost 100 percent in 2020,” he explains.

Acute food insecurity and malnutrition analysis data this year the National Drought Management Authority released in September, indicate that cases of acute malnutrition in children age six to 59 months in Kajiado were 2,930 out of a national total caseload of 142,809 while those experiencing moderate acute malnutrition were 11,719.

On the other hand, statistics on malnutrition among pregnant and lactating mothers in Kajiado County stood at 4,896, representing just more than five percent of the total cases nationwide.

On the other hand, even though data for Oltepesi health centres has shown that moderate acute malnutrition reduced from 57 in 2017 to 24 in 2020, cases of pregnant and lactating women with malnutrition rose from 39 in the same period.

“Community health volunteers have been trained to screen for malnutrition hence more referrals to the facility. Also, the increase in the number of mothers intending antenatal care means malnutrition is captured easily,” explains Mr Ogembo.

According to the National drought Management Authority analysis, these figures in the counties shows high levels of acute malnutrition, are also related to non-food security factors like social and care environment, access to health services, poor child care practices and overall healthcare environment in the arid and semi-arid land counties, Kajiado being one of them.

According to Ms Nyagaya, even though there are many drivers to malnutrition among children, as well as pregnant and lactating mothers, the importance of clinic attendance in the fight against this challenge cannot be downplayed.

“Hospitals and health centres are delivery platforms for nutrition information. They are also therapeutic feeding centres for curative and rehabilitative services,” she says.

Ruth Nasinkoi, Kajiado County nutrition coordinator, says hospitals are a reference system for community support for prevention.

“Children treated for acute malnutrition are referred back to the community from health centres, which work with community health volunteers who follow them up and ensure nutrition improvement achieved during rehabilitation is sustained through the support available at the community level,” she says.