Mixing Tradition and Training for Healthy Births

By Lane Hartill

Imagine for a minute that you are pregnant and living in Nungu, a village in northern Ghana. You're in your ninth month and, one night, contractions start. You know it's time to deliver. And for help, you have one choice: Karim.

You waddle over to Karim's compound, where you duck into a mud hut. A curtain divides the room. Behind it is a blue mat on the cement floor. This is the delivery room.

Karim tells you to squat. Two people hold you under your arms if you don't have the strength to maintain the deep-knee-bend position. It's the hot season, and the hut is well over 90 degrees inside. Karim implores you to keep your back straight and push. "Don't hunch over your stomach!" he says. "It might hurt the baby!"

Karim's bedside manners leave something to be desired. Twenty-five years ago when his wife couldn't make it to the health center, Karim took matters into his own hands. His son was his first delivery. He delivered six more of his own children and soon became the go-to deliveryman in the village.

And that has you worried. Because if there's a complication—a breach or the umbilical cord is wrapped around the baby's head—Karim, will grab a plastic bag, slide his hand in it, and do his best to maneuver the baby into the correct position. Karim has no drugs, gloves or surgical equipment. Worst of all? No medical training, either.

Your life—and that of your baby—are in the untrained hands of a 55-year-old peanut farmer.

The Donkey Cart Dilemma

Thankfully, those days are over. Karim no longer delivers babies at home. Instead, he carries a flashlight in one hand and supports the pregnant woman with the other as they shuffle to a health center, where a trained midwife is standing by.

The 6-mile hike to the health center may take 3 to 4 hours on foot. So, Karim often chooses to pull the woman to the health center on a donkey cart even through traditional beliefs forbid donkeys to pull pregnant or sick women in his village.

Karim's new role as escort service is made possible by a Catholic Relief Services project that collaborates with the Ghana Health Service, which operates in two districts in northern Ghana. The goal of the project is simple: make sure more women and babies survive childbirth. One of the biggest hurdles to overcome is persuading women to give birth in health centers overseen by trained midwives.

In Kassena Nankana, a district where the project operates, traditional beliefs have long influenced women's childbirth decisions.

Veronica Adongo, a medical assistant at a health center in nearby Talensi Nabdam district, says the former birth practices were dangerous to both mother and child. The district had one of the highest rates of maternal mortality in the country.

Collaboration of Tradition and Training

Iddrisu Zacharia, a CRS project assistant, understands the deep connections between traditional beliefs and giving birth. His father was a traditional birth attendant. And he was tapped to be one also, but opted out.

He says that many of the beliefs—a pregnant woman shouldn't ride a cart pulled by a donkey, for example—originated from a single experience that happened long ago. The event was mythologized, and chiefs and elders would instruct that it should never be replicated for fear of similar consequences.

The abandonment of these practices has led to healthier babies and mothers. Some of Ghana's worst mother and child health statistics for 2003 came from the country's Upper East region. But now, thanks to the CRS project, more children are born healthy.

Veronica says medical professionals tried for years to convince women to deliver at health centers, but they refused to go.

"We were trying to impose things on them," she says. "We didn't find out their needs. We only tried to get them to do what we wanted them to do without seeking their opinion. CRS went and asked their needs first. Based upon that, the talks sunk in."

Traditional birth attendants told CRS they could use flashlights, raincoats and boots so they could accompany women to the health centers safely.

CRS agreed to furnish the items. In addition, rather than being paid monetarily to deliver babies, the attendants received soap as a form of thanks. CRS also agreed to give the attendants soap if they accompanied the women to the health centers.

CRS set up groups to advise women on prenatal care and recruited community volunteers to check up on pregnant women. Exclusive breastfeeding was encouraged.

This collaborative process produced results: Women aren't dying in childbirth anymore. And more babies are born healthy and grow up healthy.

'They Taught Me How to Take Care of My Baby'

Even though Karim is not delivering babies anymore, his role is crucial. He remembers the story about Lydia. Nearly a year ago, Lydia Wuni showed up at his house at 10 p.m. and woke him up. She was in the late stages of labor. He took her by the hand and helped her along the road. Twenty minutes into the trip, Lydia had to stop walking.

"The woman said the pressure is too much," Karim said. Lydia squatted on the side of the road, and Karim realized the baby was crowning. Within minutes, Lydia had delivered Wahabu, a healthy baby boy.

Lydia's case is rare. Most women are instructed to go to a health center at the first sign of pain.

Take Gladys. She's sitting in a dark hut, smiling at Sara. She gave birth to her 2 days ago. Sara looks more like a doll than a child, lying still under a mosquito net on a bed made from old jeans.

Gladys, enjoying a lunch of millet dough and peanut sauce with her son Moses, couldn't be prouder. She's dressed Sara in a new Mickey and Minnie Mouse pink shirt. Sara mostly sleeps and Gladys mostly relaxes, watching over her first daughter.

Joe Akena, who heads the local health center, had seen Gladys for prenatal checkups. There, Gladys had learned how to care for herself before birth and after.

"They taught me how to take care of my baby," she says, shyly in English. "Early in the morning I'll bathe her. Then I'll nurse her. Then I'll bathe myself and make myself neat."

Not long ago, this thin 21-year-old might have given birth in a hot hut with an untrained attendant. Instead, she went to the health center and learned how to stay healthy.

And now, grinning down at Sara, Joe standing over them, proud as ever, Gladys is glad she did.

Lane Hartill recently was CRS' regional communications officer for western and central Africa, and was based in Dakar, Senegal.

Catholic Relief Services is the official international humanitarian agency of the Catholic community in the United States. We alleviate suffering and provide assistance to people in need in nearly 100 countries, without regard to race, religion or nationality.