A qualitative study into the motivations of birth companions
Late in 2017 the MANI (Maternal and Newborn Health Project) asked me to conduct a qualitative study into the motivations of Traditional Birth Attendants (TBA) who were retrained and incentivised to abandon the practice of delivering babies at home in favour of accompanying mothers to health facilities to receive skilled attention. The purpose of this study was to drill down in depth at the attitudes and incentives that might keep the Birth Companions (BC) from reverting back to the old practice that is dangerous for mothers and babies as well as illegal in Kenya. The study looked at the BC’s experiences of the transition from TBA and their experiences in the new role.
The project had instructed BCs to advocate and raise awareness on the importance of delivering at the health facility, vaccination and good nutrition in pregnancy and in the first months of a baby’s life. This study found that the new role as advocate has given the uneducated BC a new status in their communities of which they are immensely proud.
The study, which focused on drivers for both demand and supply for TBA, revealed that many mothers fear the attitudes they will encounter at the health facility. Some fear it so much they delay seeking help from the BC in an attempt to manipulate them into delivering the baby at home. These fears of disrespectful behaviour range widely from reported ageism, lack of compassion or even physical violence. Mothers also resent the health workers’ insistence on delivering babies in a particular position that is contrary to local cultural norms. The study also found that the Village Savings and Loans Associations (VSLA) set up by the project as an avenue for income generation for the BC, were not simply successful at their primary objective, but also had helped those who participated in them to assimilate a more positive message. We found that those who had not participated in VSLA had retained a message centred on fear: being arrested, causing deaths, etc; whilst those who had, were more upbeat about the project’s messaging.
Whilst this is a qualitative study and the findings and conclusions are specific to this location and this group of people, there are nevertheless some useful insights that can be explored by similar projects, such as the importance of non-monetary incentives and the importance of combining efforts to increase service-use with increased accountability of such services and public perception of their quality. Thirdly, providing an alternative for the more pressing livelihood concerns of women can also help them retain the behaviour change messaging in a more positive light.