Access to skilled birth attendance is critical in improving maternal and newborn health. However, in low resource settings, rural and refugee camps, professionally trained staff are often in short supply hence women tend to rely on traditional birth attendants (TBAs) for delivery. Despite knowledge that a health care facility delivery is safer, many women from low resource environments continue to seek for the care of TBAs. In order to understand the care provided to refugee women during pregnancy and after birth, in a refugee camp, a study was conducted in Ifo Dadaab refugee camp in Kenya. The aim of this article therefore, is to document findings on participants’ perspectives on pre and post-natal care provided to women in refugee camps during pregnancy and after birth. This was a qualitative study conducted in Ifo refugee camp in Dadaab Kenya. Nine participants were purposively selected for the study to give their perspectives on the role of TBAs in providing caregiving support to refugee women during pregnancy and after birth. The participants included two married men, three traditional birth attendants, two Somali pregnant women and two refugee safe mothers. Data was collected through focus group discussions and interviews. The data was beefed up with feedback from dissemination of preliminary findings to stakeholders’ validation conference held at Kenyatta University. Findings revealed that TBAs play a critical role in supporting women during pregnancy and after birth. However, they are not able to attend to complications associated to delivery. Among the caring support cited include, guiding and counselling pregnant women, educating them on the importance of attending antenatal clinics, massaging women during labour, praying for the baby after birth, and escorting women to the health facilities to take their babies for immunization. It was also apparent that TBAs advise pregnant women on the herbs they should have in stock while pregnant. In addition, they advise women to breast feed their babies immediately after birth. While TBAs are able to assist un complicated births at home, it was apparent that it becomes challenging for them to provide support for women with complication during the birth process. In view of this, it will be more helpful for TBAs to be encouraged to guide and advise pregnant women to deliver in the health care facility, where they can escort them to get professional attention during birth

Statement of Problem: Family planning is a determining factor in the maternal health care choices for Somali pregnant mothers in Dadaab Refugee camps. Research has revealed that during delivery, the Somali mothers prefer the services of Traditional Birth Attendants (TBAs) to those of midwives in hospitals. The preference for TBAs is borne of the belief that when women deliver in hospitals, they could be subjected to family planning against their will. The contention is that Islam and socio-cultural practices of the Somali community do not advocate family planning. The purpose of this paper is to discuss Islam’s position on family planning in order to explain the response of the Somalis of Dadaab refugee camps on family planning. Methodology & Theoretical orientation: The paper is derived from a qualitative study that involved snowball sampling, in-depth interviews and focus group discussions (FGDs). These methods brought out family planning as a determining factor in the mother’s choice of TBAs as opposed to hospital midwives in Dadaab Refugee camps. Findings: Any discourse on Islam and family planning offers two perspectives: proponents of family planning and opponents of family planning. Both perspectives use the texts of the Qur’an and Hadith (traditions) and different interpretations to justify and support their respective positions and opinions. Through primary and secondary sources, the paper interrogates both perspectives of family planning in Islam. Conclusion & Significance: It is concluded that the Somalis’ belief on family planning is informed by the two perspectives of family planning, but the opponents’ perspective holds sway. This determines the preference for TBAs for fear that mothers who deliver in hospitals could be subjected to family planning contraceptives. Recommendation: there is need to educate the community further on Islamic teachings on family planning; and more sensitization conducted on the benefits of child spacing.

Respectful maternity care is where women are accorded the freedom to make informed choices, protects them from any form of harm and harassment, provides continuous support during labour and child birth and also upholds their privacy, confidentiality and dignity. Previous studies have demonstrated that any care deemed to disrespect the woman may henceforth determine her care seeking behaviour. In the lacuna created by some forms of disrespect of women of child bearing age in the healthcare system, some women may seek alternative care from traditional birth attendants, who are neither skilled nor able to promptly recognize, manage or refer complications arising during pregnancy, labour, child birth and puerperium. Globally, the high maternal mortality rate is associated with preventable complications which occur during pregnancy, labour, child birth and the puerperium, with those who encounter near misses or who narrowly survive death, end up suffering lifelong disability which affects their quality of life. Services offered by traditional birth attendants (TBAs) continue to be sort by a few women of reproductive age in both rural and urban settings including Dadaab, despite the availability of both public and private health facilities. TBAs are preferred among the Somali community as they are deemed to offer a type of care that is regarded as being respectable to the woman and her family as well as being aligned to their culture and religion. Hence, this study aimed to investigate the perspectives of the Somali community residing in Dadaab refugee camps on respectful maternal care. A qualitative study was conducted at Ifo refugee camp in Dadaab, where three TBAs, two save mothers, two married men and two expectant women were interviewed. Two focused group discussions were conducted among the men and pregnant women. The TBAs and the save mothers were interviewed. The TBAs were also video recorded as they performed some of their activities. Data was coded, categorized into thematic areas and the content was analyzed. The findings demonstrated that TBAs and save mothers accorded the women both social and psychological support during pregnancy, child birth, and postnatal period, and treated them with respect. They accompanied the mother throughout the labour and childbirth and gave her so much encouragement. The findings further revealed that cultural beliefs and practices such as prayer, disposal of the placenta and the gender of the care provider, play a big role in maternal care of the women. The placenta is valued as a significant part of the woman’s body and thus has to be buried according to their culture, as opposed to it being disposed of after giving birth in a health facility. Respectful maternal care should be accorded to all women irrespective of their background and should also be culturally sensitive

The paper addresses Kenya’s development challenges in maternal health care with a specific focus on the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. It purposes to achieve four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp, to establish the hospital process of providing maternal health care to mothers who have gone through FGM; find out the level of preparedness of the midwives to handle mothers with religio- cultural concerns such as prayer, non-involvement of male nurses and how the practice of FGM contributes to the preference of TBA by mothers. The study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. Secondly, the specific support of midwives in refugee camps contexts remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers in spite of the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for health care workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based /mother-centered skills.

Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities.