One woman’s story of moving from home births to health center deliveries

Madjita Diarra, 67 years old, has been a traditional birth attendant in the village of Debo Bambara in Mali’s Diéma district for more than 10 years. She inherited this work from her grandmother and mother-in-law. “When I started there were three other birth attendants in my village. We were paid $1.70 for each home birth. As the payment was too little, the two other women abandoned this work. I was left alone and continued providing services for free,” explains Diarra.

In 2016, despite the opening of a secondary health center in the village, women continued to request Diarra’s services because they were free, and she had developed trust with the women over time. Diarra averaged five home births a month. The only time she accompanied women to the health center was when their bleeding did not stop after childbirth. “Despite my advanced age, I did not plan to stop supporting home births,” adds Diarra.

In February 2019, USAID funded Human Resources for Health 2030 (HRH2030) brought together women's groups, the rural hospital matron, community health workers, and traditional birth attendants to improve maternal and newborn health in the village. The women's group, of which Diarra is a member, actively carried out information and awareness-raising activities in the village to encourage women to seek out care and services in their local health facilities. Through these activities, Diarra learned about potential consequences of home birthing in her community: the risk of hemorrhages due to uterine ruptures, the risk of tetanus due to the instruments traditional birth attendants use, and the high risk of HIV and hepatitis transmission for mothers, babies, and birth attendants. “I realized that I was at risk in my job and so I decided to give up home births to save lives, including my own,” says Diarra.

In March 2019, Diarra transitioned from being a traditional birth attendant to a counselor and “accompanist” — one who accompanies pregnant women to the health center for antenatal care, services, and childbirth. Today, no woman in Diarra’s village gives birth at home. “I encourage traditional birth attendants who still continue their work to give it up and help to save lives. Health workers have more skills and resources than we do,” stresses Diarra.

Diarra is one of seven traditional birth attendants in Diéma district who have made the transition from home births to health center deliveries. Thanks to USAID support, 435 traditional birth attendants have been oriented and 313 of them have moved to health center deliveries across the five target regions. A total of 252 traditional birth attendants are now counselors and accompanists. This has contributed to an increase in the proportion of childbirths taking place at health centers from 35% to 89% over the first half of 2020.

HRH2030 is working with 1,010 women’s groups in Mali to improve maternal and child health. With support from the American people, HRH2030 aims to reduce maternal, neonatal, and infant mortality in five target regions of Mali — Kayes, Koulikoro, Sikasso, Mopti, and Ségou.