PNG: Birth attendants offer hope

By CARE Australia January 31, 2012 7 comments

©Josh Estey/CARE

by Blossum Gilmour, Mamayo Health Project Manager

Where did you give birth?
In my family’s coffee garden.

Who assisted you?
No one.

This is how a conversation started between CARE PNG staff and a new mother in rural Papua New Guinea. CARE had agreed to help the provincial government assess the support available to pregnant women and new mothers, and while the conversation above was common, the reasons why women were alone in the bush while giving birth are as individual as the women themselves.

Village Birth Assistants help local women, decreasing the barriers to giving birth at a health facility. Image: Josh Estey/CARE

The staff tried to delve to the root of women’s reasons for not going to a health centre to give birth and most of it came down to fear: fear of the health worker who is not from their village and doesn’t speak their language, fear of seeking help from a male health worker, fear that their family will be asked to pay for the service, fear that the medications they’re given will hurt them, fear that the health worker will yell at them and make them do things that feel painful or wrong.

It is a generally accepted fact that health workers in rural areas are ill equipped to deal with obstetric emergencies—they have not received the training or tools needed—and  the nearest hospital is an expensive flight away. Their inability, and in some cases unwillingness, to provide basic antenatal and obstetric care speaks to a more deeply-rooted issue.

‘Do you know what the women of PNG call midwives? Barking dogs… because they never stop making a terrifying racket’ said a teacher in a university midwifery program. She went on to explain that the unit on bedside manner has just been taken out of the new midwifery curriculum. She wants to teach new midwives that they are service providers and need to have empathy for their clients but there are other priorities for the time being.

CARE PNG is working with the provincial government to support pregnant women and new mothers. Image: Josh Estey/CARE

So what is the solution? Where to begin?

CARE PNG, in collaboration with the Provincial Division of Health, is training Village Birth Attendants (VBAs) in some of the most remote areas of PNG.  The primary role of the VBAs is to decrease the number of barriers to women giving birth at a health facility. VBAs are chosen by the women of their community and they are women themselves. This alone seems to engender trust. VBAs are then trained. They learn how to recognise the signs of high risk pregnancy and how to counsel women to go to the health centre for an antenatal check-up – addressing the individual fears that women have. VBAs then accompany the mother to the health centre and act as an advocate – both translating and explaining what the health workers are doing and ensuring the woman agrees to the interventions. VBAs assist the health worker throughout the antenatal checks and delivery, a constant companion and champion for the mother. Finally, when they are not able to get a woman to a health centre, VBAs are able to safely attend an uncomplicated delivery.

Since the introduction of Village Birth Assistants, more women at getting antenatal check-ups and attitudes towards local health centres are slowly changing. Image: Josh Estey/CARE

It’s far from perfect—VBAs are a stop-gap measure in the floundering health care system. That said, they are having an impact—more women are having antenatal check-ups and it’s hoped more will agree to professionally assisted births. VBAs are changing how women view the health care centre—one mother at a time.

Read more about CARE’s work in Papua New Guinea

7 Comments Leave new

Bottom-up planning in remote Papua New Guinea | Engage Jul 15 2013 at 12:07

[…] plans identified the need for trained Maternal Health Volunteers to, in part; address fears among women about attending health […]

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tusah Jul 05 2012 at 01:07

there have been over whelming results from VBA's/VHV's I trained in remote central province. Alot of high risk mothers have been refered to the nearest health centres for safe delivery.

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careaustralia Jul 06 2012 at 09:07

That's great to hear, tusah! Thanks for your comment.

careaustralia Feb 08 2012 at 11:02

That's interesting, bzephyr. If you add fear to those practical reasons, then the barriers to rural women having assisted births are difficult to overcome. Hopefully, the impact of VBAs is making a difference.

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bzephyr Feb 08 2012 at 11:02

It seems to me like VBAs will meet a real need. Another factor, more closely related to the fears that VSAs seek to address is how childbirth is traditionally such a private and taboo-related event.

About three weeks ago, I had arranged to hire a car to drive the 2 hours to town from a remote village. I had heard that morning that one of our neighbors in the village was due to give birth any day. Before leaving I made it clear that I was happy for her to get on board and take this chance--perhaps the only car in weeks--to get to the hospital in town. Everyone agreed, and someone went back to the birthing house. However, the message came back that her water had already broken. I wonder, though, how much the decision was influenced by how uncomfortable the ride would have been, both physically and culturally. How taboo and shaming would that have been for her to come out of seclusion!

The road was in terrible disrepair, and it eventually required us to make several attempts up a steep mountain through deep mud holes, bouncing through it like a bucking bronco. Most of the passengers needed to walk through mud that was higher than our knees.

I have recently heard beautiful stories of husbands and other male relatives taking a very active role in assuring the safety and well-being of their women during childbirth even though there may still be very strong taboo restrictions on their presence in the house, etc. I believe the times are ripe for a Village Birth Attendant to come alongside others in the community who desire to overcome the many barriers to safe and healthy deliveries.

careaustralia Feb 08 2012 at 01:02

Thanks for your story! It certainly does bring home some of the difficulties facing women giving birth in rural PNG. Imagine being in that situation and travelling in a car that was bucking like a bronco... It's great that there are positive stories of men taking active roles in ensuring women's safety. It will also be great if a VBA can help out in your community.

bzephyr Feb 08 2012 at 01:02

I work with SIL in rural PNG, and this sounds like an excellent idea. Two big reasons that women do not more actively seek out professionally-assisted births are (1) poor transportation options (both the condition of roads and availability of vehicles), and (2) the high cost of that transportation and of living in town away from their gardens during their clinic stay.

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