Story by Nadera Zohra Bouazza
Famata Hassan has a tragic relationship with childbirth. Her daughter was pregnant when she was forced to flee the conflict in north-east Nigeria. Despite the advanced state of her pregnancy, the young woman had no choice but to undertake a long and exhausting journey to safety. Once she arrived in Maiduguri, the bustling capital city of war-torn Borno state, she had enough strength left in her to give birth to twins. But not enough to survive. Famata has taken care of her two orphaned grandchildren since then.
Nigeria is a dangerous place to become a mother, with at least 800 women dying in every 100,000 live births. The highest maternal mortality rate is in the north-east of the country, where over 1,500 women die per 100,000 live births, according to WHO. These troubling statistics have turned maternity care into an urgent concern.
"Without these women, we would be doomed," Samuel Okech, responsible for health programs in Maiduguri for the International Committee of the Red Cross (ICRC), says bluntly. The women he refers to are neither health workers nor midwives, both professions in short supply in this corner of Nigeria. They are traditional birth attendants, like Famata. Most of them are older women, who have earned the trust and respect of their communities.
"Watch and learn! One day, I will not be here, and you will have to continue," Murja Goni's grandmother used to repeat, pointing to her eye with her index finger. A warning to her granddaughter that the longstanding birth traditions are passed down exclusively from woman to woman over generations.
Decades later, Murja vividly remembers these words, now that she became a traditional birth attendant herself. "I owe everything to my grandmother," she says, a shy smile on her face, her delicate body wrapped in a bright blue and red floral dress.I met Murja and Famata at the Shokwari Primary Health Care, where they attended a training session, along with a dozen other women. A hot morning wind was blowing through the tents of the makeshift clinic supported by the ICRC. Just a few hours before, Murja's phone rang. She had to get ready as a woman about to become a mother needed her help a few blocks away.
A few meters apart from the tent clinic, the bare concrete walls of what should have become a new health centre stand desolate against the barren landscape. The necessary health facility was destroyed in one of the flare-ups of conflict. In Maiduguri and all of the state of Borno, most of the healthcare centres are either damaged or destroyed. Another tragic consequence of the ongoing violence is the drastic lack of qualified medical personnel, reluctant to work in dangerous areas.
"In north-east Nigeria, there are no midwives in almost all the primary health facilities, especially in remote areas," explains Samuel Okech. "There is no other way to address this problem but to engage with the traditional birth attendants and train them," he adds.
Many health actors reproach to traditional birth attendants their lack of knowledge and dangerous practices. "Health professionals do not recognise them, but the communities rely on them heavily. They trust them," explains Peace Njideka Nwokorie, Health Assistant for the ICRC. "This is why we have to train them. For instance, we tell birth attendants not to burn the umbilical cord or lay expecting mothers to give birth on the ground."
About a dozen birth attendants in colourful abayas gathered months after having received training aimed at filling gaps in their medical knowledge and raising awareness of some risky traditional methods. Whenever asked about potential health complications during delivery, all of them give the same answer, as a well-memorised lesson: they have to refer patients to the hospital.
"Involving traditional birth attendants was a way for us to reach pregnant women and encourage them to come to the clinic, where we can detect complications," Okech explains.
Besides delivering babies, birth attendants play the role of confidants, as women have enough trust in them to open up about family conflicts and domestic violence.
"I want to help my fellow women," said Fatima Mustapha, who decided to become an attendant ten years ago, following the path paved by her neighbour. She also provides counselling to couples going through difficult times. Fatima recalls how she managed to reconcile a woman and her husband after five sessions at her home.
"This is not a job to make money. It's just a way to help", insists Falmata Muhamed, whose mother," had never collected a penny" for her much-needed services.