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It’s Time to Support Africa’s Maternal Community Health Workers

Traditional Perinatal Care Workers Save Lives but Are Marginalized And Often Unpaid

A traditional birth attendant massages a pregnant woman before assisting in delivering her baby in Kibera, Nairobi, Kenya, July 3, 2020. © 2020 Brian Inganga/AP Photo

The world recently marked the United Nations’ first International Day of Care and Support, recognizing  the work that goes into the upkeep of millions of households and families globally.

This work includes supporting and caring for children, pregnant and postpartum people, older persons, and persons with disabilities. The vast majority of this work – 76.2% of care and support work – is done by women and, despite being crucial, it is often unpaid and not recognized by communities and governments.

Take work done by traditional birth attendants in Africa for example. Historically, a traditional birth attendant was usually an older woman who assisted women and girls during childbirth and acquired her skills through observation or apprenticeship. Today, the role of traditional birth attendants has been reimagined and restructured. With the support of private health care providers, traditional birth attendants are being trained by maternal health care professionals to provide education on warning signs during pregnancy; they are empowered and supported to refer women and girls to health facilities; and, in some instances, they are trained to provide safe, quality delivery care for uncomplicated deliveries.

Traditional birth attendants are easily accessible because they live in the communities that they serve. They are more affordable than services in most health facilities. They can provide dignified care that respects women’s preferences. Because of all this, many women and girls – about 24% in Eastern and Southern Africa – rely on traditional birth attendants.

Unfortunately, governments in many countries in Africa, including Kenya, South Africa, and Sierra Leone, do not formally recognize traditional birth attendants as part of national health care systems. This means that, unless private actors step in, traditional birth attendants are not engaged as paid staff and do not receive the training and resources they could use to better serve their communities. Some governments even occasionally institute bans against them and stigmatize their work.

In responding this way, governments disregard the clear evidence that working with traditional birth attendants helps to increase accessibility and quality of maternal health care, safeguarding the life and health of women and their newborns. It is also inconsistent with their obligations to respect and fulfil human rights and their responsibilities under the UN’s Sustainable Development Goals.

As we rightly pause to recognize the contribution made by care workers, governments should review their positions on traditional birth attendants and recognize and support their work, including by ensuring they are paid and resourced adequately.

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