Screen Shot 2019-05-26 at 07.18.43.pngAlhaji Sulaimon Junaid wakes up at 5:30 a.m. every day to spend time with pregnant women waiting to deliver their babies in his birthing home � a brown cconcrete block bungalow in the rural suburb of Epe on the north of Lekki Lagoon in Nigeria’s commercial capital, Lagos. His birthing home has an office space, an antenatal and delivery room, and a section where he combines herbs for the women…

Today he has improved on his father’s craft in a significant way; He is one of over 5,000 Traditional Birth Attendants who have been trained by the Brown Button Foundation, a non-governmental organization which provides “safe delivery and contraceptive options, training of healthcare providers, and provision of maternal health tools to health facilities.” The World Health Organisation defines a trained TBA as one who has received a short training course through the formal health sector.

Brown Button Foundation was founded in 2011 by Adepeju Jaiyeoba, a lawyer who lost a friend that year, after undergoing an elective Caesarean section. While looking into the causes of maternal deaths in Nigeria, Jaiyeoba learnt that lack of access to sterile supplies during delivery, especially in rural communities, could be one factor contributing to the large number of women dying during childbirth…

So far, Brown Button Foundation has trained a total of 5,200 TBAs across the country, including Alhaji Junaid. Prior to the training, Junaid used to take deliveries of babies on the bare floor with the aid of herbs, using nylon bags as gloves, with unsterilized blades and scissors�a clearly unhygienic practice that could pose danger to both the mother and baby. Today, the training has improved his work – having learnt thatt his old practice was ‘unhygienic,’ he now uses sterile gloves, surgical blades and scissors provided in Brown Button’s Mother’s Delivery Kit, while taking deliveries…

Dr. Ephraim Ohazurike, an obstetrician and gynecologic oncologist at the Lagos University Teaching Hospital (LUTH), notes that having a skilled birth attendant is still best practice, but concedes that trained TBAs have become a necessity due to an inadequate number of skilled birth attendants, especially in rural areas…

The Lagos State Government through the Lagos State Traditional Medicine Board (LSTMB), established under the Lagos Ministry of Health to oversee the activities of the TBAs, is also making efforts to improve the capacities of the TBAs in the areas of hygiene and standard practice. The Board has three separate courses designed to orientate and expose TBAs to a code of ethics and help familiarize them with harmful practices that could be dangerous to pregnant women and their newborns. Two of the courses are mandatory courses created to teach TBAs basic human anatomy and physiology, health statistics, primary health care, traditional medicine and food nutrition for nutritional medicine, and each course runs for six weeks. Junaid has completed all three courses as his certificates, license and awards show…

Where there’s a breach of the code of conduct; the Lagos State Health Sector Reforms Law 2006 ensures that offenders are fined. The LSTMB has a monitoring task force which goes round birthing homes in search of unregistered/untrained attendants.  The code of ethics also bars TBAs from attending to any pregnant woman who has had a miscarriage or undergone a caesarean section before or if they see danger signs like oedema (swelling of the hands and feet), high blood pressure, and bleeding. The code of ethics authorizes them in these cases to refer these women to the nearest general hospital for proper care. The TBAs are also mandated to alert the nearest General Hospital in case of any emergencies while conducting deliveries, and an ambulance will be dispatched from the hospital to their birthing homes…

Other states are also finding innovative ways to address how TBAs function. In Ogun State, TBAs are being trained in the area of pregnancy complications like prolonged labour, bleeding during pregnancy and pre-eclampsia. The state recently launched a free community-based health insurance scheme called Araya Scale-up for expectant mothers and children under 5. Araya means “stay healthy,” in Yoruba.

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