Saving Lives at Birth Among Nomads of Niger

By: Dr. Rebecca Jones, The Nomad Foundation

Experts agree that every mother deserves care from a skilled birth attendant. However, for many women, this is an impossible dream.

Nomads are people without settled homes who migrate in search of pasture and water for their animals. This ancient and sacred tradition is cherished by its practitioners despite their austere living conditions and grim health statistics. Nomadic women give birth while on migration, in encampments far from cities with hospitals. Typically, they are looked after by their mothers but often they are on their own. Maternal and infant mortality among nomads is shockingly high – WHO estimates up to 15% for women and 25% for newborns.

The Nomad Foundation works with nomads in Niger, Western Africa, one of the worst places in the world to be a mother or a child. Traveling in the desert with Tuareg and Wodaabe women, we provide training for traditional birth attendants or “matrones” as they are referred to in Niger. Our goal is to prevent deaths by targeting the biggest killers: hemorrhage, eclampsia (seizures with high blood pressure due to pregnancy), and infection.

For the past six years, we have held training sessions once or twice a year for nomadic women and the results are impressive – our trained matrones have attended approximately 1000 births in encampments without a single death. Sadly, there have been deaths after evacuation to the hospital; however, the maternal mortality rate has been reduced to about 1%.

In October, we are returning to Niger with two new challenges. In an effort to empower the matrones and foster sustainability, we will be educating a few matrones from each tribe to become trainers themselves. These women are experienced, smart, and eager learners but cannot read or write. Developing training manuals with graphic memory aids has been difficult. Second, we have been invited to initiate training in a new region. Word of our matrones’ success has spread and other nomads want to benefit from the training. We are happy to fulfill this request and will be integrating the new nomadic trainers into the program.

Training begins with focused antenatal care which includes prevention of malaria, anemia, and parasitic infections.  Matrones are taught to measure blood pressure permitting early detection of pregnancy-induced hypertension. Information and supplies are given to conduct a clean birth including handwashing and use of a sterile cord tie and razor. Hemorrhage is prevented with medication (misoprostol) and adequate hydration. Warning signs of abnormal labor are reviewed and early evacuation is encouraged. Transportation remains a major hurdle as does the quality of hospital care. Finally, newborn care is reviewed including cord care and exclusive breast feeding.

Niger is considered a dangerous place to visit, especially for Americans. Two years ago, an American aid worker was kidnapped while we were on our mission and last year, four American servicemen were killed in an ambush near the Mali border upon our arrival. Few aid agencies work in Niger and fewer still focus on nomads. Despite the risks, we are determined to continue our programs because we firmly believe that every mother counts, including nomads.