If Panadol could cure all diseases, Mary Chepkisur would be a happy midwife

But it does not so she has to travel deep into a forest in Kongelai village. Her mission? Look for herbs that will act as pain killers for her patients

Being the only trained traditional birth attendant in an area of about 20,000 is no mean task for Chepkisur. She prescribes Panadol for all ailments because it is the only drug left at the local health facility

Six years after completing her training, she has been traversing the semi-arid county, attending to women who are giving birth.

“I have midwifed about 600 girls and women,” she says. “And I stopped depending on pain killers from the health center.”

Despite the Kenyan government efforts to curb pregnancy related deaths and disabilities, maternal mortality rates (MMRs) have remained soaring high in the country. Hardest hit are arid and semi-arid areas, including Pokot County

It is estimated that 566 deaths per 100,000 births occur in West Pokot County alone annually. This is a sharp contrast to the reported national rate of 466 deaths per 100,000 live births

The high MMR in West Pokot is mainly attributed to obstructed labour, high rate of infibulations (type III), and cephalopelvic disproportion (CPD) due to early marriages. It is estimated that 74% of women in West Pokot County give birth at home with traditional birth attendants (TBAs) attending most of these deliveries. 

And with poor state of the roads, TBAs are playing an important role in filling the gap for women who have to travel for long distances to access healthcare facilities

A WHO write-up indicates that in addition to attending deliveries, TBAs help with initiating breastfeeding; providing health education on sexually transmitted illnesses (STIs), reproductive health and nutrition; visiting mothers during and shortly following delivery to check for and educate them on the associated danger signs; and accompanying referrals to the health facilities for complicated deliveries.

But a worrying trend is emerging. TBAs in far flung areas in rural areas are slowly taking up cutting young girls after the government abolished female genital mutilation.

Among the Pokot community, women who have not undergone the practice are considered immature and receive little respect even from health care providers

“Yes, I know all about that. I have seen even pregnant women getting circumcised,” says Chepkisur. 

Social pressure plays a huge part in pushing even older women to get the cut. “The shame sometimes pushes them to undergo the cut before they can give birth,” she adds

Since the government passed anti-FGM laws in 2011, the local administration has been under pressure to ensure zero tolerance for any forms of mutilations. Many experienced cutters have either given up the practice or gone underground, for fear of getting arrested.

Left with little choice, women are now sending their girls to some TBAs for the cut, whose skills in ante and post natal knowledge put them at an advantage in taking up the job without raising eyebrows

Pokot is among the counties that still actively practice FGM. It is estimated that over 74% of women are circumcised 

FGM turns healthy teenage girls into women with chronic ill-health – kidney problems, pelvic and back pain, infertility and birth difficulties are common. And they are the lucky ones: others won’t survive the blood loss of the initial procedure or will contract HIV from the knives used, or die giving birth, or have stillborn or brain-damaged babies

Only about 10% of these women attending clinic receive postpartum care within 2 days. Since most maternal deaths occur in the first week after birth, this means missed opportunity in terms of recognition and responding to danger signs after delivery

Amref Health Africa agrees with WHO and UNICEF that TBAs cannot be substitutes for skilled providers, but strongly believes that they can contribute to the survival of mothers and newborns by facilitating access to needed information, clinical services and support.

For TBAs based in far flung rural area like Kongelai, accessing modern equipment and drugs is still a daydream.

Right now, they have to walk for miles to get herbal drugs for their patients

And in the process keep their culture alive by clandestinely cutting young girls