For Minesi Nachione, 80, from Gamba Village in Traditional Authority Nthalire in Chitipa, being a traditional birth attendant (TBA) is the only job she knows. She has been doing it since 1972, until some four years ago when government banned TBAs.
Nachione recalls how she started practising. She was at her house when a pregnant woman arrived.
“She said she needed my services, she had nowhere to go. I assisted her and after that, she gave birth without any problems,” says Nachione.
That woman went back and told others how she had been assisted by Nachione. The news spread and that is how she started as a TBA.
During former president Hastings Kamuzu Banda’s era, TBAs were allowed to practise.
“In 1988, government recognised me and gave me a certificate after some training. I was also given kits, gloves and other equipment necessary for delivering babies,” she says.
But now, government banned TBAs. President Joyce Banda, when laying a foundation stone for a maternity holding shelter at Mulanje Hospital in May this year, emphasised that government does not want TBAs to deliver babies.
“Traditional birth attendants (TBAs) must stop delivering babies. TBAs can have another good role to play. Because they are experienced, they can be referral point,” the President said.
This, she says, will help reduce maternal deaths in the country, which hover at 675 per 100 000 live births. She also launched the Presidential Initiative on Safe Motherhood in April this year to support the same cause.
Malawi Health Equity Network (Mhen) executive director Martha Kwataine supported the President’s directive, arguing that more women die during delivery at TBAs than in hospitals. She still maintains her stand.
In an interview, Kwataine said distance is not an excuse for going to TBAs since the consequence of delivering at TBAs are worse than the energy spent on the journey.
“Distance can force people (to go to TBAs), but pregnancy is not an emergency. When you start antenatal clinic, you are told about the expected delivery date. You can, therefore, decide when to go to hospital,” she says.
Kwataine warned that there are issues such as obstetric fistula, ruptured uterus or HIV and Aids which TBAs cannot handle effectively since they are not trained.
But Limbani Gondwe from Church and Society of the Livingstonia CCAP Synod warned that distance should not be ignored when making determination on TBAs.
“Distance matters. We are looking at a place where public transport is not available. In this circumstance, women have no choice but to look for TBAs,” she said.
Another issue that has to be looked into are the facilities at the hospitals. Gondwe said even if some women can force matters and travel long distances to the hospitals, facilities, especially in rural hospitals, leave a lot to be desired.
Nachione says at one time, a woman came to her house after the ban was already issued.
“I told them to go to the hospital, but they refused. They even warned me that if their relative died, I would be responsible. Knowing how we live in the villages, I had no choice but to assist them,” she says.
Kwataine’s concern about HIV and Aids transmission is real.
For example, Gogo Nachione has no gloves or any equipment. The few items she has are the ones she got in the 1980’s.
“It’s been long since I got them. I do not have gloves and I use my bare hands to help women deliver. I know that there is HIV and Aids, but there is nothing I can do. It’s better for me to catch the virus while helping women than to leave them helpless,” she says.
The house she uses to deliver babies is not good either. It is a grass-thatched structure which has two rooms—one for ‘examination’ while the other for delivery.
The delivery room has an old bed with only a plastic mat and an old bed sheet on it. Some razor blades are on the window.
Nachione says she has helped to deliver many babies with no financial incentive whatsoever.
“I charge nothing. I feel it is a service to people and God will reward me,” she says.
Her appeal is for government to provide hospitals with midwives at convenient places throughout the country so that the ban can be successful.
“If delivery centres are at convenient places, women will not have problems going there. But sometimes they go there and there is no nurse to help them. This also has to be looked into. Because as long as nothing happens, I will not stop helping them,” she says.
There is talk that Nachiome’s equipment should be taken away as this will make her stop helping women deliver babies. But women in the village do not want to hear of it.
“Who will assist us in giving birth. If they want to take away the equipment, then government should provide an ambulance for us,” says one of the women who has benefitted from Nachiome’s services.
T/A Nthalire refused to comment on the matter.
With her rich experience and services in helping women to deliver, it is extremely difficult to stop women in her village from going to her. Government should find a common solution that will benefit both sides.