In rural Nigeria, traditional birth attendants are part of the solution
Just 46% of deliveries in Nigeria happen under the protective eye of a doctor, nurse, or midwife. The government is trying to change that – and in the meantime, traditional helpers are learning when and why to bring their charges to the clinic.
- 3 November 2025
- 5 min read
- by Abdullahi Muritala
Oluwatobi Aroyewu, 34, went into labour around midnight on 11 February 2024, in the Gaa Akanbi area of Ilorin, Kwara State. She whispered to her husband to take her to Oke Isegun Faith Home, where her Iya Abiye, a Yoruba term for traditional birth attendant (TBA), would attend to her. It was a familiar place she often visited for antenatal advice and prayers.
Her husband, gripped by anxiety, woke a neighbour who owned a car. Moments later, they sped off to the faith home. There, 43-year-old Stella Emmanuel, the Iya Abiye, who lived within the compound, rushed out to meet them.
“Mrs. Stella was so good, kind, and calm. She held me firmly, and with the help of God and her, I delivered a boy successfully,” Oluwatobi recounted, smiling.
Halfway to hospital
Not all mothers are as lucky as Oluwatobi, however, and Nigeria’s Federal Ministry of Health has emphasised that deliveries should occur under trained nurses or midwives in recognised facilities, instead of under the care of traditional birth attendants. That’s because complications like postpartum haemorrhage and neonatal infections – leading causes of maternal and infant deaths – require the intervention of highly-trained medical workers.
But the reality, according to the 2024 National Demographic and Health Survey, is that only about 46% of births in Nigeria were attended by skilled health personnel.
That has further worrying impacts on public health. Women who deliver at home or under the care of TBAs often miss the critical first contact with the health system, leading to delays in newborn and childhood vaccinations.
However, in some communities, TBAs like Stella Emmanuel have received special training in order to bridge this gap, helping ensure that both mothers and babies receive needed medical attention and immunisation.
Empowering the TBAs
Just a day after Oluwatobi’s son was born, Emmanuel took both mother and child to the Police Training School Clinic, where he received his first vaccination.
But it was only in 2016, when she participated in a series of training programmes in Abuja and Ogun State, that Emmanuel began referring patients to health facilities for vaccinations and other medical treatments after childbirth.
One such training was organised by the Abilad Foundation, with support from the Safer Hands Initiative (SHI), both community-based organisations committed to reducing maternal mortality and morbidity. SHI has, since 2023, reached over 6,000 women, distributed 10,000 birthing kits, and trained more than 200 TBAs across 12 states.
At the session, medical experts walked more than one hundred TBAs through safe and hygienic delivery practices using sterile kits. The training also covered the use of misoprostol tablets – used to prevent postpartum haemorrhage, one of the leading causes of maternal death – and how to monitor blood pressure and weight to detect complications early.
Emmanuel says that before the training, she relied exclusively on her own experience to assist mothers in childbirth. “But since the training, my risk management toolkit has expanded,” she said.
A path to safer deliveries and healthier childhoods
According to the World Health Organization (WHO), Nigeria recorded the world’s highest number of maternal deaths in 2023, accounting for over 28% of the global total. (Though they’ve since improved, Kwara’s sky-high maternal mortality rates made headlines in recent years.) On the combined rate of neonatal, maternal and child deaths, Nigeria ranked second after India.
Several studies have shown that early childhood immunisation is associated with significant reductions in infant mortality, especially in low-income countries. One trial in Guinea-Bissau found that newborns who received the BCG and oral polio vaccine within the first 72 hours had a 59% lower risk of death within the first 60 days. Another study in Bangladesh linked early BCG vaccination to a 41% reduction in infant mortality, while DTP vaccination reduced deaths by 24% among children aged six weeks to nine months.
Neonatal immunisation offers direct protection against specific pathogens, but also connects newborns with the health system for continued care.
Because Emmanuel now ensures her patients’ babies are vaccinated on their first day of life, she helps link them to ongoing healthcare. “We refer them to doctors and call them for complicated issues,” she said.
A thriving alliance
Over time, this collaboration has grown stronger. Emmanuel now works closely with Dr Abdulqadri Balogun, Medical Director of the Police Training School Clinic, and Nurse Taiwo Mustapha, who oversees immunisation there. “We have a good relationship with the clinic, so our patients can be attended to easily,” she said.
Emmanuel’s role doesn’t end at delivery. “We give patients proper medication, orientation, and hygiene lectures during antenatal, delivery, and postnatal periods,” she said. “Some listen and follow the advice, while we keep encouraging those who don’t.”
Despite her progress, Emmanuel still operates under modest conditions within the church premises. “I only get small tokens – what some people call recharge card money,” she said with a faint smile. Rising inflation and economic hardship, she added, make her work even more challenging.
Have you read?
Bridge to the clinic
Dr Balogun, meanwhile, says he has witnessed first-hand the changing rapport between TBAs and the formal health system. “They now refer patients with complications to us for proper diagnosis and medication,” he said.
He has observed that TBAs’ attitudes toward health have changed. “They always call doctors whenever any issue is beyond their knowledge. Without hesitation, they refer every patient with complications to us – and also for immunisation.”
He added that the TBAs have learned to separate cultural beliefs from medical realities. “One thing I cherish about them is that they now know everything is not spiritual. Anytime they notice something unusual, they alert us – even at midnight.”
For Dr Balogun, the contribution of TBAs to Nigeria’s maternal health system must not be dismissed. “Many would suggest scrapping them because they are not formally equipped,” he said. “But to me, we can’t do without them. There are communities without access to primary health care, and TBAs remain their only option.”
He believes their collaboration with trained medical workers can go even further if the government and health agencies invest more in training, infrastructure and motivation. “They are a crucial part of community health development,” he stressed.
More from Abdullahi Muritala
