Every day, about 800 women die because of complications during pregnancy. Causes are multiple, but poor attendance for prompt and continued antenatal care, as well as access to skilled delivery, are among the main ones.

Repeated research shows that overcrowded health centers and overworked skilled health workers make facility visits largely unappealing for many women in the developing world. In addition, long wait times due to severe shortage of skilled health workers is also a problem.

In 2012, the World Health Organization released recommendations on “Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting” that suggests that until there are sufficient midwives or skilled health workers, one option is to train traditional birth attendants (TBAs) in simple outreach work so they can assist with monitoring low-risk pregnancies while referring more complicated cases to health facilities.

TBAs are ubiquitous in many regions of Africa and Asia.

They have learned their skills from older women in the community, generally through practical experience and oral tradition. The skills they acquire may not always be medically-sound and can even put a woman at risk, when training is not appropriate or they use unsafe traditional methods during the delivery procedure.

However, TBAs are very highly valued and respected women in their communities who understand the local culture and speak the local language.

TBAs provide guidance during the women’s pregnancy, are involved at the birth itself and may even assist in the post-partum period.

Although skilled health workers can often respond adequately to obstetric emergencies and save lives, TBAs are still preferred by community members. This is why the integration of TBAs into the formal systems may increase skilled birth attendance and help with the shortage of skilled health workers.

Training TBAs in non-delivery community-based roles helps with the burden of shortage of staff at the facilities, strengthens the relationship between TBAs and skilled health workers, and may even increase births at the facility because the women have the best of both worlds: skilled health workers who can deal with complications and the traditional birth attendant with whom they feel comfortable and can be an extra hand during birth.

MI’s Community-Based Maternal and Newborn Health and Nutrition project in Kenya is doing just this, training TBAs in non-delivery community-based roles.

Knowing that as a birth companion, the TBA’s role is the first point of contact for a pregnant woman in her community, MI worked to increase that role to one that supports a pregnant woman’s access to health care. The new role of the TBA to a Birth Companion includes accompany the mother to the health facility, and stay throughout labour and delivery, providing support to the woman as well as to the skilled health workers.

To formalize this transition, MI coordinated information meetings to sensitize the Health Facility Management Committees (HFMC) of 30 health facilities on “Birth Companions”. This ensured a collaborative relationship between health facility staff and Birth Companions.

The process was so successful that the HFMC initiated a resource mobilization strategy to support the work of Birth Companions, such as allocating funds from the health facility to provide transport reimbursement to birth companions.

Our project supported the Ministry of Health County guidelines to transition TBAs to Birth Companions.

Birth Companions report to be happy in their new roles as they still feel respected by their community, and respected by health facility staff, as they help reduce work load in an official and trained manner.  With official Birth Companion Service Cards and recognized apparel, they have a new role in their communities that everyone is happy with, including themselves.

So far, 345 birth companions have adopted their new roles of accompanying women to the facility for antenatal care, skilled delivery and postnatal care.

The United Nations Sustainable Development Goals aim to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. In Kenya, redefining the roles of TBAs is showing to be one way to improve maternal and newborn health. Having a voice in the community to encourage mothers to attend antenatal care and being a support to the pregnant women during delivery and extra hands for the skilled health provider are all essential in achieving this goal.

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