THE VITAL ROLE OF TRADITIONAL BIRTH COMPANIONS
Thanks to the generous contributions of 15 individual donors, we recently hosted a week-long training workshop for a group of Traditional Birth Companions (TBCs). This workshop was designed to enhance their skills, expand their knowledge, and equip them with tools to provide even better care to pregnant women and newborns in their communities. This comprehensive training exceeded our expectations and was an impactful week for all involved.
TBCs hold a unique and essential position within their communities. Historically, their primary role has been to assist women during home births, but today, they play a much broader part - supporting women throughout their pregnancies and encouraging them to deliver in health facilities. This transition has been crucial for maternal health.
Above: Traditional Birth Companions Waizera Legei, Polis Kester, Mulejo Mwasi, and LeeLee Rioto
Between 2020 and 2022, 88% of Kenyan women who gave birth did so in a health facility – up from 61% from 2009–2014 (Kenya DHS, 2022). When women deliver in a health facility, they are more likely to receive the care they require in the case of an emergency, such as haemorrhage, where rapid medical intervention can be life-saving. This increase in health facility deliveries is due to a variety of factors, and it appears to have made a significant impact on maternal mortality rates in Kenya, which have decreased from 530 deaths per 100,000 live births in 2020 to 355 deaths per 100,000 live births in 2022 (UNFPA). Although this remains above the global average of 233, this progress deserves recognition, and the role of the TBC cannot be overlooked when acknowledging the steady improvements in maternal health in Kenya. As Shadrack Noah Kuraru, TLP’s Community Liaison and a Community Health Promoter, observed, “These TBCs, these women, have their talents, and that’s why they are doing this work for free and willingly.” Their dedication to improving maternal health is evident, and the training provided them with the resources to do even more.
The workshop, which was delivered in partnership with the Laikipia County Ministry of Health, included 19 experienced TBCs, predominantly Maasai women (95%). They ranged in age with 5% aged 30-40, but the majority over 50: 53% aged 40-59, and 42% over 60. These women brought with them decades of experience - 32% have been TBCs for 10-20 years, while 26% have been in the role for over 30 years. While 58% had received some formal training, 42% had not, and 79% of those trained had never participated in a refresher course. Many TBCs continue blending traditional practices with modern approaches, with 42% using herbs to manage complications like bleeding or labor issues.
Shadrack Noah Kuraru delivering a session during the TBC training workshop
The training focused on a range of topics which proved important to ensuring a comprehensive approach. As Frankie Sadler, Director of The Caitlin O’Hara Community Health Clinic reflected, “What they learnt ranged from washing their hands and the importance of hand hygiene, all the way to learning about the newest evidence-based practice of HPV testing.” Adding, “This brings together a holistic approach, which is what we're trying to do at The Leo Project.”
Pre and post survey responses showed not only an increase in knowledge, but indicated that behavior will change as well. Before the workshop, only 63% of the TBCs said they would “always” refer a woman to a health facility in cases of prolonged labor, and 26% did not recognize labor lasting more than 12 hours as a danger sign - something that the WHO identifies as a critical risk factor. After the training, these numbers improved dramatically: 100% of participants identified prolonged labor as a danger sign, and 94% said they would refer a woman to a health facility in such cases. “I think the link between those factors is really important. By the end of the training, they're saying, ‘not only is it a danger sign, I'd refer.’ That's a really good knowledge change,” said Frankie. This change is profoundly important. Just last year, the clinic team was called too late to assist a woman experiencing prolonged labor, resulting in the tragic loss of her baby. Improved recognition and timely referrals could prevent such devastating outcomes in the future.
In addition to gaining a better understanding of risk factors and subsequent actions, the TBCs shared that they learned about balanced diets for maternal and child health, moving beyond staples like maize meal and milk to incorporate fruits and vegetables. Shadrack shared that following the training, several participants have begun purchasing vegetables at local markets, a meaningful step toward healthier eating habits for them and the women they support.
Addressing the sensitive topic of HPV and cervical cancer was another crucial element of the training. Shadrack explained, “Today, the community fears cancer more than HIV.” Providing the TBCs with information about HPV screening helped the women to understand the importance of early testing and prevention, allowing them to now discuss HPV and cervical cancer with their communities in an informed and de-stigmatizing way.
Frankie Sadler handing out a certificate of completion of the TBC training
One of the most profound outcomes of the workshop was the recognition it brought to the TBCs. Each participant received a certificate of completion of the training as well as a bag filled with essential tools, including gloves, solar powered flashlights, and safe disposal boxes for contaminated items. These symbolized more than resources - it was a validation of their work and a reminder of their critical role in the community. “When they have that black bag, with those small things like a torch, that will help them be recognized by the community,” explained Shadrack. As one TBC shared, “This training shows us that someone recognizes our work and wants to support us.”
By investing in their development, we help to ensure that the TBCs are partners in The Leo Project’s, as well as the government’s, work to improve the health of pregnant women in Laikipia County. This program has reminded us of a simple yet powerful truth: when you invest in people, you invest in the future.
If you would like to support additional TBC training workshops, or our work in general, one way you can do so is by donating.