by Imroze Goel
‘At last the joy of seeing a living child in my lap!’ Maghoo was delighted to have her first baby boy delivered at home by a trained traditional birth attendant (TBA).
Maghoo has to work with her husband and mother-in-law in the fields as men do and she has to cook for a large family. Poverty and poor health practice often threaten her. ‘Life is hard and without the proper knowledge and health awareness we rural people are blind,’ she says.
Maghoo lost her first four babies during home-based deliveries by an untrained TBA in the community. During her pregnancies, she had to walk long distances, sometimes in desert areas, to offer sacrifices, because her family believed that she had an evil spirit in her womb. They spent almost all their savings and sold their animals to try to get rid of the evil spirit. After eight years of marriage she could not give a baby to the family, who wished to see a baby born to their eldest son. Maghoo became very lean and anaemic.
The family started telling her husband to marry another wife, since she was not able to have any children for the family.
In the meantime the family had to move to another village. In this village there was a trained TBA who provided information about mother and child health, hygiene and safer childbirth.
Maghoo, pregnant again, was visited by the trained TBA, who saw that she was lean and anaemic and found complications. The next week a SaCHA (Sahara Community Health Associations) health team visited the village. During the men’s awareness session about maternal and child health, Maghoo’s husband took great interest and asked many questions. He shared his wife’s problem, discovered the facts and was pleased to get answers. He became motivated and took his wife to SaCHA’s women’s motivator and midwife who provided them with basic mother and child health care awareness, which changed their practices and their attitude towards safe delivery. Then, with the help of the TBA, she was taken to the nearest hospital regularly for antenatal care during her pregnancy. Her husband arranged and paid for the rickshaw transport. She visited a midwife regularly and received proper care and diet. Eventually she delivered a baby boy.
The family and husband were all delighted to see their first son. After learning from the maternal and child health counselling, they stopped all the wrong practices. Her husband is now not willing to consider marrying another woman. He allows Maghoo to use family planning and visit health teams – he even happily takes her to the clinics.
Maghoo was the victim of a lack of knowledge and of men’s power and control in women’s lives.
The two things that made a difference for Maghoo in her fifth pregnancy were:
- her husband’s care and wise decisions during her pregnancy
- care from a midwife and a trained TBA who helped her get medical advice during pregnancy.
The SaCHA team are continuing to run awareness programmes in communities on maternal and child health for men as well as for women. They show skits (short dramas), share messages, tell stories and involve the men who attend. Maghoo and her husband are now SaCHA volunteers, who themselves refer women and men to attend community meetings.
Imroze Goel is the Coordinator at SaCHA (Sahara Community Health Associations), Diocese of Hyderabad, Kunri, Pakistan. Maghoo’s name has been changed.
Traditional birth attendants (TBAs)
There is an ongoing debate among experts about whether trained TBAs are effective at preventing maternal deaths. As a result of research, some governments have decided not to provide money to train TBAs.
Many TBAs are poor and uneducated, but pregnant women within their communities often prefer to see them first, rather than a midwife or doctor from outside the community. The effectiveness of a trained TBA will depend on the quality of her training and her own motivation to change her practices. If there is still pressure from the community to deliver babies at home in the traditional way, and if the TBA fears missing out on income by helping women to see midwives and doctors rather than delivering at home, she may not provide the life-saving advice that is necessary.
Where possible, TBAs should help women ensure that they deliver in a health centre with a professionally trained midwife. However, the reality is that some TBAs work in remote areas, far from health centres and hospitals.
TBAs play a vital role in recognising problems during and after delivery, so that the woman who delivers at home and runs into problems can be transferred to a health centre to receive effective treatment as quickly as possible.
Maghoo was anaemic – having weak blood. Anaemia is common in pregnancy, because pregnant women make extra blood for the growing baby. It is a common cause of death that is easy to prevent.
Symptoms include tiredness, weakness and feeling faint, especially when getting up from a sitting or lying position. A good diet, including foods high in iron such as green leafy vegetables, eggs and red meat, can prevent anaemia from developing.
However, many women start pregnancy without iron stores in the body and cannot get enough iron from diet alone. Iron and folate tablets should be available as part of antenatal care at your health clinic.
To improve access to tablets and use by mothers:
- Instead of relying on mothers to come to the clinic for tablets, community health workers could give them out.
- Reassure mothers that black stools (faeces) are common with iron tablets, and that they should not worry.
- If the tablets are not available, or only available sometimes, then the problem should be taken up with the district health authority (see Saving a mother’s life).