Black Midwives Alliance Meet Traditional Birth Attendants

Living in Zanzibar as a pregnant woman can be challenging when it comes to accessing health services. Despite the government and private institutions making many efforts, there is still a need for investment in healthcare provision. Research conducted by Fakih, Nofly, and Mrisho (2016) indicates that limited access to human resources and supplies, geographic distribution, and traditional beliefs contribute to the low number of women delivering in facilities.

In October of this year, we had the opportunity to visit Kizimkazi with visitors from the United States of America. The purpose was to observe the Kizimkazi clinics (both Dimbani and Mkunguni Clinics) and have discussions with local traditional birth attendants (TBAs) as part of our ongoing efforts to enhance maternal and newborn care.

Traditional Midwives chitchatting with the US Black Midwives.

A great way to kick off a conversation is to start with familiarization

Our hosts in Kizimkazi graciously welcomed us and the team from the United States. The visit began with a brief introduction from both sides. The local TBAs in Mkunguni, Kizimkazi introduced themselves and expressed gratitude for the support provided by our team from the U.S. During their introductions, numerous concerns were raised by the Kizimkazi birth workers. One particular concern that stood out is the stigma that is associated with accessing modern health services in remote communities. One of the TBAs, who is also a community health volunteer, stated that too many people in their village refuse to acknowledge their health problems in a timely fashion, and are often unwilling to seek help at modern hospitals and clinics. As a result, door-to-door visits have been conducted to educate and encourage those who are ill (both men and women) to seek assistance at clinics. Although there has been some progress, it is clear that collective efforts are required to bring about lasting change in this area. 

Birthing a healthy community as a result of interest and passion

“When I was a young girl, I used to help my mother out as she was delivering babies to several women in the community. My mother involved me, by assigning me several tasks such as handing over razorblades and many other things. Through all of this, I developed an interest in birth work”.

                                                                  -Traditional Birth Attendant

Traditional Birth Attendants in Kizimkazi.

The traditional birth attendants in Kizimkazi had a strong interest and passion for their work long before they received training and participated in seminars at Mnazi Mmoja Hospital in Zanzibar. However, they stated that during a training they had to attend in recent years, they were taught how to support vaginal births but not how to handle emergencies. Therefore, if any emergencies arise, they quickly transport the expectant mother to the hospital. Even in non-emergency situations, they ensure that both the mothers and newborns are taken to the hospital within 24 hours of birth. The local TBAs stated that collaboration between traditional birth attendants and hospital midwives is important. When there is a shortage of healthcare workers at certain delivery hospital, for example, they “could step in to assist with catching babies”.

“The current generation lacks the interest and passion in pursuing birth work”

-Traditional Birth Attendant

Another TBA voiced her concern about the lack of interest shown by young girls and women in learning about midwifery and birth work in general. She emphasized the need to involve them in this field and suggested that the situation arises from a limited opportunity to learn from traditional midwives at home, unlike during their time growing up. According to the TBA, this change can be attributed to the fact that most women in Kizimkazi now prefer giving birth at hospitals due to their increased awareness of its significance, which is in fact great!

Changes can be good, but also challenging

“As TBAs, how do you all feel about hospital births rather than home births. Have you seen changes in outcomes compared to before, when most women gave birth at home?”

-U.S. Midwife

During a conversation between a U.S. midwife and a TBA, the former inquired about any discomfort experienced due to recent changes in the delivery setting. The TBA responded, stating that in general, herself and fellow TBAs feel positive about these changes as they are significant, particularly in managing emergencies. This indicates that the local TBAs are accepting of modern childbirth practices. However, they also expressed concern regarding the high number of caesarean-sections compared to vaginal deliveries, which often have negative impacts on maternal health.

This issue sparked a discussion between the local and U.S. birth workers regarding possible reasons for the prevalence of c-sections. Does the current generation prefer this method? Are doctors not adequately trained to assess when a vaginal delivery is feasible? Or could it be attributed to negligence on behalf of healthcare providers?

Numerous questions were raised during this conversation, prompting suggestions from the U.S. midwives regarding the importance of comprehensive assessments for pregnant women who have previously undergone c-sections. Conducting such assessments would help minimize unnecessary c-sections by eliminating assumptions like "once a C-section, always a C-section."

Calling for Male Midwives

While it may be commonly assumed that midwives are exclusively female, it is important to note that men can also pursue a career in this field. However, the presence of male midwives is limited in both Zanzibar and the United States, and efforts should be made to encourage more men to enter this profession. By doing so, they can effectively contribute to improving the health of local populations and the global community.

Both the local TBAs and their counterparts from the U.S. emphasize the significance of prioritizing nutrition for pregnant women and those with newborns, as it greatly impacts their physical and mental well-being. Additionally, there is a shared agreement that home birth may be preferable over hospital births. However, there remains a major question regarding whether the infrastructure in Zanzibar is currently equipped to adequately support home births.

U.S. Black Midwives and Healthcare Providers of Kizimkazi Mkunguni Clinic.

After engaging in insightful conversations with the TBAs, the WAJAMAMA team and the crew from the U.S. expressed their gratitude to the local heroes for generously sparing their time and expressed excitement about future collaborations. Subsequently, both teams visited Mkunguni Clinic to observe firsthand its recent refurbishment and complete renovation by WAJAMAMA (You can read about this renovation by clicking here). They also took the opportunity to converse with clinic workers regarding any challenges they may have encountered in terms of service provision or availability of equipment.