Reduction of maternal mortality in Mandera County - the role of birth companions.

Tuesday 12 September 2017

By Agnes Egesa

Fatuma (left) with baby Barwaqa and her mother Gababo

Maternal mortality in Mandera County in northern Kenya remains the leading cause of death among women.This is further compounded by the long distances that they have to walk to access medical care. 

One of the major contributors to mothers giving birth at home with the help of traditional birth attendants (TBAs) is myths and misconceptions surrounding delivery of babies by male nurses at the health facilities. 

Save the Children with funding from European Union (EU) has supported the Mandera County health department to train TBAs converting them to birth companions in Mandera West, Banisa and Mandera South sub-counties.  Once trained, the birth companions identify pregnant women, ensure they attend at least 4ANC visits, support them in developing individual birth plans and accompany them to give birth in hospital.  

Shimbir Fatuma health center (in Mandera South sub-county) is amongst the 10 facilities supported by the EU fund. In November 2016, five TBAs were trained and converted to birth companions. In July 2017 Save the Children spoke to them to find out how the training has changed their attitude and that of their community members

Story in beneficiaries own words

“I used to sit at home and wait for women in labour to come for my services. I would deliver them using my bare hands. After each delivery, I would receive small gifts like pieces of bar soap, money or dress materials.” Mumina a former Traditional Birth Attendant (TBA) and now a trained birth companion at Shimbir Fatuma Health centre explains. 

Khadija also a former TBA says: “Young girls who were pregnant experienced a lot of difficulty as they gave birth mainly as a result of consequences of Female Genital Mutilation (FGM) . I used razor blades or our traditional knife to extend the birth passage and many times I would cut the baby’s head. The babies always bled to death whenever I cut their heads accidentally.” 

 “We had many women whose babies were delivered legs coming out first. Sadly, all these babies died. I would lose almost six babies in a month,” says Gababo now a birth companion.

Khadija adds: “Separation of the baby from the mother was very difficult. I used to pull the baby away from the mother until the cord separated. I would then apply grass to the bleeding portion of the cord hoping that the blood would stop flowing. Sometimes the babies bled to death. Women bled so much after giving birth. Every month at least two women would die due to bleeding.”

The facility nurse at Shimbir Fatuma Health centre, who works closely with the five birth companions says there has been a shift in health seeking behaviours in the community of Shimbir Fatuma. 

Gababo says: “In the past, we did not trust the health workers. Our culture does not allow a woman to be examined by a male health worker. We therefore discouraged women from delivering at the health centre because there were no female health care providers at the facility.”

So what changed?

The faces of the birth companions light up when the question is posed and they unanimously respond, “Training happened!” 

Gababo says: “The training that we received in November 2016 changed our way of thinking and doing things. We learned the importance of ante-natal care; hospital delivery and ensuring children receive all the vaccines. As soon as we came back, we mobilized all the women and informed them that we had stopped our home delivery services. We accompanied women in labour to deliver at the health facility and kept them company until they gave birth. Since December 2016, we have lost only one woman. She was referred from a village which is 30 kilometres away.”

“Our relationship with the health care workers has changed. We work very closely with them. We have the freedom to call them any time of the day and night. We now trust them. There is no single day that passes without one of us referring and accompanying a woman or a child to the health facility,” adds Gababo.

“Our greatest joy is that for the past six months, we have not lost any woman during labour, neither has a child died in Shimbir Fatuma. We have witnessed children who were born limp and looking lifeless brought back to life by the health workers. Previously, we used to think they were already dead. The hospital staff has also provided us with gloves for use in case a woman comes to us within minutes of delivery. In these instances we deliver them but inform the facility staff to examine the mother afterwards,” Says Mumina.

Fatuma, 32 is Gababo’s daughter. She gave birth to her eighth baby, Barwaqa just two months ago at Shimbir Fatuma health center. She says: “I had all my seven children delivered in my own house. But during my pregnancy with Barwaqa, my mother (Gababo) convinced me to attend ante-natal clinic. When labour started, she took me to the hospital and stayed with me until my baby was born. I have experienced the difference between delivering at home and at the hospital. I used to bleed a lot and suffer from abdominal pains. This time I lost very little blood and I was given medicine for pain when I left hospital. I have decided to join my mother in telling other women to appreciate the services provided at the health facility.”

Mumina and Hadija, both former TBAs


Shimbir Fatuma health center (in Mandera South sub-county) is amongst the 10 facilities operating as community health units, supported by the European Union (EU) fund. The project titled Accelerating the reduction in maternal, new-born and child mortality in Mandera County is a 30 months project covering six sub-counties. Save the Children is implementing the project in three sub-counties of Mandera South, Mandera West and Banisa, while Health Poverty Action is implementing in Mandera East, North and Lafey.

The project has supported training of 30 traditional birth attendants and re-orienting them as birth companions. Shimbir Fatuma has 5 trained birth companions.

The training of the five birth companions who were formerly TBAs, has contributed to the notable increase in facility deliveries which have doubled from 95 (Jan-June 2016) to 192 (Jan-June 2017). 4th ANC attendance has increased from 12 (Jan- June2016) to 56 (Jan-June2017) –source DHIS

Mandera County has the highest maternal mortality rates at 3,795 per 100,000 live births (UNFPA-Kenya).