Meet Fatima, Hauwa, and Iyabo: Traditional Birth Attendants and HIV Educators in Nigeria

Hauwa Saliu palpating a pregnant woman under the supervision of Mrs. Faustina Ajayi

Traditional birth attendant Hauwa Saliu listens to fetal heart sounds under the supervision of Faustina Ajayi, a nurse-midwife.

Few women in Niger state, Northern Nigeria, have access to obstetricians or other trained health care workers. Many live in rugged localities and villages far from health facilities. For rural families with limited resources, traditional birth attendants (TBAs) have played a vital role in helping women deliver their babies. Yet TBAs traditionally receive no formal training or knowledge of safe labor and delivery practices, and have little to no understanding of mother-to-child HIV transmission.

Thanks to funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Centers for Disease Control and Prevention (CDC) has partnered with the Government of Nigeria and the Institute for Human Virology Nigeria (IHVN)—an international nonprofit organization—to provide training that ensures TBAs can help women have safer deliveries. This unique training program benefits everyone, creating a stronger health system, building TBA skills, and reducing HIV transmission.

To date, IHVN has trained 61 TBAs on safe labor and delivery practices, basic skills, and hygiene for midwifery in Niger State. The nurses at the Basic Health Center in Beji, Bosso also equipped the TBAs to carry out home visits and refer complicated deliveries to the hospital. As trusted community members, the TBAs ensure confidentiality of patient information for women living with HIV, which helps them avoid stigma.

Fatima Musa (35) has been a TBA for four years, Iyabo Ibrahim (34) for six years, and Hauwa Saliu (50), whom they call “Mama,” has been a TBA for so many years that she cannot recall. Both Fatima and Hauwa learned the skill from their mothers. The three have served several communities like Angwan Gwari, Angwan Bini, and Sabon Gari in Niger State. They say their services are not only better because of PEPFAR funded IHVN training, their communities now appreciate and value their expertise more.

“Before the training, we were using rat feces [to cut] the umbilical cord after delivery….We now use hand gloves, jik [antiseptic], forceps, and aprons during delivery to prevent infections,” they say. The TBAs serve all women—those who have HIV and those who do not.

Mrs. Faustina Ajayi, a nurse midwife in the antenatal clinic at the Basic Health Center in Beji and TBA supervisor, says Fatima, Hauwa, and Iyabo come in every week to learn more and practice their skills. “Any patient that comes, we delegate activities [to the TBAs] and watch them. They can even tell the gestational age of the fetus and record deliveries after birth,” she says. Ajayi notes that more women now support the services of the trained traditional birth attendants because they have seen them in the clinic and have more confidence in them.

Fatima, Hauwa, and Iyabo also educate the village and ward heads about HIV testing and counseling and antenatal care. According to them, “The village head passes the information to ward heads so as to encourage more women to utilize the antenatal clinic that takes place every Wednesday at the Center in Beji.” As a result, more women know their HIV status and have access to treatment that prevents mother to-child HIV transmission. The TBA’s training teaches them to educate pregnant women and their families on:

• HIV/AIDS facts
• HIV counseling and testing
• Preventing mother-to-child HIV transmission
• Importance of taking HIV drugs on schedule
• Planned delivery, connecting to care
• Universal precautions against HIV

As of September 2013, The ACTION in Community Project has trained 40 TBAs, and the ACTION Plus Up Project has trained 21 in Niger State. Through funding and support from PEPFAR and CDC, IHVN provided HIV testing and counseling for 23,199 pregnant women. The TBAs referred approximately 4,680 of these pregnant women for antenatal care. This ensured that all HIV-positive women delivered their babies in a hospital.

Trained TBAs like Fatima, Hauwa, and Iyabo will continue to create a stronger public health infrastructure in Nigeria through their work, and by teaching younger TBAs about safe labor and delivery practices.

Date: 2014

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