Crisis at Birth: Confronting Unconventional Practices for Maternal and Neonatal Well-being in the Hinterlands of Africa

Abstract

To editor: We write to draw attention to a matter of profound significance in maternal healthcare, specifically centering on the perils entailed by the escalating prevalence of unconventional birth practices in rural Africa. This phenomenon encapsulates a spectrum of practices, ranging from unhygienic delivery procedures and unorthodox improvised episiotomy to inadequate cord care, collectively posing a formidable threat to the well-being of both mothers and newborns. Unconventional birth practices are culturally or personally preferred methods of childbirth that differ from those of routine hospital births. In rural Africa, a significant number of women still deliver at home, carrying various risks due to the lack of immediate access to medical help in case of complications. Additionally, the employment of untrained birth attendants may further compromise an already ominous mode of delivery. Historically, traditional birth attendants (TBAs) have played a pivotal role as the primary human resource for women during childbirth, with their roles evolving across cultures and times. Presently, they attend to the majority of deliveries in rural areas of developing countries, highlighting their enduring significance in maternal healthcare.1 Recent studies show that, in rural African communities, up to 60-70% of deliveries are still conducted by TBAs, with limited training and access to sterile equipment.2 In recent years, there has been a concerning surge in the adoption of unconventional birth practices in rural African communities. While these practices may be deeply rooted in cultural traditions, it is imperative to scrutinize their implications on maternal and neonatal health. This editorial aims to shed light on the potential perils associated with these practices, emphasizing the urgent need for evidence-based interventions and awareness campaigns. One of the most pressing issues is the prevalence of unhygienic delivery procedures in these communities. The use of non-sterile instruments, unsanitary birthing environments, and the absence of proper hand hygiene significantly elevate the risk of infections for both mothers and newborns.2 Studies indicate that infections related to unhygienic birth practices account for 20-30% of postpartum sepsis cases in rural areas, contributing to maternal mortality rates that are three times higher than those in urban settings.3 The repercussions of such unhygienic practices extend beyond the immediate postpartum period, often leading to long-term health complications. The practice of unorthodox improvised episiotomy, often performed without anesthesia or proper surgical instruments, is another cause for concern. These practices lead to infection rates of 35-50% among rural mothers, with cases of severe postpartum hemorrhage and psychological trauma commonly reported.3 Episiotomies are meant to facilitate a smoother delivery, but when performed in unsanitary conditions and without proper medical oversight, they can result in severe complications such as infections, hemorrhage, and long-term psychological discomfort for the mother.3,4 Inadequate cord care practices further compound the risks associated with unconventional birthing methods. Improper treatment of the umbilical cord can lead to infections, sepsis, and other life-threatening complications for the newborn.5 Cultural beliefs and practices surrounding cord care must be approached with sensitivity, but it is crucial to promote safe and evidence-based alternatives to prevent unnecessary harm.6 A recent study highlighted that inadequate cord care is directly linked to neonatal sepsis, contributing to 30% of neonatal deaths in rural African settings where traditional birthing methods are dominant.7 Understanding the root causes of the increasing prevalence of these unconventional birth practices is vital for effective intervention. Cultural norms and beliefs play a significant role in shaping childbirth practices in these communities. Any strategy aimed at addressing this issue must be culturally sensitive, engaging community leaders, traditional birth attendants, and local healthcare providers to promote safer practices while respecting cultural diversity.5,6 The rise in the cost of conventional healthcare is directly related to the lack of use of the facilities among people in rural Africa. A substantial portion of the rural African populations cite high healthcare costs as a primary barrier to accessing hospital-based maternal care.8 To tackle this issue effectively, a multi-faceted approach is necessary. Enhancing the accessibility and affordability of professional maternity care by means of subsiding care and training more healthcare workers and traditional birth attendants should be of utmost priority.7 Public health interventions should prioritize education and awareness campaigns tailored to the specific cultural contexts of rural African communities. Empowering local healthcare providers with training in evidence-based obstetric care and promoting the importance of antenatal and postnatal care can contribute significantly to reducing the risks associated with unconventional birth practices. Improving healthcare infrastructure and access in rural areas is paramount. The lack of well-equipped healthcare facilities often compels individuals to resort to traditional practices.7,8 By investing in the establishment of well-equipped birthing centers, training local healthcare providers, and ensuring the availability of essential medical supplies, we can mitigate the reliance on unconventional birth practices. It has however been noted that establishing rural birthing centers can considerably reduce maternal mortality, especially in areas previously lacking adequate healthcare infrastructure.9 While the perils of unconventional birth practices are apparent, there is a notable gap in research on the specific health outcomes and long-term consequences associated with these practices.10 Therefore, we advocate for more longitudinal studies on maternal health in rural African communities to guide evidence-based policy-making and improve birth outcomes. Future studies should focus on systematically investigating the prevalence, causes, and health implications of such practices, providing a foundation for evidence-based interventions and policy recommendations. In conclusion, the escalating prevalence of unconventional birth practices in rural Africa poses a grave threat to maternal and neonatal health. Urgent and comprehensive efforts are needed to address the root causes, engage with local communities, and implement evidence-based interventions. This correspondence serves as a call to action for researchers, healthcare professionals, policymakers, and the broader international community to collaborate in safeguarding the well-being of mothers and newborns in these vulnerable populations. Acknowledgments The authors would like to acknowledge the Lind League, Nigeria, for providing the invaluable resources to kick-start, culminate, and leverage this research project while enabling our capacities. Funding None. Conflicts of Interest None. Data Availability Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.